Maryn McKenna

Journalist and Author

New MRSA group discussion, caveat lector

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A UK-based site called iCareCafe posted a link in the comments to the previous post, inviting readers who are MRSA patients or caregivers to visit. Per my rules I’m elevating it to post status so that you can see it and I can comment on it.

Here is their post:

…The icarecafe has been set up to provide a space for patients, carers and their supporters online.
Some of the members have set up a discussion group on the subject of MRSA. The group has asked lots of questions which are still in the process of being answered. So we thought it appropriate if we invited people from other MRSA discussion group and blogs to ask if they wished to participate.
To have a look at the discussions so far please have a look at http://www.icarecafe.com/?page_id=1107&group_id=71
Best wishes
Belinda Shale
Moderator – the icarecafe

My due diligence:

  • As you’ll see in the right-hand sidebar, I am a sympathetic member and promoter of authentic communities online. However, as I have warned before, I am skeptical of sites that exist mainly to sell products to patients.
  • The iCareCafe appears to be an authentic discussion forum that covers numerous diseases and conditions, though a few of the members are using what appear to be “stock art” pix of models to represent themselves; make of that what you will.
  • The MRSA forum currently has 6 threads running; in a few, people are sharing their stories, and in a few others, people are aggressively pushing nutritional regimens and recommending cleaning products.
  • The iCareCafe is backed by a marketing company, as it discloses here:

    …The icarecafe is a project from The Patients Voice (which is itself part of Healthcare Landscape. By way of earning our living we provide our clients with medical market research services. Or to put it another way we run surveys and focus groups and things of that nature so that we can provide patients with a voice.

FWIW.

Five-fold increase in flu+MRSA deaths in kids

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I have a story up this evening at CIDRAP News about a new paper in the journal Pediatrics that analyzes the incidence of child deaths from pneumonia caused by the combination of MRSA and flu, a sad and scary development that we’ve talked about here, here and here.

(NB: CIDRAP News is the original-reporting and news-aggregation arm of the Center for Infectious Disease Research and Policy at the University of Minnesota, an infectious disease research center headed by noted epidemiologist Michael Osterholm, PhD. I have a part-time appointment there. CIDRAP News is the best-read infectious-disease website you have never heard of, with about 10 million visitors a year, and is a notable resource for news on seasonal and pandemic flu, select agents and bioterrorism, and foodborne disease.)

It is bad netiquette and not fair use to reproduce another publication’s entire story here, even if I wrote it. Here though are the highlights:

  • 166 children died of influenza in the past three seasons (2004-05, 2005-06, 2006-07) according to 39 states and 2 local health departments (86 this year in preliminary reporting)
  • The proportion of deaths from bacterial co-infection rose each year, from 6% to 15% to 34%, a five-fold increase
  • Almost all of the bacterial co-infections were staph; 64% of them MRSA
  • The rapid rise in MRSA colonization (from 0.8% of the population in 2001 to 1.5% in 2004 — that’s more than 4 million people) may be playing a role
  • And, some of these deaths could have been avoided if children had had flu shots — but overall, only 21% of under-2s and 16% of 2- to 5-year-olds get the two shots they need to be fully protected against flu.

Please click through to CIDRAP for more.

The cite is: Finelli L, Fiore A, Dhara R, et al. Influenza-associated pediatric mortality in the United States: increase of Staphylococcus aureus coinfection. Pediatrics 2008;122:805-11.

UK: Hospitals’ MRSA deaths could bring manslaughter charges

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Last Wednesday was the first day of the new federal fiscal year, and therefore the day on which HHS’s new “non-reimbursement for medical errors” rule went into effect. Under this new rule (blogged here and here and covered in this New York Times story), the Center for Medicare and Medicaid Services will no longer reimburse hospitals for the increased care that a patient needs after an extreme medical error has happened. While infecting a patient with MRSA is not specifically disavowed in the rule, it outlaws reimbursement as of this year for infections associated with vascular catheters and coronary artery bypass graft surgery, and next year (Oct. 1, 2009) for surgical site infections following orthopedic procedures. (Disappointingly, CMS rejected requests to define staph septicemia and nosocomial MRSA infection as “never events.”)

Now, however, it seems that the UK government is willing to go much further than our own. According to a story in The Independent (first flagged here by ace flu blogger Crawford Killian), “tough new manslaughter laws” will allow corporations — including healthcare institutions — to be held accountable for deaths in which corporate behavior plays a role:

Maria Eagle, the Justice minister, told a meeting of more than 100 chairs and non-executive directors of NHS trusts that where managers ignore warnings of health risks, prosecutions may follow. She said: “Putting the offence into context, imagine that a patient has died in a hospital infected by MRSA and the issue of corporate manslaughter has been raised. Could the organisation be prosecuted and convicted? The answer is ‘possibly’. (Byline: Robert Verkaik, law editor)

Public attitudes in the UK are ripe for this change. In July, there was significant protest after it emerged — via a government report — that 345 patients died of Clostridium difficile infection at three hospitals, after government warnings, with no punishment to the hospitals. In fact, according to The Independent, the chief executive of the trust that operated all three was allowed to resign with $150,000 in foregone pay, and is now suing for additional compensation.

So far, US protests and citizen action over nosocomial MRSA infections have been within individual states (see this recent post on the new Nile’s Law in California). But isn’t it interesting to see what coordinated national action — granted, in a smaller country — can do.

More teen MRSA deaths

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I just want to note that there is a sad uptick in news of MRSA illnesses and deaths among teens:

  • 18-year-old Alonzo Smith of Kissimmee, Fla. died this past Monday, Sept. 29.
  • 17-year-old Saalen Jones of Philadelphia died on Tuesday, Sept. 23.

In addition, just in the past two weeks there have been school outbreaks in:

Non-pharm prevention alternative for MRSA skin infections

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Longtime reader and botanical-medicine expert Robyn spotted this new story and study this morning and pointed it out in the comments to a previous post. It’s about a product, but it’s a product with science to back it, so under my rules regarding commercial products, I am moving it up to post status. (Robyn didn’t say, but given the internals of her post I assume, that she has no commercial interest in this. Right, Robyn?)

The product under investigation is an over-the-counter cream called StaphASeptic that contains the natural antimicrobials tea tree (Melaleuca alternifolia) oil and white thyme (Thymus vulgaris — the “white” refers to the preparation not the species) oil, along with the commercial antiseptic benzethonium chloride. That product’s effect on isolates of CA-MRSA was compared against two common OTC first aid creams, one containing the topical antibiotic polymyxin B and the other containing both polymyxin B and the topical antibiotic neomycin.

The authors found that the botanical-containing cream did a better job of killing CA-MRSA in a time-kill analysis, finding specifically that it went on killing longer — up to 24 hours — than the other two creams. The assumption obviously is that this non-antibiotic cream would do a better job of protecting superficial wounds and scrapes from MRSA infection than the antibiotic-containing ones, while presumably not promoting resistance.

But the important question, which Robyn raises, is whether the essential oils are not in fact acting as natural antibiotics, possibly synergistically. Let’s remember that the majority of antibiotics — including, for instance MRSA drug-of-last-resort vancomycin, and its replacement daptomycin — were initially isolated from natural substances (fungi, in both those cases). Overall, however, botanical products receive much less research attention that pharmaceuticals, so their action and their therapeutic potential remain unexplored.

The cite is: Bearden, DT, Allen GP and Christensen JM. Comparative in vitro activities of topical wound care products against community-associated methicillin-resistant Staphylococcus aureus. Journal of Antimicrobial Chemotherapy (2008) 62, 769–772. NB: The research was supported by an unrestricted grant from StaphASeptic ‘s manufacturers, Tec Laboratories Inc., and JM Christensen, of the Oregon State University College of Pharmacy, disclosed a consultant relationship with Tec.

CDC educational campaign on antimicrobial resistance

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The Centers for Disease Control and Prevention has a long-running educational campaign called “Get Smart: Know When Antibiotics Work.”

But with flu season starting, the agency has decided to make an extra push, hoping to prevent parents from asking pediatricians to prescribe antibiotics for colds and flu. (Which are, all together now: Viruses! And are not affected by: Antibiotics! Gold stars all ’round.) So it has named next week, Oct. 6-10, as “Get Smart About Antibiotics Week.”

There’s a website page specifically for the campaign, which seems to be aimed mostly at health-care institutions and public agencies — places that would mount campaigns and plan activities to reinforce the stewardship message. (The campaign has 14 health-agency and professional-association partners.) If you’re in any of those roles, there are scripts, ads, PSAs, pre-written “articles” and web graphics and widgets. Find them here.

If you’re looking for more general information that you can, for instance, share with friends, this page has explanations in everyday language.

Here’s a question: Are there any readers who are health-care professionals (doctors, nurses, NPs, PAs etc.) who feel you are pressured to prescribe antibiotics? If so, please get in touch via the comments or the email address in the right-hand bio box. I would love to hear from you.

The importance of MRSA in a flu pandemic

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Constant readers will know that, in another part of my life, I write a great deal about seasonal and pandemic influenza, a subject I’ve been following since writing the first story in the American media about avian influenza H5N1 (in August 1997; find it on this page.)

And people concerned about MRSA realize that flu and MRSA have an important overlap: For decades, long before the emergence of MRSA, staph was one of the most important contributors to secondary bacterial pneumonia, which occurs after the flu virus has damaged the lung tissue and allows staph and other bacteria to take hold.

In the past few years, we’ve been reminded of this interaction because of the shocking rise in cases of necrotizing pneumonia caused by MRSA (blogged here and here). Twice in the past two years, the CDC has asked state health departments to report any cases of flu/MRSA co-infection; in the 2006-07 flu season, 22 children died from MRSA necrotizing pneumonia secondary to flu.

Comes now one of the giants of staph research to warn of an unconsidered danger of MRSA: as a contributor to deaths in a flu pandemic. Dr. Theodore Eickhoff, who wrote some of the earliest papers on hospital-acquired staph infections, has written an assessment in Infectious Disease News of two new pieces of research into deaths during the 1918 flu pandemic. Both papers contend that it was bacterial pneumonia that was the major killer in that global storm of death, and not the novel flu virus itself.

Eickhoff looks forward from those findings to consider what havoc a new pandemic could wreak in this era of massive MRSA transmission. He contends that national planning for pandemics — a huge effort and expense for the US and other governments over the past few years — has paid insufficient attention to the possibility that bacterial infection will be as significant a danger as whatever new flu has emerged:

Authors of both of these reports point out that their findings have important implications for pandemic preparedness today. U.S. preparedness policy, and indeed that of almost all other countries, has been focused on preventing or modifying influenza virus infection itself. Thus, vaccine development and anti-viral drugs (eg, neuraminidase inhibitors) have been the major efforts, and a great deal of stockpiling has already taken place. Clearly it is equally necessary to stockpile antibiotics effective against primarily community-acquired organisms causing post-influenza pneumonia today, including both MSSA and MRSA. Much more consideration needs to be given to the possible role of pneumococcal and possibly other bacterial vaccines as part of pandemic preparedness.

Good news from California

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Last night, California Gov. Arnold Schwarzenegger signed an extremely important bill, California SB 1058. The new law, formally called the Medical Facility Infection Control and Prevention Act, requires California hospitals to do MRSA screening on high-risk patients (such as in ICUs, admitted from long-term care facilities, or known to have a previous MRSA infection) and to report their rates for hospital-acquired infections including MRSA to a newly created body with the state Department of Public Health.

This new law puts California in the vanguard of states who are requiring healthcare institutions to count and track MRSA infections. (For a complete list, visit the database maintained by Consumers’ Union’s Stop Hospital Infections project.) This is vital not only for controlling MRSA, but also simply for helping us to understand how much MRSA is out there. Because MRSA has not been a reportable disease, and is not subject to any national surveillance, state counts like these are one of the best ways of assembling a fuller picture of the bug’s spread.

The most important reason to hail the passage of this law, though, is that it represents a memorial to a MRSA victim, and a determination by his survivors that no one else should meet the same fate. SB 1058 is also known as “Nile’s Law.” Nile is Nile Calvin Moss, who died in 2006. In response, his parents Carole and Ty Moss founded Nile’s Project and became tireless advocates for MRSA surveillance and screening. Among other efforts, Carole was appointed by Schwarzenegger to a state commission on hospital-acquired infections, where she is the sole voting member representing health-care consumers.

It is no small thing to step out of your grief and make your loss into a force for change. Carole and Ty Moss deserve congratulations.

A small self-promotion

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I have a long story in the new (October) SELF Magazine: Morgellons mystery.

It is not about MRSA; it’s about Morgellons, a syndrome which approximately 12,000 sufferers claim is a new, unrecognized disease, but which medical authorities say is a delusion. The story is a look at the experience of several people who identify themselves as having the disease, contrasted with the efforts of several researchers — including the head of a new CDC investigation — to figure out what exactly is going on.

It’s a medical mystery story, and a meditation on the nature of evidence and belief.

And it raises the question: When something arises that fits no past pattern, how do we recognize it, describe it and prove its existence to others? It’s a question that should resonate with advocates for MRSA – especially community MRSA infection.

Lotrs more MRSA news coming this week.

Disease-related Do Not Fly list?

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This is not strictly MRSA-related, but it is so striking it’s worth posting on. This morning, the Centers for Disease Control and Prevention, the US public health agency, revealed in its weekly bulletin that it has begun maintaining a “Do Not Board” list for people who are thought to be a communicable-disease risk to others.

In slightly more than a year, 33 people have been refused transportation because of the list, which is operated in conjunction with the Department of Homeland Security.

The CDC began operating the list in June 2007, shortly after tuberculosis patient Andrew Speaker flew to Europe and back despite requests by public-health authorities that he not fly; he returned via Canada, driving into the United States to evade an alert given to airlines to locate him. At the time, Speaker was thought to have extensively drug-resistant (XDR) TB, an extremely dangerous form of the disease. Later, his doctors asserted and the CDC agreed that his TB was multi-drug resistant (MDR) — still dangerous, but nowhere near as dangerous as the almost-untreatable XDR form.

Patients’ names can be placed on the list by several entities though all requests are reviewed, the CDC says:

…state or local public health officials contact the CDC Quarantine Station for their region†; health-care providers make requests by contacting their state or local public health departments, and foreign and U.S. government agencies contact the Director’s Emergency Operations Center (DEOC) at CDC in Atlanta.
To include someone on the list, CDC must determine that the person 1) likely is contagious with a communicable disease that would constitute a serious public health threat should the person be permitted to board a flight; 2) is unaware of or likely to be nonadherent with public health recommendations, including treatment; and 3) likely will attempt to board a commercial aircraft.
Once a person is placed on the list, airlines are instructed not to issue a boarding pass to the person for any commercial domestic flight or for any commercial international flight arriving in or departing from the United States. (MMWR 57(37);1009-1012)

An important point here is the phrase “would constitute a serious public health threat.” Under US law (42 USC 264), most public health functions belong to the states, but the federal government is empowered to detain and isolate or quarantine people known or suspected to have a small list of communicable diseases: cholera, diphtheria, infectious tuberculosis, plague, smallpox, yellow fever, viral hemorrhagic fevers (such as Ebola), SARS, and novel strains of flu. The Do Not Board list, however, reaches beyond that list, according to the CDC bulletin:

The public health DNB list is not limited to those communicable diseases for which the federal government can legally impose isolation and quarantine; the list can be used for other communicable diseases that would pose a serious health threat to air travelers. However, to date, the list has only been used for persons with suspected or confirmed pulmonary TB, which is transmitted via the respiratory route and which has had transmission documented during commercial air travel.

Detecting and protecting against disease threats to the US is well within the CDC’s mandate. Still, this raises a huge list of questions, from how medical privacy is maintained when a patient’s name is so widely circulated, to whether healthy people with similar names will be mistaken for sick ones, to how easily people get off the list once they are deemed well.

The CDC says that, of the 33 people placed on the list in the past 15 months, 18 already have been removed. But the persistent problems with the original No-Fly list — snagging air marshals and toddlers and causing passengers to change their names — suggests that this may not be as easy to manage as the CDC thinks. It would be good to hear more about what safeguards they propose — or whether they have left that part of the issue to be handled by DHS.

UK grapples with community MRSA

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Regular readers in the US will have noticed that the MRSA situation here is quite different from Europe. In the UK, for instance, hospital MRSA has been an enormous scandal, but community MRSA — both skin and soft-tissue infections, and fatal invasive infections such as necrotizing pneumonia — has been much less of a concern.

That appears to be changing. Today, the BBC’s Radio 4 broadcast a documentary, “The Bug That Can Kill Within Hours,” that focuses on fears of a dramatic rise in the UK of cases of serious community MRSA. According to the UK’s Health Protection Agency, lab-confirmed cases of community MRSA strains hit 1,361 in 2007, three times what they were the year before. (Soundfile here, starts automatically.)

The documentary refers to CA-MRSA as “PVL-MRSA,” a recognition of the fact that most of the community strains produce the toxin Panton-Valentine leukocidin, or PVL. (PVL is known to destroy white blood cells, but whether it is responsible for the virulence of CA-MRSA is a hotly disputed question in MRSA research.) Aside from the difference in terminology, any of the statements from the accompanying BBC website story could have been said here any time in the past 10 years:

Professor Brian Duerdan, the Inspector of Infection Control at the Department of Health, admits however that many aspects of this virulent bug are a mystery.
“We do know that it spreads in the community amongst close contacts, families, people who share the same sporting events. But we still need to know a lot more about its exact prevalence in the community,” he said.

People who have been tracking the relentless expansion of CA-MRSA, espeially its dominant clone USA 300, are likely to find some of the statements in the documentary both troubling and poignant. The UK is beginning to deal with some of the wuestiosn that the US has struggled with: how much surveillance to do, how to spend scarce research dollars, and what the consequences may be if CA-MRSA is not focused on now.

Hugh Pennington, Emeritus Professor at the University of Aberdeen, and President of MRSA Action, told the BBC that the HPA lacks the resources to keep proper surveillance on outbreaks of infection from this strain of bugs.
“The scandal here is that we know what to do, the technology’s there to spot these things as they are appearing and we know how to react to them.
“It would be quite wrong if we allow these things to develop and of course history tells us that it we do neglect these bugs, we neglect them at our peril.”

Indeed.

A plea (and, if you need relevance, an example of the failure of US healthcare)

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Constant readers will know that I keep the personal buzz on this blog to a low rumble, so as to stay out of the way of the news about MRSA, which affects hundreds of thousands of people beyond n=me. Today, though, I’m going to break my own rule, tell you a story, and launch a personal plea. Readers outside the US will be astounded such things can happen. Readers in the US will recognize how sadly common to our fractured system stories like this are. And they will be right. And yet, this one has particularly touched me.

So: Lori Hall Steele, of Traverse City, Mich., is a prolific freelance writer and blogger and the divorced mother of a 7-year-old son. She is also newly diagnosed with amyotrophic lateral sclerosis. She is bedridden and using breathing support and is unable to work. As a freelancer, she no doubt has not-excellent health insurance. Her bills are extraordinary. And, to add insult to grave injury, she is about to lose her house to foreclosure.

Before she became ill — her first symptoms appeared a year ago — Lori wrote an essay for the Washington Post, about watching Bambi with her son and trying to explain, yes, the death of Bambi’s mother. As often happens, they held the essay for months, and it was published in June. It is extraordinarily resonant. Please consider reading it. Tissues will help.

Let us be candid with each other: ALS is a one-way trip. People who support Lori are not expecting miracles; they are asking only for compassion, and for the ability to keep an ill young mother and her child together in the home they love for whatever time she has left.

If you are touched by Lori’s story, please consider visiting Save Lori’s House, which details fundraising efforts to help her, including a PayPal account.

Writers around the US are rallying to offer what support we can, via a blogathon of which this post is one entry. Lori’s friends are attempting to log the blogathon here.

(And because we always worry about such things on the intertubes: This has been vetted by many eyes. The chair of the Writers’ Emergency Assistance Fund, an arm of the American Society of Journalists and Authors, has been in contact with the family since the spring and has spoken by phone with family and friends. If you Google Lori’s hometown newspaper, the Traverse City (MI) Record-Eagle, and put her name in the search box, you will see notices of fund-raisers for her dating back early this year. So there is no evidence this is a scam.)

I appreciate your indulgence and support, all of you. We’ll get back to MRSA tomorrow.

Gram-negatives need love too

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Britain’s Health Protection Agency warns today that the supply of new drugs for resistant Gram-negative infections — Acinetobacter, Pseudomonas, Burkholderia — is in even worse shape that the drug pipeline for MRSA and other Gram-positives.

“Over the last ten years the pharmaceutical industry has significantly invested in antibiotic treatments for bacteria such as Staphylococcus aureus (including MRSA). There is however a big public health threat posed today by multi-resistant gram-negative bacteria and therefore there is an urgent need for the pharmaceutical industry to work towards developing new treatment options to tackle infections caused by these bacteria, in the same way as they did for bacteria like MRSA.” (Dr. David Livermore, HPA press release)

The announcement comes between two important events: the release of the HPA’s annual survey of antibiotic prescribing patterns in England, Wales and Northern Ireland (report .pdf here, 2mb); and the start next week of the HPA’s annual scientific conference, which will have a full-day symposium on resistant infections (agenda here).

Interesting: The meme “MRSA’s taken care of, let’s get on to the gnarly Gram-negatives” has picked up traction in the past few months. While I’d certainly agree with the second proposition — pharmaceuticals for resistant Gram-negatives are the next big task — I reject the first, that the MRSA problem is solved and all we have to do is wait for the drugs to roll down the pipeline. Doesn’t exactly square with all those posters at the last ICAAC and IDSA exploring emerging resistance to daptomycin and other new compounds.

For a full and thoughtful exploration of the Gram-negatives problem, see this recent New Yorker article, written by the inestimable Dr. Jerome Groopman. (True story: When Groopman’s first book came out, I interviewed him by phone – I was working in Atlanta – and wrote a complimentary piece about it. Fast-forward several years, he has at least one more book out, has become a writing rockstar – in addition to being a hugely respected Harvard clinician and professor — and I am doing a journalism fellowship on genomics at Harvard Medical School. I’m standing in line at the Longwood area Starbucks, and I spy Groopman about four people ahead of me. And I’m too shy to say anything. So much for reportorial moxie.)

New CDC educational campaign on CA-MRSA, aimed at parents

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This morning, the CDC is launching a “National MRSA Education Initiative” aimed at raising awareness among parents and average health-care professionals — not academic center researchers so much as front-line nurses, NPs, PAs and others who are likely to be the first set of eyes on a community MRSA infection.

The campaign’s front door is a newly constructed page on the CDC’s website that looks well-stocked with fact sheets for parents and for health-care workers; lots of informative photos, most of them taken by physicians, of what a MRSA skin infection looks like; specific information about MRSA infections in schools and in sports; and a free-of-charge radio PSA.

Especially useful, for those who might need it, is a copy of the CDC’s recommended “treatment algorithm” for suspected MRSA — a flowchart or decision-tree for choosing antibiotics when MRSA is suspected. The algorithm was the result of a number of meetings of experts convened by the CDC and represents the best advice on what to take when. It’s a useful thing to consult if you suspect you may be dealing with MRSA and wonder whether you have been given the appropriate drug. All of these materials are downloadable and printable; open-access/no copyright because they are government-produced.

From the agency’s press release (not posted yetposted here):

The National MRSA Education Initiative is aimed at highlighting specific
actions parents can take to protect themselves and their families. CDC
estimates that Americans visit doctors more than 12 million times per
year for skin infections typical of those caused by staph bacteria. In
some areas of the country, more than half of the skin infections are
MRSA. …
“Well-informed parents are a child’s best defense against MRSA and other
skin infections,” said Dr. Rachel Gorwitz, a pediatrician and medical
epidemiologist with CDC’s Division of Healthcare Quality Promotion.
“Recognizing the signs and receiving treatment in the early stages of a
skin infection reduces the chances of the infection becoming severe or
spreading.”

New MRSA-control campaign on Web

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A new website offering personal stories of MRSA patients and survivors has launched: The Stop MRSA Now! Coalition (here and in the “MRSA communities” list on the right).

It offers materials including a downloadable handbook, an email link to ask questions of experts and a spot to submit your own MRSA story. Included among the coalition members is Phoenix Suns’ player Grant Hill, who lost 6 months of his career to a post-surgical MRSA infection while he was with the Orlando Magic.

Sharp-eyed readers will notice a familiar tiny logo on each page of the site. It’s the corporate diamond of The Clorox Company, which sponsors the coalition. Diluted bleach can be used to disinfect MRSA-contaminated syrfaces, but to give Clorox credit, the site abstains from using MRSA as a marketing opportunity. The handbook, for instance, doesn’t say “Use Clorox”; instead, it says:

All washable (hard, non-porous) surfaces
of bathrooms and living areas should be disinfected routinely,
especially in public settings like schools and workplaces.
If no disinfection instructions exist, use 1 tablespoon of
disinfecting bleach diluted in 1 quart of water (1:100 concentration),
or use another Environmental Protection Agency approved
disinfectant according to the manufacturer’s
instructions to disinfect commonly touched surfaces.

Emergency medicine in crisis (important for MRSA also)

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Constant readers may remember that, before I began this MRSA project, I spent a year as a media fellow with the Henry J. Kaiser Family Foundation, researching overcrowding and stress in emergency rooms. (Some stories from that project here, here and here.)

So I was particularly interested in and saddened by a post on the excellent blog Health Beat (now in the blogroll!) that explores in good detail why emergency rooms are so crowded and especially what the loss of experienced emergency nurses is doing to the quality of emergency care.

Why is this important for MRSA? Well, if you or a family member is struck with what looks like one of the dramatic presentations of MRSA — bone infection, rapidly progressing pneumonia, even a serious skin infection — where are you likely to take that problem? Yes, to the ER. Even if you have insurance; an increasing number of studies are pointing out that the vast majority of people waiting for care are not the uninsured or undocumented, but insured people who can’t get care from their regular doctors.

So be prepared.

If you don’t believe in evolution…

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…is taking new antibiotics an act of bad faith?

Given, you know, that they’re designed to counter the evolution of disease organisms into more resistant forms?

Just asking. Prompted, probably, by the news that our governor here in Minnesota, Tim Pawlenty, has endorsed teaching creationism in schools here.

Perhaps we’ll see him wearing these T-shirts? (I like the Atlantis one myself): Teach The Controversy.

(Actually, I would like an answer to my question. If anyone can explain the argument, post it in the comments please?)

We pause in our goggle-eyed convention watching to bring you…

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[I’m sorry, faithful readers. It’s the most compelling election of my voting lifetime. I’m riveted. Also, I spent hours in the ER Sunday getting stitched up from a bike crash. A very clean ER … I hope.]

… an intriguing paper on controlling antibiotic prescribing within health care institutions.

Limiting inappropriate use of antibiotics is one of the central goals of the movement to control MRSA. Often, that’s interpreted as getting primary-care docs and pediatricians to resist pressure from consumers, especially parents with busy lives who need to limit their sick child’s illness so they can get back to work (or put the child back in day care) and stubbornly insist that antibiotics will help even when the illness is viral. But it’s just as important, possibly more important, to control inappropriate use in hospitals, where sick patients with depleted immune systems who are getting lots of drugs provide a fertile breeding ground for resistant strains.

So how to do that? If possible, you want the intervention to be systematized, not exceptional; you want it to be a routine occurrence, so clinicians don’t feel singled out for their prescribing choices, and you want it to be not face-to-face, so that the encounter remains about the patient and the drug, not about a clash of personalities.

A team at Johns Hopkins’ children’s hospital seems to have hit it whang in the gold. In the Sept. 15 issue of Clinical Infectious Diseases, Allison Agwu, Christoph Lehmann and colleagues describe a Web-based system that they instituted that significantly reduced inappropriate dosing and saved more than $370,000 in a year while making clinicians and pharmacists happier than they were with the previous system (which involved pagers and was face-to-face).

By chance, the Wall Street Journal ran a story this morning looking at such intervention programs, though not the Hopkins one — a story I missed because, in my normal reading time, I was interviewing Agwu and Lehmann. (H/t Joanne Kenen for alerting me to it though.)

Not-reimbursing hospitals for MRSA: The reaction

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You’ll remember that early in the summer we talked about the proposal by the Center for Medicare and Medicaid Services to cease reimbursing hospitals for the additional care of a patient that is required when a hospital gives a patient a nosocomial infection. CMS has been debating whether to include several types of hospital-acquired infection in the 2009 iteration of its “never event” no-reimbursement list. (CMS has not announced its final choices.)

Healthcare’s reaction has been, hmmm, not positive. At The New Health Dialogue, Joanne Kenen captures the reactions, many of which run along the lines of “infections are inevitable because patients are so sick.” But she’s also found a marvelous (and appalling?) argument that goes, more or less, “Preventing infections will be more costly, not less, because hospitals will introduce additional procedures to protect themselves.”

This recalls the intriguing and dismaying suggestion in JAMA a few weeks ago that “search and destroy” active surveillance is driven less by wanting to halt in-hospital transmission and more by hospitals wanting to build a case that patients brought the infection with them.