Bug Puts Hospitals On Edge, On Guard
'Nasty' Bacterium Resists Antibiotics, Forces New Actions

By Susan Levine
Washington Post Staff Writer
Monday, May 14, 2007

Hospitals across the Washington region are mounting increasingly aggressive defenses against a virulent bacterium resistant to antibiotics that turns seemingly minor skin abrasions, cuts and sores into serious, even life-threatening, infections.

At Franklin Square Hospital Center in Baltimore, clergy wipe down their Bibles after visiting patients' rooms so as to spread only the Word. Medical charts are tucked into plastic pouches to minimize the chance of germs being transported with people heading to tests or therapy.

At the University of Maryland Medical Center, more than a third of all patients are tested upon admission, discharge and frequently in between for what the infection control director labels "a nasty bug." Using nasal swabs and molecular technology, doctors learn within hours whether someone is carrying the bacterium.

Like facilities elsewhere in the country, the hospitals have experienced a sharp rise in the incidence of methicillin-resistant staphylococcus aureus, known as MRSA, coming from the community into their emergency rooms and patient wards. In the District, where a task force is considering a citywide response, this strain of microorganism appears responsible for a jump in hospitalizations since 2004.

The challenge is not just treating people exhibiting the red, swollen skin abscess or painful skin inflammation that are classic warning signs. Millions of Americans are unknowingly "colonized" with MRSA but show no symptoms. They pose a different issue: How can hospitals immediately identify and separate them when they're admitted for whatever medical reason?

"We need to do more. Just how much more to be effective is not clear," acknowledged Harold Standiford, who heads infection control at the University of Maryland Medical Center. The 669-bed institution recently expanded its testing surveillance to all nine intensive care units, at a cost of hundreds of thousands of dollars.

The pathogen commonly resides in nasal passages or on skin and can be transmitted easily by casual contact with another person or a contaminated surface. Whether on a bedside table or an X-ray machine, a stethoscope or Bible, it can survive for days.

Hospitals have long battled internal staph infections that could fight off the usual antibiotics. The patients most at risk were those with weakened immune systems or those recovering from surgery or in intensive care.

Then several years ago, a variant emerged in communities across the United States. It spread rapidly, garnering attention because its victims were generally younger, healthy people. Some were professional athletes whose seasons or careers were derailed.

A Virginia Health Department conference Friday in Richmond will include Bubba Tyer, director of sports medicine for the Washington Redskins, who will talk about the team's half-dozen MRSA cases since 2004. The meeting will bring together government officials, physicians and hospital administrators to discuss a comprehensive counterattack to the threat.

One concern is that the new strain could become entrenched in hospitals. "We are starting to see outbreaks," Donald Goldmann, an infectious disease expert at Children's Hospital in Boston, told a national audio conference this year.

Some data also suggest the bacterium is becoming less susceptible to the alternate drugs prescribed as treatment. Given federal estimates that antibiotic-resistant staph infections are responsible for about 130,000 U.S. hospitalizations and for 17,000 deaths annually, the ramifications could be daunting.

Floyd Rodgers landed in Washington Hospital Center in March when what he thought was an insect bite on his face became ugly and tight. The 46-year-old District man, who shares a bathroom with others in his apartment building, suspects he picked up the infection from a razor or towel someone else had used.

He remained in isolation for much of his 11-day stay as doctors tried different antibiotics. "It was real big, like a fist," Rodgers recounted. "It was hard to swallow." The specialist brought in on his case, Krishna Dass, said Rodgers could have risked septic shock had he delayed seeking help.

"MRSA keeps getting worse," Dass said. Washington Hospital Center now does routine screening and cultures of patients with conditions that could make them more vulnerable to the bug.

City officials first asked District facilities to report their incidence of cases last year; the task force could recommend mandatory reporting. Some members are urging a major public health campaign.

"Every hospital . . . out there is grappling with how to handle this," noted Keri Hall, an epidemiologist at the University of Virginia Medical Center, which produced a video to explain to MRSA-positive patients why strict gown-and-glove precautions should be taken whenever anyone, from a relative to a surgeon to a housekeeper, enters their room.

Virtually no U.S. health-care facilities have taken measures as stringent as those in a few European countries. They have largely defeated MRSA by testing and isolation so widespread that it has been dubbed "search and destroy."

But some, like the University of Maryland Medical Center, are moving in that direction. Compared with Virginia and the District, Maryland has the most comprehensive anti-MRSA efforts underway. Seven Maryland hospitals are part of a national project to encourage novel yet common-sense approaches to block the bacterium.

At Johns Hopkins Hospital, STOMP -- for Stop Transmission of MRSA Permanently -- became the mantra in September. The campaign updates staff with weekly numbers of possible transmissions. It emphasizes hygiene by ensuring that alcohol-based hand gels are never out of reach in a patient's room.

Franklin Square Hospital Center, one of the first project sites, emphasizes the use of disposable gowns and gloves for any staff members entering isolation rooms. The hospital goes through 24,000 gowns every quarter -- five times its previous volume.

What's being learned will filter soon to more facilities, thanks to the Maryland Patient Safety Center. The center, a collaboration of the state hospital association and the national Delmarva Foundation, also hopes to have training in community clinics and doctor's offices.

"This particular problem touches everyone," said Margaret Toth, the foundation's chief quality officer. "If we're to address it only as a hospital issue, we'll make no dent."