Tag Archives: mrsa

CHCH Center, Sac Bee investigate hospital-acquired infections

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In a series titled “Death by Complication,” the California HealthCare Foundation Center for Health Reporting and The Sacramento Bee teamed up to investigate hospital-acquired infections in the state as well as efforts to combat them.

In the centerpiece, the CHCF’s Deborah Schoch used records and privacy waivers granted by a cooperative family to explore how an apparent hospital-acquired C. difficile infection seems to have killed an otherwise healthy 75-year-old man who was originally hospitalized for a broken femur. The cause of death was listed as “complications.” His story was far from unique, Schoch writes.

One in 20 hospital patients get infections. In California, roughly 200,000 people get hospital infections annually, and 12,000 of them die, according to state Department of Public Health statistics. That makes such infections one of the state’s leading causes of death, ahead of automobile accidents and Alzheimer’s disease.

Yet these deaths have remained mostly in the shadows. They often are classified as “deaths from complications,” an oblique term used in obituaries and often unquestioned by relatives and friends.

Even the best doctors can be baffled whether an infection was acquired before or after a patient was admitted, and if it was the principal cause of death or no factor at all.

Many health care providers historically have viewed hospital infections – going by obscure names or acronyms such as C.diff, CLABSI, VRE and the more familiar MRSA – as a sometimes inevitable consequence of being hospitalized.

In related pieces, reporters find that while hospitals are waking up to the toll taken by hospital-acquired infections, neither they nor the state have really managed to take authoritative measures to address the problem.

See the full series, complete with infographics, on CHCF’s site.

Series reveals gaps in communication of hospital inspection results

Jodie Jackson Jr. of the Columbia (Mo.) Daily Tribune took an in-depth look at patient safety at University Hospital, part of the University of Missouri Health Care system.

Jackson found that inspections, by CMS and the FDA, have repeatedly turned up systemic practices that compromised patient safety. At the same time, the Joint Commission awarded the hospital a full accreditation, raising questions about why the agencies don’t share information.

In a blog post, Jackson, a Midwest Health Journalism Program Fellow, says he has “examined some 700 pages of documents and have had national infection control leaders examine the reports that formed the basis for the series.”

Rather on drug resistance, psychology and Norwegian fish farms

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Dan Rather Reports, HDnet’s investigative series, has devoted its latest episode to antibiotic overuse and the resistance it has created. A transcript of the hourlong program is available in PDF format. Rather focuses first on primary care physicians and upon understanding the psychological and economic pressure they’re under when they choose to prescribe antibiotics that might not be strictly necessary. When he talked to Dr. Rita Mangione-Smith of Seattle Children’s Hospital, she illustrated that those forces can and have overcome clinical good sense.

In the 1990s, it was really bad. Okay, there are a couple of studies that were done – that were published in the Journal of American Medical Association, in JAMA, that showed that if you looked at national level data, we were, you know, prescribing antibiotics in greater than 50 percent of outpatient visits for most children with colds. And antibiotics do nothing for colds.

Rather extends this focus on psychology to his investigation of antibiotic-averse Norway as well. Norway, as you have likely heard, has kept antibiotic use and resistance so low that even good old penicillin can be relied upon there to fight many bacterial infections. While others have focused on Norwegian central policy, Rather also considers how Norwegian mores and attitudes toward medical intervention have helped that country’s physicians resist the temptation to overprescribe antibiotics.

As Gunnar Simonsen, head of that country’s microbial resistance surveillance system, told Rather, “Many Norwegians will not like to take drugs unless strictly necessary. That’s not a kind of an official policy. That’s how we were brought up.” Simonson said the other pillar of his anti-resistance campaign was simply infection control – fewer bacterial infections means fewer opportunities to use antibiotics.

In addition to primary care physicians, Rather looks at that other great breeder of resistance: large-scale livestock feeding operations. Here, he contrasts the well-known American story to that of Norway, where antibiotic use in industrial fish farming was slashed 97 percent from 1994 to 2008. Over that same time, farmers say they actually increased fish survival rates by replacing the antibiotics with vaccines. Prevention instead of cure.

Related

Hospital infections on rise in Nev., reporters find

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

lasvegassun

Part two of Marshall Allen and Alex Richards’ Las Vegas Sun hospital investigation series “Do No Harm” takes on hospital-acquired infections. Even though no agency in the state tracks such things, the duo managed to find 2,010 instances of drug-resistant bugs in local hospitals between 2008 and 2009. That number included 647 instances of hospital-acquired MRSA.

In the story, the explain how they overcame industry resistance to dig up the data themselves:

No health agency tracks these cases. In fact, hospitals derailed proposed legislation in 2009 that would have required them to publicly report cases of MRSA in their facilities.

However, hospitals are required by law to submit to the state billing records based on each patient visit. The Sun obtained that information from 1999 to 2009 and analyzed the 2.9 million hospital billing records as part of its two-year investigation, “Do No Harm: Hospital Care in Las Vegas.”

Because of how the records are coded, the Sun was able to identify the number of infections by the two bacteria, and for the years 2008-09 further identify the cases in which the records say the patients acquired the bacteria while hospitalized.

While it’s hard to put their numbers in a national context because of widely varying methods of measurement and reporting, the duo can say that such infections jumped 34 percent from 2008 to 2009. Allen and Richards then establish two facts:

  1. Some institutions have developed ways to keep MRSA and friends under control.
  2. None of those institutions are in Las Vegas, where inspections show that hospitals could be doing a lot more.

Efforts to force Nevada hospitals to disclose MRSA cases withered under heavy industry opposition, though the legislature is now considering a watered-down version that would not public the MRSA rates of specific facilities.

It’s worth noting that the paper has published responses from readers who have plenty of their own hospital horror stories. The website includes their input both in text and through excerpts of some of the voicemails Allen has  received since the first part of the series was published. They are heart wrenching but serve as an excellent example of how reporters can involve readers in a project.

Superbug: Member’s book about MRSA released

Pia Christensen

About Pia Christensen

Pia Christensen (@AHCJ_Pia) is the managing editor/online services for AHCJ. She manages the content and development of healthjournalism.org, coordinates social media efforts of AHCJ and assists with the editing and production of association guides, programs and newsletters.

Superbug: The Fatal Menace of MRSA,” AHCJ member Maryn McKenna’s second book, has been released today. McKenna, a member of AHCJ’s board of directors, has written extensive primers about MRSA and avian and pandemic influenza for AHCJ members. She also will moderate a luncheon session, “Influenza! Lessons learned from a year of H1N1,” at Health Journalism 2010.

McKenna, an independent journalist who also wrote “Beating Back the Devil: On the Front Lines with the Disease Detectives of the Epidemic Intelligence ServiceBeating Back the Devil, was featured on NPR’s Fresh Air this morning to talk about methicillin-resistant Staphylococcus aureus. Her Superbug blog keeps up with the latest news and developments about MRSA.

Transmitter tracks health-care workers’ washing

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Despite constant reminders and a high-level of industrywide awareness, studies indicate that less than half of American health care workers wash their hands as frequently as they ought to. This contributes to the health-care-associated infections that kill tens of thousands annually. Now, NPR’s Gigi Douban reports, one Alabama hospital has resorted to high-tech monitoring devices to keep tabs on the handwashing practices of its employees.

washing
Photo by Arlington County via Flickr.

Workers wear a special wireless transmitter, from which, Douban writes, “the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.”

“If they’re habitually not complying, we can send them an e-mail or send them a text message, something that goes to them personally,” says Harvey Nix, CEO of Proventix, the company that developed the monitoring system at Baptist Princeton.

According to Douban, the CDC is currently investigating the effects of the technology upon the behavior of health workers.

AP looks at drug resistance worldwide

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The Associated Press has neatly wrapped up its wide-ranging look at drug resistance and the threat it poses to global health into a flash-based multimedia presentation. The presentation consists of stories, infographics, videos and a photo/audio slideshow.

The two videos explain drug-resistant strains of various infectious diseases. The first looks at the wide availability of powerful antibiotics without guidance or prescription, addresses the problem as it has emerged both in the United States and in locales like Mexico and the Philippines. The second, which is about the use of antibiotics in large-scale livestock operations, relies on just one source, Dr. Craig Rowles of Elite Pork Partnership.

The AP uses infographics to establish the spread and scope of the problem, relying heavily on various world maps. I particularly like the timeline that accompanies the malaria graphic (click “statistics” in the upper right, then “malaria”); it shows the span of time from when each malaria-fighting drug was introduced to the date at which a resistant strain emerged.

Finally, they drive the problem home with three strong anecdotes, including a Southeast Asian boy with drug-resistant malaria, a man fighting the drug-resistant tuberculosis that killed his HIV-positive partner, and a woman who lost an infant daughter to MRSA.

Stories in the series:

The package is accompanied by this video.


MRSA project earns AHCJ member an award

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

The National Association of Science Writers awarded AHCJ member Michael Berens the Science in Society Journalism Award for his part in the November 2008 series “Culture of Resistance,” a tale of the spread of methicillin-resistant Staphylococcus aureus (MRSA) through Washington that Berens wrote with fellow Seattle Times reporter Ken Armstrong. Berens and Armstrong uses databases and public records to chronicle the resistant bacteria’s rapid spread.

The press release quoted a judge as praising their work thus: “Although we’re awarding for local coverage, I think this piece has also had a rather profound national impact as well.”

FDA opposes antibiotics overuse in animal feeding

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

Citing the dangers of drug-resistant microbes, newly appointed Food and Drug Administration chief Joshua Sharfstein testified against the over-use of antibiotics by animal feeding operations (12-page PDF). Sharfstein said drug-resistant bacteria make up 70 percent of the approximately 2 million infections caught annually in American hospitals, leading to a high cost, both financially and in terms of human life.

In particular, Sharfstein spoke against the use of antibiotics in small, constant doses for growth promotion. Instead, he said the FDA wants them to be administered only for treatment purposes and with a veterinarians supervision.

(Hat tip to Maryn McKenna)

McKenna talks about MRSA in pigs, farmers

Andrew Van Dam

About Andrew Van Dam

Andrew Van Dam of The Wall Street Journal previously worked at the AHCJ offices while earning his master’s degree at the Missouri School of Journalism, and he has blogged for Covering Health ever since.

In addition to the strains of MRSA that arose in hospitals and the community, there is one that seems to correlate pretty strongly with pig farmers and, in many cases, is present in both the farmers and their stock. Bonnie Powell, founder of The Ethicurian blog, interviewed journalist (and AHCJ member) Maryn McKenna about MRSA and the recent discovery in the Netherlands of a strain linked to commercial pork production.

Scanning electron micrograph depicts clumps of methicillin-resistant Staphylococcus aureus bacteria.
CDC/Janice Haney Carr

This 2005 scanning electron micrograph depicts clumps of methicillin-resistant Staphylococcus aureus bacteria. Magnified 9560x.

[The presence of a clear link between factory farms and human cases of the pig-linked MRSA ST398 strain] depends on your standards of evidence. MRSA ST398 has been found colonizing pig farms and pig farmers in the US, Canada, and in the European Union. You can argue about how prevalent it is — it’s easy to cast doubt on whether it is common, because not very many studies have been done. But you can’t argue that it is there.

The argument over whether ST398 in pigs is causing MRSA disease in humans is more subtle. It definitely has in the Netherlands, though not often so far. Has it done so in the US? No one has done the microbiology to tell.

As for the food supply, McKenna says it’s theoretically possible to contract MRSA from meat.

If MRSA ST398 is in pork — it’s been found in Canada and Europe, but not here yet — then the issue is not eating the pork (as long as you cook it), but rather handling it. It is possible that you could handle raw pork, unthinkingly touch your eyes or nose, and colonize yourself.

McKenna, who is writing “Superbug: The Rise of Drug-Resistant Staph and the Danger of a World Without Antibiotics,” urges better testing and monitoring of MRSA and the outbreaks thereof, and cautions that, even if they are not yet shown to harm humans, resistant drug strains are still a matter of public concern.

McKenna also wrote a comprehensive primer for AHCJ to help educate reporters about MRSA and the surrounding issues.