MRSA Staph Infections (public health concern,) -among areas cited: S.F. and Portland.

Morning Everybody
I'm not sure how much the local media (nor national,) is playing this up, (I don't watch TV, usually am too busy...)

I have many family members in the healthcare field, and am, myself, looking to head into nursing, (having done the direct care-supervised care thing in various residential and non-residential treatment facilites for like, 20 years...)

A conversation with a close family member (RN) who's had gigs in several hospitals back east revealed that they were increasingly uncomfortable with our loved ones spending a whole lot of time in the actual hospitals, (and/or) in managed care.

Their quote: '...there's a lot of stuff flying around these days that can be pretty nasty, so it's best to be in and be out asap.'

I've been keeping an eye on it, and there have been two rather direct articles on the issue in the NY Times over the past couple of days.

Though this is not a new topic, -they are finding that the problem (Staph,) actually is likely to turn up to be more widespread (and lethal,) than AIDS. Long and the short of it?

The foretold situation of bacterial infection that is completely resistant to most drugs is no longer a 'here and there,' intermittant scenario. (There were situations you'd hear about with guys comeing back from 'Nam with way-fierce cases of VD and such (again, the bugs were stronger than the meds,)
-THIS is a lot more transmissable, and (as is turning out,) a lot more lethal.
-Unfortunately, there are varying reports as to what really prevents the staph from spreading, (they are saying that regular 'gloving,' and healthcare practitioners completely scrubbing up (etc,) between patients will break the chain,

-and then (in todays article regarding the highschool in Md. where a boy recently died,) -where not just 'sore on sore,' and surface contact, but articles of clothing and shared sports equipment also facilitates the spread.

Now, I know for a fact that there are a lot of Medical folks who read 'MindHerd,' as well as 'Fresno Famous,' so I'll not feign brilliance here,
-but, having worked with HIV-AIDS infected people (from back in the early days when it was first thought to be 'male-toxic-shock,' or GRID, -I KNOW there can be a lot of incorrect information out there, (we had to sift through a ton of it, -and it took a few years to really understand best methods of dealing with the situation.)
(My population was not just adults, -but children as well, (very messy but very lovable bunch...)

The areas involved (so far,) as severe?
Among them:
San Francisco and Portland, Oregon.
(There are other areas such as Monroe County, NY, which, if you knew how remote and removed Monroe Co. NY is... I mean, jeesh, no disrespect, but I think Andy and Barney are still protecting the peace there...)

I'm reprinting two articles:
(First from Oct. 17)
(Second: Today (Oct. 19)

My goal in so doing?
Well, as stated, a LOT of folks read MindHead, and a lot read FresFam. -Aside from the usual stupidity that comes and goes,
-I think it would be an excellent opportunity to discuss the issue, maybe understand the best way to deal with this as an intelligent community.

This stuff is NOT just hitting hospitals and convalescent centers (which is bad enough,) but it's showing up pretty much wherever you have people sharing surfaces (locker rooms, sports equipment scenarios, restrooms, (etc,)
--which also can easily tie in with (any) public place where folks congregate (social halls, bars, resturants, theatres, stores, gyms, etc...)

A few things creep me out in particular:

-First?
Most places (like, on the planet,) when it comes to common public and private social areas?,) really do NOT follow the protocol, (let alone the necessary regimine,) required to completely sanitize all public surfaces from germs.
-Don't believe everything that the nice paper band on the hopper says in the hotel room, 'k?

(Having been trained and having worked with various facilites where we HAD to do this on a continuous level, I can assure you that the general public is lax in this...
(A local doctor (GP) that I (no longer,) am treated by used to have patients who left their used toilet tissue in the wastepaper basket for godssakes...)
-A bit extreme and shocking, but it happened quite a bit, and was only corrected once I brought it to staff attention and complained.-More shocking?
A lot of you may not find this scenario to be unusual.

-Second?
The Staph infection (a type of 'superbug,') has been reportedly resilient and resistant against even 'hospital grade,' cleaning methods and solutions, (please note the term 'hospital grade,' cleaning
--most places do no where near 'hospital grade,' cleaning, like, ever.)

(There was another article a week or so back about this being a rising problem (also in the NY Times,) in hospitals, labs, and 'clean rooms,' (as they were finding that, even with traditional and intensive sterilization methods for surgical areas and ER's
---there was still a lot of bacteria.)

-Third?
When dealing with HIV-AIDS, (as well as other pathogens,) the common protocol was to clean surfaces, as well as completely avoid any open wound (blood-blood,) contact,
---but the 'traditional,' understanding was that the virus had a very limited band of existance outside of a warm body, (thought to be practically 'nil,'
(-with conspiracy theorists, alarmists, germophobes, and homophobes saying that HIV could survive hours or days outside of a human host...
(I don't go to those churches anymore, btw...)

-Exception to this would be airborne pathogens, but that (usually,) very tight filtered masks (high micron,) went a long way to preventing airborne concerns from spreading,
---truly viral cases are kept quarantine...

-Staph? From what I'm reading here, (article 2) is possibly transmitting and transporting on shared athletic equipment, and uniforms.-and not just on 'smooth / moisturized surfaces,' (such as plastic/vinyl/rubber equipment,
--but on/in fibres (clothing-uniforms,) as well.

(those better versed can correct me if I'm wrong, -but we usually banked on stuff dying off once the air and sunlight got to it,
---with Staph they're treating the situation of simply 'unwashed funky,' sports uniforms harboring the concern.
(This is discussed in the second article.)
(Strangely enough it is somewhat remeniscient (sounding,) of Leprosy (Hansens) and other virus' which we had to watch out for while working with saturated and dried fabrics, in the auto restoration/upholstry trade.)

-Fourth?
Because we're dealing with 'superbugs,'
my understanding of the situation is: whereas traditional treatment methods were effective, ---or could be made more effective by simply 'upping the strength of the dosage,'
--this stuff has developed immunity to (either,) traditionally used, (strength wise,) (or) even any presently known meds.
-So in a way, a lot of bets are off...

This post is meant in NO WAY to be alarmist, simply an FYI
---as well as to open a door on this.
Considering who cruises these threads, I'd like to hear what's on folks minds (particularly you Med. types,)
-as I can see this becoming a bit of a problem,

We are not that far from S.F. and interract with it all the time.
We also have a lot of folks who have hit Portland (over the past year,) as it's become 'The Place,' for the arts of late,,,

----and even you 'Fresno is in the middle of nowhere' types,
---yeah... You ever been to Monroe County NY?
I didn't think so.
(Shame of it is? It's a really pretty area of the state, and doesn't have a whole lot of money, either, (which makes it doubly painful to read about.)

-penny for your thoughts, people?

Articles reprinted below:

Article One:
////' Deadly Bacteria Found to Be More Common///
By KEVIN SACK
Published: October 17, 2007 ATLANTA, Oct. 16

— Nearly 19,000 people died in the United States in 2005 after being infected with virulent drug-resistant bacteria that have spread rampantly through hospitals and nursing homes, according to the most thorough study of the disease’s prevalence ever conducted.
(Dr. Elizabeth Bancroft called the findings “astounding.”)
RelatedText of the Study (JAMA) Back Story With The Times's Kevin Sack (mp3)
The government study, which is being published Wednesday in The Journal of the American Medical Association, suggests that such infections may be twice as common as previously thought, according to its lead author, Dr. R. Monina Klevens.
If the mortality estimates are correct, the number of deaths associated with the germ, methicillin-resistant Staphylococcus aureus, or MRSA, would exceed those attributed to H.I.V.-AIDS, Parkinson’s disease, emphysema or homicide each year.

By extrapolating data collected in nine places, the researchers estimated that 94,360 patients developed an invasive infection from the pathogen in 2005 and that nearly one of every five, or 18,650 of them, died.
The study points out that it is not always possible to determine whether a death is caused by MRSA or merely accelerated by it.
The authors, who work for the Centers for Disease Control and Prevention, cautioned that their methodology differed significantly from previous studies and that direct comparisons were therefore risky.

But they said they were surprised by the prevalence of serious infections, which they calculated as 32 cases per 100,000 people.
In an accompanying editorial in the medical journal, Dr. Elizabeth A. Bancroft, an epidemiologist with the Los Angeles County Department of Public Health, characterized that finding as “astounding.”

The prevalence of invasive MRSA — when the bacteria has not merely colonized on the skin, but has attacked a normally sterile part of the body, like the organs — is greater, Dr. Bancroft wrote, than the combined rates for other conditions caused by invasive bacteria, including bloodstream infections, meningitis and flesh-eating disease.

The study also concluded that 85 percent of invasive MRSA infections are associated with health care treatment.
Previous research had indicated that many hospitals and long-term care centers had become breeding grounds for MRSA because bacteria could be transported from patient to patient by doctors, nurses and unsterilized equipment.
“This confirms in a very rigorous way that this is a huge health problem,” said Dr. John A. Jernigan, the deputy chief of prevention and response in the division of healthcare quality promotion at the disease control agency.
“And it drives home that what we do in health care will have a lot to do with how we control it.”

The findings are likely to stimulate further an already active debate about whether hospitals and other medical centers should test all patients for MRSA upon admission.
Some hospitals have had notable success in reducing their infection rates by isolating infected patients and then taking extra precautions, like requiring workers to wear gloves and gowns for every contact.

But other research has suggested that such techniques may be excessive, and may have the unintended consequence of diminishing medical care for quarantined patients.
The disease control agency, in guidelines released last year, recommended that hospitals try to reduce infection rates by first improving hygiene and resort to screening high-risk patients only if other methods fail.

Dr. Lance R. Peterson, an epidemiologist with Evanston Northwestern Healthcare, said his hospital system in the Chicago area reduced its rate of invasive MRSA infections by 60 percent after it began screening all patients in 2005.
“This study puts more onus on organizations that don’t do active surveillance to demonstrate that they’re reducing their MRSA infections,” Dr. Peterson said.
“Other things can work, but nothing else has been demonstrated to have this kind of impact.
MRSA is theoretically a totally preventable disease.”

Numerous studies have shown that busy hospital workers disregard basic standards of hand-washing more than half the time.
This week, Consumers Union, the nonprofit publisher of Consumer Reports, called for hospitals to begin publishing their compliance rates for hand-washing. Lisa A. McGiffert, manager of the “Stop Hospital Infections” campaign at Consumers Union, said,
“This study just accentuates that the hospital is ground zero, that this is where dangerous infections are occurring that are killing people every day.”

MRSA, which was first isolated in the United States in 1968, causes 10 percent to 20 percent of all infections acquired in health care settings, according to the disease control agency. Resistant to a number of front-line antibiotics, it can cause infections of surgical sites, the urinary tract, the bloodstream and lungs.

Treatment often involves the intravenous delivery of other drugs, causing health officials to worry that overuse will breed further resistance.

The bacteria can be brought unknowingly into hospitals and nursing homes by patients who show no symptoms, and can be transmitted by contact as casual as the brush of a doctor’s lab coat.
Highly opportunistic, they can enter the bloodstream through incisions and wounds and then quickly overwhelm a weakened immune system.

On Monday, a Virginia teenager died after a weeklong hospitalization for an MRSA infection that spread quickly to his kidneys, liver, lungs and the muscle around his heart.
Local officials promptly closed 21 schools for a thorough cleaning.
A major difference between the new study and its predecessors is that it compiled confirmed cases of MRSA infection, rather than relying on coded patient records that sometimes lack precision.
The study found higher prevalence rates and death rates for the elderly, African-Americans and men.
The figures also varied by geography, with Baltimore’s incidence rates far exceeding those of the eight other locations:
Connecticut;
Atlanta;
San Francisco;
Denver;
Portland, Ore.;
Monroe County, N.Y.;
Davidson County, Tenn.;
and Ramsey County, Minn.

Dr. Klevens said further research would be needed to understand the racial and geographic disparities.

Article Two:
//// 'Schools in Several States Report Staph Infections, and Deaths Raise the Alarm.///
By IAN URBINA
Published: October 19, 2007 SANDY SPRING, Md., Oct. 18

— When the football players here at Sherwood High School were not getting the message about washing their uniforms and using only their own jerseys, the school nurse paid a surprise visit to the locker room. She brought along a baseball bat.
“Don’t make me use this,” the nurse, Jenny Jones, said, pointing out that seven players on the team had already contracted a deadly drug-resistant strain of bacteria this year.
“Start washing your hands,” she said.
“I mean it.”

School officials around the country have been scrambling this week to scrub locker rooms, reassure parents and impress upon students the importance of good hygiene.
The heightened alarm comes in response to a federal report indicating that the bacteria, methicillin-resistant Staphylococcus aureus, or MRSA, are responsible for more deaths in the United States each year than AIDS.

MRSA (pronounced MEER-suh) is a strain of staph bacteria that does not respond to penicillin or related antibiotics, though it can be treated with other drugs.
The infection can be spread by sharing items, like a towel or a piece of sports equipment that has been used by an infected person, or through skin-to-skin contact with an open wound.

On Wednesday and Thursday, scores of schools were closed and events were canceled in
Connecticut,
Maryland,
North Carolina,
Ohio and
Virginia as cleaning crews disinfected buses, lockers and classrooms.

More closings are planned on Friday.
School officials in Mississippi,
New Hampshire and
Virginia reported student deaths within the past two weeks from the bacteria, while officials in at least four other states reported cases of students being infected.

The federal report, written by doctors at the Centers for Disease Control and Prevention, found that nearly 19,000 people had died in the United States in 2005 after an invasive MRSA infection.
The study also suggested that such infections might be twice as common as previously thought.

This week, health officials began reporting a growing number of cases in schools, gyms and day care centers, and not just in nursing homes and hospitals, as has often been the case in the past.

Nicole Coffin, a spokeswoman at the centers, said that while the results of the study are striking, it is important to realize that about 85 percent of the infections reported from the bacteria were in health care settings.
“MRSA in the community is typically a mild skin infection that rarely becomes life-threatening,”
she said, adding that even when it does become more severe, the death rates for this type of infection are low.

Here in Sandy Spring, students seem to be getting the message that they need to take extra care.
“I think they’re taking it seriously now,”
William Gregory, the principal at Sherwood High School, said of members of the football team.
“She is pretty emphatic,”
he said, pointing to Ms. Jones.
“But the students are also seeing the reports of deaths, and that has reminded them.”

He added that as he visits locker rooms now, the tell-tale stench is gone from athletes’ uniforms, and students are calling him and the nurse diligently when cuts do not seem to be healing.

Elsewhere in the state, more than two dozen staph infections have been reported by four Anne Arundel County high schools over the past three weeks.
County officials sent letters to parents explaining that crews have been scrubbing schools with hospital-grade disinfectant.

Ashton Bonds was one of the rare cases of a death from MRSA contracted outside a health care facility.
Mr. Bonds, a 17-year-old football player from Staunton River High School in Moneta, Va., died Monday from the bacteria.
“He put up a fight,” said Veronica Bonds, Ashton’s mother.
“He was strong. I just think he was just tired, too.”
In response to the death, students throughout the county protested what they called unsanitary conditions in their school buildings.
Although school officials have observed that the bacteria mostly affect student athletes, cases have been reported in children of elementary school age as well.
“I worry about her getting sick anyway, but I don’t want her to catch something that will make her very, very ill,”
said Kelli Stammen about her 2-year-old daughter, who attends city-sponsored recreation and library classes in Grove City, Ohio, where a 17-year-old high school student was put in intensive care unit in September with a staph infection.

The C.D.C. study found that 27 percent of all invasive MRSA infections originated in hospitals, while 58 percent began outside of a hospital but in patients with some recent exposure to the health care system.
The remaining 15 percent of invasive MRSA cases originated in the community without any apparent health care risk factor.

Bob Driehaus contributed reporting from Cincinnati.