The MRSA mess: a culture of resistance

PATIENTS entering Washington hospitals are at risk of pain, suffering, amputations and death from an infection the medical community has known about for decades. A sloppy, uneven response by some hospitals has failed to confront the infection or adequately inform the public.

A Seattle Times investigation, "Culture of Resistance," began Sunday with a headline that set the tone for the three-day series: "How our hospitals unleashed an epidemic."

For all the medical issues and bartering of risks versus expense of prevention, the alarming core of the exhaustive and superlative reporting by Michael J. Berens and Ken Armstrong was the revelation of a breakdown in rudimentary cleanliness and hygiene.

A failure as basic as getting medical staff around patients to wash their hands has had lethal consequences. Consumers of health care — patients and their families — have been kept in the dark for years.

Unknown to thousands of hospital patients, they have faced two persistence foes. One is an antibiotic-resistance germ called MRSA, methicillin-resistant Staphylococcus aureus, which is spread by touch or contact. For years, many hospitals resisted use of MRSA screening for even the most-vulnerable patients facing the most-invasive procedures.

Six out of seven people infected with MRSA contract it at a health-care facility. The dangerous turf and fertile ground is well established. The germ moves throughout a hospital. One response has been that virtually all Washington hospitals isolate MSRA-infected patients.

The word epidemic is invoked by the series with good reason. In 2007, the federal Centers for Disease Control and Prevention put the ravages of MRSA in a context of human suffering. At more than 18,000 deaths a year, the infection claims more lives than AIDS. Shockingly, the CDC still has not issued guidelines that place a clear priority on screening.

The 2009 state Legislature in January must lead, with a hard look at mandatory screening or, at minimum, screening in critical-care cases. Identifying carriers is fundamental to protecting patients and institutions.

The exemplary work by Berens and Armstrong stirred immediate results.

State health officials announced Tuesday they will require hospitals to report all cases linked to MRSA. Washington is one of 25 states that must report, beginning this year, other infections. MRSA was not on the list.

Transparency is key. The public has no uniform way of knowing about or judging the diligence and success of individual hospitals to address the MRSA epidemic. Infections and deaths should be public record and available to consumers of health care.

The Seattle Times investigation found the U.S. Department of Veterans Affairs had taken the MSRA epidemic seriously and worked hard to protect VA patients. Tacoma General Hospital has used with success a two-part test to screen patients. Experience in Pierce County has shown the cost of aggressive testing is more than offset by avoiding the cost of treating one MRSA infection.

Remedial efforts pay off. Harborview Medical Center is the region's premier trauma center and the primary-care provider for legions of poor and chronically or desperately ill citizens. Harborview's MRSA rate was reversed by instituting and enforcing tough infection-control measures for intensive-care patients, and then repeating the process for elective surgery. Strangely, Harborview is one of two Washington hospitals that still room MRSA patients with uninfected patients.

The Seattle Times series points to a twofold challenge. Hospital cleanliness and enforcement of hygiene rules must be aggressively monitored. The public has a right to know if hospitals meet the rules. And most basically, the public has a right to know about MRSA infection rates and related health traumas and death.

Berens and Armstrong exposed the epidemic to the light of day. Sunlight is a powerful disinfectant. Use it to defeat a stubborn, lethal medical hazard.