ALBANY, N.Y., Aug. 21 (UPI) -- Antibiotic-resistant hospital-acquired infections kill tens of thousands of patients each year, but the lack of concern baffles one U.S. doctor.
"Infections spread by people in beautiful white coats have killed far more than al-Qaida ever has," Dr. Barry Farr, professor emeritus at the University of Virginia, told UPI's Caregiving.
"Florence Nightingale said, 'If we knew that 1,000 people were dying each year of spreading infections and chose not to take effective measures to control them, that would be as criminal as to take the same number out on Salisbury Plain each year and shoot them.'"
"MRSA first arrived at the University of Virginia Health System in March of 1978 by a patient, and it spread out of control over the next three years -- causing almost half of all hospital-acquired staph infections in the third year," Farr said.
Dick Wenzel, a University of Virginia Hospital epidemiologist, spearheaded effective measures in the early 1980s to fight an outbreak of methicillin-resistant Staphylococcus aureus, known as MRSA.
Farr says that MRSA is a problem pathogen that is completely out of control in the U.S. healthcare system.
"It wasn't known at the time that anyone had ever controlled it, but Wenzel decided to do cultures and put all patients with MRSA in isolation. Most people who have MRSA don't have any problem from it -- they may just carry it in the nose without symptoms -- but once we started doing cultures and isolating all the carriers, it went down and kept going down until it was gone. At the time we didn't know it had been controlled in Denmark, which had used similar measures."
MRSA tends to arrive and stay -- in hospitals and nursing homes -- and many in U.S. healthcare seem desensitized to it, according to Farr.
Staphylococcus aureus, known as "staph," is a bacteria commonly found on the skin and in the nose of healthy people, causing no harm. But occasionally, it can get into the body and cause an infection -- often via a surgical wound, a urinary catheter or a ventilator, according to the Centers for Disease Control and Prevention in Atlanta. MRSA are staphylococci that are resistant to some of the highest concentrations of antibiotics, the CDC says.
While MRSA has been largely contained to hospitals and nursing homes, it has now been reported in otherwise healthy, non-hospitalized persons without contact with healthcare personnel or patients, referred to as "community-based MRSA," or CA-MRSA.
While some physicians and health officials say that "hospitals are where the germs are and they always will be," how do some countries and some U.S. hospitals drop their hospital-acquitted infection rates to less than 5 percent?
Good hygiene, identifying and isolating those with an infection, training and a change of hospital culture, according to Dr. Loren Roth, senior vice president of quality care and chief medical officer of the University of Pittsburgh Medical Center.
Across our hospital system, four or five years ago, the hospital system was committed to reducing central-line associated blood infections, or CLABS, which can occur when any line is inserted into the patient for blood or fluids such as an IV," Roth told Caregiving.
"We developed a protocol that require an IV to be inserted under sterile conditions -- we drape the patient, sterilize the patient, and whoever is inserting the IV wears a cap, mask and a sterile gown. In addition, we train people on how and where to insert the IV, how to maintain it and to remove it as quickly as possible."
I've witnessed numerous IVs and I've never seen this type of sterile procedure used; however, I have seen several IV infections.
The University of Pittsburgh Medical Center -- comprised of numerous hospitals -- reduced its infection rate by 80 percent in several intensive care units, and in some of its hospitals no infections have occurred over a significant period of time, according to Roth.
Do these more sterile rigorous procedures cost a lot?
"Not really," said Roth. "We find that cost for the extra time, gowns, etc., is a fraction to what it costs a hospital to treat an infection, which we estimated costs an additional $15,000 to $25,000 per infection."
Roth says all doctors, nurses and other personnel are instructed to wash their hands before and after seeing a patient.
"We stress hand washing and put up signs to remind patients to remind caretakers to wash their hands," Roth said.
Why don't more hospitals follow the successful example of the University of Virginia and the University of Pittsburgh health systems?
"If you are assigning blame for the failure of MRSA control, it should not be leveled at U.S. doctors and nurses -- they are every bit as good and responsible as those in Denmark where MRSA has been controlled to less than 1 percent using a method that works.
The buck stops at the infection control leader's desk -- usually a nurse or part-time nurse-- who tends to follow what the CDC says and usually does not rock the boat, Farr said.
"There is nothing good to say about this failure. Some CDC officials seem to have been asleep at the switch on this problem."
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Next: An innovation reduces infection rates further and the CDC responds
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Alex Cukan is an award-winning journalist, but she always has considered caregiving her primary job. UPI welcomes comments and questions about this column. E-mail: consumerhealth@upi.
