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We are honored to announce that Hospital Infection Control & Prevention has been awarded First Place in the Newsletter Journalism Award category by the National Press Club in Washington, DC, for a special report on patients infected with MRSA. This one’s for you Maddy.
“MRSA Patient Stories,” a two-part series in the Nov-Dec 2010 issues of HIC, claimed top prize in the category of Best Analytical Reporting in Newsletter Journalism. While putting some pressure on the Centers for Disease Control and Prevention to adopt more aggressive measures against the pathogen, the report lent a human face to the annual toll of Methicillin-resistant Staphylococcus aureus (MRSA).
Infection preventionists, epidemiologists throughout the nation's hospitals, hold the discussion for an instant about how transmission occurred and whether the MRSA strains arose in the community or in the hospital. At the human level, it doesn't matter. Health care epidemiologists can point out the obvious caveats and logistical problems to some of the things MRSA activists presume and propose, but there is no medical calculus for the rended heart. These stories will be heard.
These powerful narratives may do more to change the culture and practice of infection prevention in the nation's hospitals than a thousand clinical reports to Congressional committees. Change is coming in infection prevention because from the patient's perspective a 300-page CDC guideline with a phone book of references is a doorstop indictment of an approach that has failed. A child is dead and her mother draws her breath in pain to tell her story.
"When they removed her from life support they warned us that she would only live for a few minutes," Beth Reimer told us, recalling her six-week old daughter Madeline "Maddy" Renee Reimer. "My daughter actually lived for 13 minutes and I was able to hold her as she took her last breath."
MRSA is now killing more Americans annually than HIV/AIDS. This is in part a story of intersecting epidemics, one declining to a chronic condition while the other gains new footing in the community. Still, the vast majority of these bacterial infections are acquired in the nation’s hospitals by patients seeking treatment for some other malady. They literally never see it coming. The individual stories of these patient’s – some 20,000 of them lost every year -- often die with them.
Infection preventionists and health care epidemiologists have been fighting the scourge of MRSA for decades, giving ground grudgingly as they hector health care workers to wash hands, don gloves and gowns, and practice other measures to keep MRSA from spreading from patient to patient within the hospital. Many times this works; too often it doesn’t. Patients who have acquired MRSA can confirm that in hellish detail.
In part two of our report we revealed that data from the Veterans Affairs (VA) hospital system – at that time still unpublished – found that as much as 76% of the 100,000 invasive MRSA infections occurring annually could be prevented. Going beyond current CDC guidelines, the VA has adopted a bundle approach that features aggressive MRSA testing and patient isolation in all of its 153 hospitals.
The CDC is aware of the findings, but balks at urging widespread implementation of the VA policy. “Our job here at CDC is to make sure that all health care is safe — not to tackle a specific organism at the exclusion of others,” Michael Bell, MD, deputy director of the CDC division of Healthcare Quality Promotion, says in our report.
You might fairly ask, “This, from the nation that eliminated polio and led the world in eradicating smallpox?” However, there is another side to the story and we reflect it in our analysis. We interviewed clinicians who similarly cautioned against tailoring infection control efforts against a single pathogen, arguing instead for a standard precautions approach that includes flexibility to go to more enhanced measures.
Indeed, as bad a bug as MRSA has been, there are troubling signs of emerging pan-resistance in other pathogens, including a broad array of gram negatives. For example, New Delhi metallo-beta-lactamase (NDM-1) — a virtually untreatable gram negative bacterial enzyme that originally emerged in hospitals in India — continues to spread globally.
“If I come into a hospital — whether I have MRSA, VRE or multidrug resistant acinetobacter — it doesn’t matter how you label me,” said Patti Grant, RN, infection preventionist, HIC board member, and reliable source of uncommon sense. “This [screening approach] is taking us all back to relying on an isolation sign or a patient label to practice basic good infection prevention and control. We need to put our resources where we can actually start preventing infections at the bedside. I don’t think labeling people with MDROs is going to be the answer.
Publisher’s note: This is Gary Evans fifth award from the National Press Club since 1996, including three 1sts and two honorable mentions (2nd). He also has won several journalism awards from newsletter and specialized publishing associations, including a Best Investigative Award in 1992 from the Newsletter Publishers Foundation for a report on the mysterious Florida HIV dental outbreak that led to the death of Kimberly Bergalis.