MRSA -- what it is and how it spreads

Nasty infection

New law could lower incidence of potentially fatal MRSA

October 18, 2007

By J.T. MORAND Staff Writer

Joe Rieber went into the hospital for an appendectomy, and came out with a life-changing disease.

He said he's one of the lucky ones because he survived after contracting an infection caused by a bacteria called MRSA.

Now, a new state law requiring testing for the infection at hospitals might ensure that more patients don't go through what Rieber did.

In March 2005, in the midst of tax season, Rieber, a certified public accountant from Buffalo Grove, was rushed to a hospital to have his appendix removed before it burst. During surgery, doctors also discovered he had Crohn's disease, a chronic inflammatory condition of the digestive system, and removed part of his intestines.

While convalescing in the hospital for the next couple weeks, he had a tube put up his nose and was poked with lots of needles as doctors conducted tests and monitored his condition before releasing him in early April.

Feeling well enough to return to work, Rieber was looking forward to easing back into a routine.

Then, his troubles really began.

By the end of the month he was back in the hospital with coughing, fevers spiking above 100 degrees at night and chills.
Scary diagnosis

His diagnosis came like a scene from a science fiction movie: One day, while Rieber and his hospital roommate, Paul, lay in their beds talking, doctors and nurses came in wearing masks, gowns and gloves, he said. They whisked Paul away to another room and informed Rieber he had methicillin-resistant Staphylococcus aureus, or MRSA.

"It was very scary," Rieber said. "We were chatting and the next thing I know he's (Paul) being evacuated."

Pinpointing an exact number of MRSA deaths a year is difficult; most health organizations have only estimates. The Institute for Healthcare Improvement said there are 5,000 MRSA deaths a year, while some other organizations estimate deaths in the tens of thousands.

Regardless, drug-resistant pathogens are a growing threat in the United States, according to the Centers for Disease Control and Prevention, which reports that 2 million people get some sort of an infection in a hospital every year, and about 90,000 die as a result of those infections.

MRSA infections occur most frequently among persons in hospitals and healthcare facilities who have weakened immune systems, according to the Centers for Disease Control.

MRSA infections are resistant to most common antibiotics.

There are two kinds of MRSA--community acquired (CA) and hospital acquired (HA). Patients and lawmakers think HA-MRSA is preventable.

MRSA lives harmlessly in the nasal passages of about 30 percent of Americans. When it invades the body it can cause a serious infection. It can spread easily by shaking hands with someone who has the bacteria on their hands or by touching items such as clothes and table tops in which the bacteria is living. MRSA can also be airborne.
The law

In August, the state legislature approved a bill requiring all hospitals to test intensive care unit and at-risk patients for MRSA. It also requires hospitals to isolate patients with MRSA and requires appropriate hand hygiene for healthcare workers. The bill also requires all hospitals to report MRSA cases to the Department of Public Health.

It received bi-partisan support in both chambers, was signed into law Aug. 20 and became effective immediately.

Jeanine Thomas, founder of the MRSA Survivors Network, has been pushing for a law like this for years. The Hinsdale resident developed a MRSA infection after one of many surgeries she had in 2000 to repair a broken ankle. It left her bed-ridden for months. Her story can be read at MRSA-survivors.org.

"The key to getting this under control is prevention," Thomas said. "This (law) is going to save thousands of lives a year in Illinois."

Thomas also wants to raise awareness that it's easy to contract MRSA even in your doctor's office if healthcare professionals don't use precautions. Patients should insist doctors wash their hands and put on new gloves when they walk into the room, she said.

"You have to protect yourself."
Preventive tool

Evanston Northwestern Healthcare officials launched a MRSA screening process for all inpatients in 2005, two years before the new law was passed.

The noses of patients staying overnight are swabbed and the samples tested for MRSA, said Lance Peterson, M.D., epidemiologist and director of Clinical Microbiology and Infectious Disease Research at Evanston Northwestern Healthcare.

Peterson, who developed the program, is also a Professor of Pathology and Medicine at Northwestern University.

If patients test positive, they are put in isolation. Before anyone enters a MRSA-positive patient's room, they must wear a disposable gown and gloves. MRSA-positive patients are put on a five-day therapy regimen, which includes applying a topical antibiotic on the nose and washing with an antiseptic soap. Peterson said his regimen can be followed during the same time patients receive treatment for what brought them there. It can also be done outside of the hospital.

Out of the 40,000 patients admitted to the three hospitals in the Evanston Northwestern Healthcare system--Evanston, Glenbrook and Highland Park-- each year, 100 were developing MRSA infections prior to the screening program, Peterson said.

The hospital system saw a 60 percent drop in the number of MRSA infections in the first year of the program, or just 40 infections a year.

"From the published evidence, we thought it would take two years to see a 50 percent reduction," Peterson said. "So, a 60 percent reduction in one year is very impressive, even if not perfect."

Rieber, who contracted MRSA, wishes the screening and reporting act was in place years ago.

He spent about seven months recovering from his MRSA infection, at which time he lost 50 pounds.

"Climbing stairs was a real chore," the 60-year-old said. "I had to rest when I got to the top of the stairway." He also had to give up Tai Chi classes and walks at the Chicago Botanic Garden.

He has resumed those activities, but MRSA never really goes away. He tested positive for it last May, and underwent a week-long washing treatment. He said the infection can reoccur.

Rieber now pays closer attention to his health. He steers clear of situations that might make him sick, especially anything that could put him in the hospital again. For example, he'll work through rush hour when he's in downtown Chicago to avoid the blood pressure-raising and stress-inducing traffic snarls on the way home.

He's also more aware of the cleanliness of the environments he's in, such as restaurants and airplanes. He has become vigilant about dust in his home.

"I've been sensitized to things involving cleanliness," he said.

http://www.pioneerlocal.com/evanston/lifestyles/health_family/604011,on-hospitalsafe-101807-s1.article