Resistant bacteria showing up at hospitals
December 15, 2007
ASPEN ” A growing bacterial infection crisis in the U.S., involving a bacterium commonly known as MRSA, is being felt in Colorado, just as it is in other states, including a rising number of cases in Aspen and the Roaring Fork Valley.
The valley’s two hospitals both have detected the disease, which typically is carried into the facilities on the skin or in the nose of patients who may or may not be sick, but are “colonized” by the bacteria.
Nationwide, health officials are reporting that MRSA, formally known as Methicillin-Resistant Staphylococcus Aureus, last year killed more people in the U.S. than AIDS. In the Roaring Fork Valley area, however, data about the disease is elusive, according to health officials, because hospitals are not legally required to report MRSA infection rates to the state.
But according to the infection control specialists in the two main hospitals in the valley, there have been no deaths here that could be attributed to MRSA.
At Aspen Valley Hospital, infection control specialist Kathy Gibbard confirmed that 10 cases of MRSA have been detected among their patient population in 2007, although she did not have information readily available as to what the specific infection sites were, or as to how or where they were acquired.
In fact, she said, it is not known if the infections were hospital-acquired or were contracted outside the hospital.
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“It’s not something that we’re currently testing for,” she said, referring to lab work that might differentiate between infections contracted in the hospital versus infections acquired elsewhere. And, she said, the lab processes tests that are sent from outside doctors’ offices as well as tests ordered from within the hospital.
At Valley View Hospital in Glenwood Springs, infection-control specialist Trish Cerise said that in 2006, the last year for which statistics were available, the hospital’s lab detected MRSA in 38 cases, among 98 total indications of staphylococcus infections found in samples submitted from the hospital’s service area. That service area, she stressed, includes doctors’ offices, clinics and other hospitals located from Aspen to Eagle to Rifle.
The size of its service area, Cerise said, accounts for the likelihood that “our numbers are going to be a lot higher than theirs,” referring to the number of cases reported at AVH.
In general, said both Cerise and Gibbard, the two main local hospitals enjoy a lower infection rate overall than their urban counterparts. They said the infection rate at AVH and Valley View is about 2 percent of patients, where in larger hospitals around the U.S. it is considered “acceptable” if a hospital reports infection rates of around 5 percent.
Gibbard said that the number of incidents of MRSA at urban hospitals ” where it is considered a problem ” has jumped from 5 to 10 percent in the 1980s to as high as 40 percent or more in the late 1990s. And in a 2005 study of large, urban hospitals, she said, it was found that 45 percent of all staphylococcus cases were methicillin resistant.
Gibbard and Cerise both stressed that AVH has an established set of protocols that are intended to help contain the spread of MRSA, and that education and prevention are the best weapons now available.
“Education of the public about the prevalence of the disease is important,” Cerise said, “but I think education of the public about ways to prevent contracting it is even more important.”
According to Gibbard, people over 65 are more susceptible to MRSA due to weakened immune systems. But in the hospital environment, she said, no one is immune to infections through wounds, open surgical sites, catheters or breathing tubes, all ways through which the bacterium can enter the human body and cause problems.
The secret to cutting down on the disease, she said, is “educating people on better hygiene.”
The frequent washing of hands is critical, she said, and people in all circumstances must not share towels, clothing, sports equipment, tooth brushes or other articles that permit the transference of bacteria.
In a hospital, if MRSA is detected on or in a patient, that patient is isolated and special clean-room precautions are initiated, meaning anyone who enters must first don sterile garments over their clothes and must wash hands with a special cleanser.
Methicillin-Resistant Staphylococcus Aureus can be contracted either in hospitals or, according to health experts, in certain community-based circumstances outside the health care system.
According to a website maintained by the nationally respected Mayo Clinic, “Staph bacteria are generally harmless unless they enter the body through a cut or other wound, and even then they often cause only minor skin problems in healthy people. But in older adults and people who are ill or have weakened immune systems, ordinary staph infections can cause serious illness.
“Staph infections, including MRSA, generally start as small red bumps that resemble pimples, boils or spider bites,” the website continues. “These can quickly turn into deep, painful abscesses that require surgical draining. Sometimes the bacteria remain confined to the skin. But they can also burrow deep into the body, causing potentially life-threatening infections in bones, joints, surgical wounds, the bloodstream, heart valves and lungs.”
Cerise, in relating anecdotal evidence of the rising incidence of MRSA cases, told of patients who came to the hospital with what they thought was a spider bite, but which turned out to be MRSA.
She also said that local hospitals have lower infection rates than hospitals in urban areas, and thus are able to observe less stringent precautionary controls than the larger hospitals in the cities.
But, she said, “We’re having more patients that are coming in with it, [although] they are not getting it in our hospital.”
Nationally, stories in newspapers, magazines and on television for years have told of rising infection rates at hospitals, known as “hospital-acquired MRSA” or HA-MRSA, and more alarmingly have revealed a relatively new phenomenon known as “community-acquired MRSA” or CA-MRSA, meaning it can be contracted in a variety of situations common to communities across the nation.
Some stories, for instance, have told of the virus being contracted under such diverse circumstances as high school athletes during practice, or prison inmates.
And in February 2003, the Colorado Department of Health was notified of a “cluster” of CA-MRSA infections among members of a fencing club and their household members. Other potential hot spots mentioned by public health experts have included child-care centers, prisons, and among men who have sex with other men.
Experts have noted that the staphylococcus in its basic form, called S.aureus, has been around for most of human history, though it did not pose a serious public health risk until relatively recently.
“Although S. aureus has been causing infections (staph infections) probably as long as the human race has existed, MRSA has a relatively short history,” declares the website http://www.medicinet.com. “MRSA was first noted in 1961, about two years after the antibiotic methicillin was initially used to treat S.aureus and other infectious bacteria.”
The gene responsible for the bug’s resistance to methicillin, according to the website, “has continued to evolve so that many MRSA strains are currently resistant to several different antibiotics. S. aureus is sometimes termed a ‘superbug’ because of its ability to become resistant to several antibiotics. Unfortunately, MRSA can be found worldwide.”
According to the CDC, it appears that more people in the U.S. now die annually from MRSA than from AIDS.
The superbug was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005, CDC researchers report in the Oct. 17 issue of the Journal of the American Medical Association.
That same year, roughly 16,000 people in the U.S. died from AIDS, according to CDC figures.
The national estimate is more than double the incidence of MRSA reported by CDC researchers five years earlier, one article concluded, citing researcher R. Monina Klevens.
In Colorado, the state legislature in 2006 passed a law requiring that hospitals report all “hospital-acquired infections” to state health authorities, starting in January of next year, but MRSA is not among the diseases that must be reported by outlying rural hospitals.
The infection specialists both predicted that current studies of the disease probably will lead to reporting requirements in the coming years for all Colorado health care facilities, including the smaller, rural hospitals.