Journalist and Author
Folks, MRSA activist Jeanine Thomas, who helms the group MRSA Survivors Network and was substantially responsible for getting Illinois to pass its MRSA reporting legislation, is heading the movement to observe World MRSA Day on Oct. 2, 2009.
Jeanine has been tireless in pressing for reform despite her own MRSA injuries. Please consider visiting her site and checking out the network and the October observance.
Constant readers: You may not be aware that Consumers Union (yes, the nonprofit that publishes the magazine Consumer Reports) has a marvelous project called Stop Hospital Infections that has been instrumental in pushing for hospital-infection reporting and MRSA-control laws, offering support to citizen activists who want change in their states and offering text of a model MRSA-control act. (Stop Hospital Infections is in the blogroll at right.)
They have just released a survey — of more than 2,000 U.S. adults, performed March 12-16, 2009 — that gives us an excellent, and very sobering, look at what is happening with hospital-acquired infections. The news is not good:
The press release describing the poll — undertaken with the American Cancer Society, American Diabetes Association and the American Heart Association in advance of a Congressional briefing on healthcare reform — is here. The full results of the poll are here.
Happy New Year, constant readers. I hope you had relaxing holidays; I myself have been pounding the keyboard, forging through a chapter. (I hope to post pieces at some point, but I need to talk to my editor about when is the right time in the process.)
While I was out, there were a few interesting developments on mandatory reporting of MRSA infections, which we have talked about here, among other posts.
First, the Canadian province of Ontario has launched an amazing website that reports MRSA rates for all its hospitals and allows you to search all its hospitals by name or map location. This is part of an initiative launched last May by the provincial Ministry of Health and Long-term Care that created mandatory reporting for eight indicators of patient safety: C. difficile, MRSA, VRE, standardized mortality rates, ventilator-associated pneumonia, central line infections, surgical site infections, and hand-hygiene compliance. C. diff reporting began in September; MRSA, VRE and mortality rates rolled out on Dec. 30; and the other four will be reported from April 30.
When I look at the very incomplete patchwork of reporting we have achieved state by state in this country, I find the Ontario achievement just stunning.
But, some good news from the US also: Over the holidays, Virginia made its first report of invasive MRSA infections, acting on an emergency order written by Gov. Timothy Kaine following the death of a teen named Ashton Bond in 2007. Strangely, there is no sign of the report on the website of the Virginia Department of Health (if anyone knows where it has been posted, please let me know).[UPDATE: The Virginia DOH very kindly got in touch to say that the numbers are drawn from a set of spreadsheets that are hosted here.] The Virginian-Pilot said:
There were 1,380 invasive MRSA cases reported from Dec. 1, 2007, through the end of this November. The rate for this region of Virginia was 15 per 100,000 people, slightly less than the state rate of 18.
People 60 and older had the highest rate of incidence, and blacks had higher rates than whites. …
Only about 30 percent of the cases reported to the Virginia Health Department listed a known outcome. Of those, there were 35 deaths.
The data do not distinguish between whether MRSA was acquired in a hospital or in the community. The state also doesn’t require reporting of the less serious forms of MRSA that involve skin and tissue infections. (Byline: Elizabeth Simpson)
I especially applaud this caution, attributed to Dr. Christopher Novak, an epidemiologist with the Virginia DOH:
“Just because you’re reporting it doesn’t mean it’s under control.”
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.
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.
I’m deep into writing again and therefore slipping on posting; apologies to regular readers! But here are some items of importance from the past week:
It turns out that European governments — in contrast to the United States — are taking very seriously the emergence of MRSA in food animals and its potential for transfer to humans. (For background, posts here, here, here and here.)
How seriously? They’re doing a sampling survey of pigs on farms across the European Union, at a cost of about $3 million in EC funds, with matching funds expected from each government.
The MRSA survey piggybacks (sorry) on a year-long survey of Salmonella incidence that the EC called for in September 2007. But in December, following publication of several significant papers about the ST 398 MRSA strain in pigs and pig farmers, the EC Directorate-General for Health and Consumer Protection pushed for an addition to the Salmonella study: a same-time sampling for the presence of MRSA strains in pig operations across 29 countries.
The sampling is taking place from January to December of this year, with results mandated by mid-2009, though individual country authorities may release data earlier if they choose. (In the wake of the finding of three ST 398 cases apparently caused by retail meat in the UK, the Soil Association has called on the British government to release whatever data it has ASAP. Before the EC decision, the UK government had refused to test its pigs; cf. these House of Lords minutes.)
Of note: The Soil Association is pressing the argument that ST 398 has developed in the setting of widespread use of antibiotics in food animals, and contends the strain’s arising in the Netherlands is especially alarming because they have some of the lowest animal-antibiotic use rates in the EC it illustrates the difficulties that even a society conscientious about antibiotic overuse can have keeping track of veterinary applications. The Netherlands has been successful limiting overuse in humans, but has found controlling veterinary use much more of a struggle. (Thanks to the Soil Association for correcting my misunderstanding!)
