Political tides may ebb and flow, but for victims of hospital-acquired methicillin-resistant Staphylococcus aureus, or MRSA, the opportunity is always at hand to improve patient safety. New legislation is pending in Augusta to strengthen recent MRSA tracking, prevention and reporting, not only in Maine hospitals but in nursing homes as well.
Support for the effort crosses partisan lines, but pits cost-conscious hospitals against consumers and others in the health care community.
MRSA has brought disability and fear into the life of 62-year-old Norm Pacholski of Hermon. In September of last year, months after undergoing a knee replacement for longstanding injuries suffered while serving in the U.S. Army, Pacholski experienced a sudden, severe pain and inflammation in the new knee. Testing of fluid pulled from the infected knee confirmed the presence of MRSA.
Repeated hospitalizations and surgeries have left him unable to work, drive or bear weight on his right leg, and dependent on his wife, Coco, for many activities he once undertook easily on his own. He’s scheduled later this month for another try at a new titanium knee, hoping this time to avoid complications.
“This can happen to anyone,” he said. “You go into a hospital, you don’t know what you’re going to come out with.”
The MRSA bacteria commonly are present on the skin and in the nasal passages of healthy people and often cause no illness. But especially in patients with weakened immune systems, it can infect the urinary tract, blood, lungs, open wounds and other body sites. Because it is resistant to most antibiotics, it can be lethal as well as lead to amputations and organ failure. It often is acquired in institutional settings such as nursing homes and hospitals, where it may be passed easily from one vulnerable patient to another, often by nurses, doctors and other staff, as well as by visitors who do not practice careful hand washing and other infection control strate-gies.
A bill submitted by Rep. Adam Goode, D-Bangor, would require all Maine hospitals to screen high-risk patients for MRSA before admitting them, beginning Jan. 1, 2012. As defined in the bill, high-risk patients include those who:
- Are admitted from another hospital or nursing facility or who have been discharged from a hospital or nursing facility within one year.
- Are admitted from a correctional facility.
- Are admitted to the hospital intensive care unit.
- Receive renal dialysis for kidney failure.
- Have open lesions that appear to be infected.
- Are admitted for joint replacement or cardiac surgery.
The bill also would require nursing homes to screen all patients for MRSA upon admission. The screening process consists of using a sterile swab to collect a sample from the inside of the nose. Patients found to be carrying MRSA would have to be housed in a private room or with another MRSA-carrying patient. Visitors and staff would be required to observe contact precautions including gloves, gowns and masks.
In addition to MRSA testing and management, the bill would require hospitals to report MRSA data to the National Health Safety Network at the U.S. Centers for Disease Control and Prevention and to make the information publicly available upon request. Information on the prevalence of other drug-resistant organisms, such as Clostridium difficile, also would be collected and made public.
Goode says the bill is intended to encourage hospitals to improve their infection control practices while at the same time helping health care consumers select high-performing institutions for themselves and their loved ones.
“My general feeling is that there is a fair way to compare rates of MRSA among the hospitals in Maine and that the information should be publicly accessible for patients trying to choose a hospital to care for them,” Goode said.
Jeff Austin, spokesman for the Maine Hospital Association, said the organization is still reviewing Goode’s bill but likely will oppose it. Hospitals should report actual patient infection rates, he said, but in requiring screening of certain patient populations and insisting on isolation and precautions for patients who are not symp-tomatic, Goode’s bill oversteps its regulatory intent and seeks to legislate actual patient care.
A similar bill in 2009, also sponsored by Goode, led to a requirement for all Maine hospitals to screen high-risk patients for six months and report results to the Maine Quality Forum office of the quasi-state Dirigo Health Agency. The results of that project, which wrapped up in June 2010, are still being compiled into a formal report that will be shared with the Legislature’s Health and Human Services Committee. Ellen Schneiter, who recently took over as director of the Maine Quality Forum, said the value of the report is limited by differences in the way hospitals interpreted and reported the screening data.
Goode’s bill was drafted with support from Bangor resident Kathy Day, a retired nurse whose father died after contracting MRSA infection in his lungs after a routine admission to a small rural hospital in northern Maine. Day says her father’s untimely death raised her awareness about the prevalence and severity of MRSA in-fections.
“I learned it is preventable. There are hospitals that have succeeded in reducing and even eliminating MRSA,” she said. “Maine hospitals aren’t doing that.”
Day referred to a 2001 MRSA reduction pilot program at the VA Pittsburgh Healthcare System that was expanded in 2007 to more than 150 VA hospitals throughout the nation. The effort incorporates universal MRSA screening and isolation of patients. Limited information about the initiative is available on the VA website, www.va.gov.
Day said passage of Goode’s bill, LD 267, is essential to reducing the incidence of MRSA and other health care-associated infections in Maine’s hospitals, nursing homes and communities.
“Unless somebody has a family member or a loved one who has suffered from this, they just don’t know the impact,” she said.
By pressuring institutions to appropriately identify, isolate and treat patients harboring drug-resistant organisms, Day said, tragedies like her father’s death and Norm Pacholski’s long struggle to regain his health and independence can be avoided.