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 AHCJ's social media efforts and edits and manages 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.