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http://www.whidbeynewstimes.com/ ... =1099145&more=0
Superbug battle: Hospital moves against MRSA
Nov 07 2007
How do you treat an infection that has built up a resistance to certain types of penicillin? Very carefully.
A trite punch-line for an unfunny joke, but the reality is that Methicillin-resistant Staphylococcus aureus, or MRSA, has more than leveled the playing field at health care facilities across the country.
Doctors and nurses everywhere are on the defensive and Whidbey General Hospital is not immune to the bacterial onslaught.
Although no Island County residents have died from MRSA thus far, the threat and increasing number of cases has placed health officials everywhere on high alert. After learning that a student became infected with MRSA, officials at Port Townsend High School located just across Admiralty Inlet announced Thursday that they will shut down all of the school's athletic facilities this week. Monday, one of Port Townsend's elementary schools was closed for the day after a staff member came down with MRSA.
\"MRSA is in the community and we see it frequently at the hospital and in the physicians clinics,\" said Belinda Hawkins, Whidbey General Hospital infection control registered nurse.
The federal Center for Disease Control reports that, in general, it is not necessary to close schools to \"disinfect\" them when MRSA infections occur. MRSA skin infections are transmitted primarily by skin-to-skin contact and contact with surfaces that have come into contact with someone else's infection. The panic created by the infection, however, has caused the CDC's information to fall on deaf ears.
MRSA was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005, CDC researchers reported.
At Whidbey General, infection prevention permeates every facet of hospital operations. MRSA, tagged as one of the \"superbugs,\" has not altered the process, but diagnosing the infection proves a constant challenge.
\"We're always looking for people who may have an infection that's not diagnosed,\" Hawkins said.
Treating MRSA involves testing and ascertainment of exactly which antibiotic can be used for the highly discerning bug.
\"You can treat MRSA with some antibiotics,\" Hawkins added, \"but we use these antibiotics very judiciously.\"
And that judiciousness is exercised only after the laboratory work is finished. A culture is taken from the patient and the bacteria is collected and allowed to propagate in a controlled environment. A selection of antibiotics is then applied to the specimen in order to determine each one's effectiveness. The last step is to then treat the patient with the correct antibiotic. Antibiotics stewardship, an infection control measure at the hospital, ensures that antibiotics are prescribed only when absolutely necessary.
Dr. Gabriel Barrio, Whidbey General Chief of Medicine, said MRSA has gone from an indefinable blip on the medical radar to an undeniable blot. The doctor said the emergence of the bug is timely, serving to reinforce steps the hospital is already taking to battle infection.
\"This marries nicely with some of the Institute for Health Care Improvement goals for improving patient safety, in that we're trying to reduce the number of hospital-acquired infections by the implementation of certain policies,\" Barrio said.
It's out in the community
Shannon McDonnell, Whidbey General registered nurse and Infection Control Committee chairperson, said a decade ago MRSA was largely confined to hospitals.
\"Now we're seeing it out in the community,\" she said. \"I was working as a public health nurse when we started seeing it in our community. Community-acquired MRSA usually presents as a skin infection or an abscess.”
Barrio said the bug is non-discriminating. It does not target certain demographics. The hospital has seen 2-year-olds with the infection. A varsity soccer player came down with MRSA and a talented basketball player visiting Whidbey Island was sent to Children's Hospital in Seattle because of the severity of his infection. The kids were young and healthy.
The chief of medicine said MRSA has grown in resistance similar to the manner in which mosquitoes became immune to DDT, or Dichloro-Diphenyl-Trichloroethane.
\"We're trying to control malaria and when you have billions or trillions of organisms, there's always going to be a couple that are naturally resistant to the thing,\" he explained. \"The thought with MRSA is similar, because of the rapid spike in community-acquired MRSA, we think that in the community somewhere one of these blips happened.\"
The goal of infection control has two components, to appropriately treat infections that arrive at the hospital and to prevent their transmission to the halls of the facility. The Center for Disease Control has written policy on Preventing Infections in Health Care Facilities. Whidbey General follows the CDC's lead.
\"It's a constant process,\" Barrio said.
When an infection makes its way into the hospital, transmission-based precautions, which include hand washing, and wearing gloves and gowns, are used by staff and visitors. Surveillance is another mechanism effectively employed at the hospital. And McDonnell constantly has her ear to the ground.
\"If I hear something's happening in the community, I may address the emergency department doctors and tell them to be aware of it,\" the infection control practitioner said. \"Then we do more targeted surveillance on those possible diseases that may be coming in our doors.\"
When the federal government cut the CDC's funding for tuberculosis surveillance in the 1980s, Barrio said the medical community saw a resurgence in the disease.
\"That showed us the power of prevention simply by watching and acting quickly,\" he said.
A person can have MRSA or another infection prior to checking into the hospital and not have symptoms of an infection. The federal government is proposing that hospitals foot the bill for treatment if an infection is diagnosed after admission. The change would usher in more active surveillance - like nose and urine cultures - when a patient checks in to a hospital.
\"Certain populations are at more risk for infection than others,\" McDonnell said. \"Those that have a suppressed immune system, those with lung disease, and the elderly.\"
Barrio said the fight against the \"superbug\" will continue and the most effective weapon can - and should - be wielded by everyone.
\"We think MRSA is here to stay and leading the battle to contain it are health care professionals, administration and the public,\" he said. \"The best defense against infection is clean hands.” |
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发表于 2007-11-19 07:08:16