Hospital MRSA screenings would be required under proposed legislation

Washington hospitals will be required to screen vulnerable patients for a potentially deadly germ called MRSA under proposed legislation spurred by a Seattle Times investigation.

Hospitals would also have to isolate infected patients in private rooms. And for the first time since 2004, hospitals would be subject to surprise inspections by the state Department of Health.

These measures, if passed, would establish Washington as one of five states that have taken extraordinary steps to mandate how medical centers battle germs and protect patients.

"If hospitals won't take meaningful steps to stop drug-resistant infections then we'll pass legislation to make sure they do," said Rep. Tom Campbell, R-Roy, who is sponsoring the measures.

At least a dozen more states are debating similar legislation that would mandate some form of screening.

MRSA, or methicillin-resistant Staphylococcus aureus, is spread by touch or contact and can slip through small breaks in the skin. Most infections occur on the skin and are easily treated, but the germ can be fatal if it gets into the blood.

Six out of seven people infected with invasive MRSA contract it from a health-care facility, according to the federal Centers for Disease Control and Prevention.

Campbell said the patient-safety initiatives were in response to last month's Seattle Times series "Culture of Resistance," which detailed how MRSA infection rates have soared as hospitals often ignored steps to control the threat.

In the first comprehensive tracking of the germ, The Times found that the number of hospitalized Washington patients infected with MRSA escalated over the past decade from 141 a year to 4,723.

The Times gained access to state files that revealed 672 previously undisclosed deaths attributable to the infection.

The Times also found that Washington hospitals have adopted a haphazard array of infection-control measures that often fail to screen critically ill or surgical patients for MRSA.

The proposed legislation would standardize how hospital patients are screened for MRSA, Campbell said.

All patients admitted to a hospital will answer a questionnaire to identify those who are at highest risk of infections, such as those who've had previous medical complications or anyone undergoing surgery.

Patients identified as high-risk will undergo a quick, painless and inexpensive test that identifies who's infected or a carrier. A cotton swab is swirled in the nose, where MRSA bacteria often resides.

The primary goal is to quickly isolate infected patients to prevent spread of the germ within the hospital.

At least two hospitals do not always isolate infected MRSA patients, the Times found. For instance, at Harborview Medical Center, the state's largest hospital, MRSA patients sometimes share rooms with noninfected patients.

Harborview officials said they don't have enough private rooms to accommodate every infected patient.

Public disclosure

The most contentious portion of the legislation is expected to center on public disclosure. A provision would order state health officials to publicly report MRSA-infection rates for each hospital.

Under current law, hospitals are not required to publicly disclose MRSA-infection rates.

At least a dozen patients have contacted The Seattle Times in the past month and reported that hospitals refused to allow them to review infection-control policies or infection rates.

Hospital officials argue that infection-control policies are private documents and that infection rates are only meaningful if adjusted for such factors as hospital size and type of patients.

Campbell also seeks to reinstate surprise inspections to more accurately gauge hospital infection-control programs. At the request of hospital officials, Washington legislators in 2004 voted unanimously to require a four-week notice by state health inspectors — even the exact hour of arrival.

Some hospitals exploit the advance notice to temporarily hire extra nurses and cleaning staff, several nurses told The Times.

Before drafting the bill, Campbell said he consulted with the federal Centers for Disease Control and Prevention and the Consumers Union, a nonprofit group that has helped introduce MRSA screening legislation in other states.

Campbell, a chiropractor, is a member of the legislature's Health & Wellness Committee. Last year, he successfully spearheaded the state's first law that requires hospitals to publicly disclose certain infection rates, and he's sponsored numerous laws that have strengthened oversight and licensing of health-care professionals.

Officials at the Washington State Hospital Association, a lobbying group for most of the state's hospitals, said they are reviewing Campbell's proposals and will take a formal position once the legislative session begins on Jan. 12.

Overall, the association supports a uniform strategy to screen patients for MRSA and does not oppose surprise inspections, said spokeswoman Cassie Sauer.

Changes at hospitals

Only a handful of the state's 25 largest hospitals already have in place the infection controls proposed in Campbell's bill, according to a survey by The Times.

Since the series, two large Seattle-area hospitals have announced plans to expand MRSA screening.

Swedish Medical Center in Seattle has begun screening for the pathogen on all patients who undergo orthopedic, cardiac or neurosurgical procedures. Hospital data show these groups are at the highest risk of infection, said Dr. John Pauk, an infectious-disease specialist at Swedish.

"It's not the people who you know have an infection that is the problem — it's the ones you don't," he said of the need for expanded screening.

Infections after cardiac surgery are among the most expensive complications, typically adding tens of thousands of dollars to the cost of medical care. As for orthopedic patients, a Seattle Times analysis of Washington hospital records found hundreds who underwent amputation after they contracted MRSA.

The University of Washington Medical Center will also be expanding its screening. Officials said they will begin a pilot program next month to test all intensive-care patients for MRSA.

Michael J. Berens: 206-464-2288 or mberens@seattletimes.com; Ken Armstrong: 206-464-3730 or karmstrong@seattletimes.com