The Center for Disease Control and Prevention has finally put a hard number on the number of persons who die each year as a result of infection from bacteria resistant to antibiotics: 23,000. They were able to strain out those for whom the infection was the primary cause of death from the much greater number who had mixed causes of mortality.
The hospital setting is where most of these superbugs are born, raised and transmitted.
The New York Times ran their obligatory "unless prompt action is taken" editorial and Sherrod Brown, Democratic senator from Ohio -- and son of a physician -- wrote to inform the Times that he is reintroducing a Strategies to Address Antimicrobial Resistance Act. Good for him! In the hysteria within the Beltway about insurance reform it's refreshing to know that there is at least one U.S. senator out there still concerned about actual health care delivery.
And the service we deliver to America is, and has been for many years, contaminated.
Disclaimer: This following episode is not for the faint of heart.
The policy at the Heart Hospital of New Mexico was to orient new employees to the operating room, where various vascular procedures are performed. I had asked the surgeon I thought was the best -- though they were all very good -- and he let me watch an open heart operation from a position just beyond the draping of the patient's head.
What first captured my attention was the casual ease with which the he sawed open the sternum with a miniature circular saw, not unlike one you might buy at Home Depot. The breast plate was winched apart to expose the heart. To my untrained eye the heart looked fine, beating away as you might expect.
During the hour and a half when he literally held the heart in his hands and sewed veins harvested from the patient's leg to replace the clogged arteries, the surgeon took the time to explain the theory behind his every move.
By happenstance, our paths crossed a few years later at a community hospital that had recruited this well-known surgeon to develop a cardiac program for them. My role as a nurse was to help with post-op care after the patient's first 48 hours in intensive care. We rehabbed the patients and dressed their surgical incisions.
Not long into the new cardiac endeavor, we all noticed that the chest wounds were getting red and hot with ugly discharge -- all signs of infection. Cultured in a petri dish, the culprit proved to be methiciliin-resistant staph aureus, known colloquially as MRSA (mer-sah). MRSA is the poster boy for superbugs gone wild.
The new facility, of course, was anxious to please and put cultures from every surface in sight under the microscope. The offender was an ancient carpet, saturated with MRSA.
To say that hospitals and their regulator, the Joint Commission, have been misguided about preventing the spread of hospital ("nosocomial") infections would be an understatement. Early on, they identified caregivers' hands as the primary vector in the spread of MRSA. From then on hand washing is where they concentrated all their effort. The problem got worse, but they kept on doing the same thing, expecting different results. It wasn't long before we were washing our hands both before putting on gloves and after we took them off.
Left unsanitized were blood pressure cuffs, thermometers, scales, glucometers and other bedside equipment that circulated from quarantine, to regular rooms -- and then stored in hallways.
Closed ventilation systems are common practice now in hospital construction, but the nearest I can find to a filtering and maintenance regulation is in the OSHA Technical Manual, Section IV, paragraph A:
All rooms should have adequate ventilation to remove contaminants. If air recirculation is required, then adequate filtering must be required.
I, personally, have never heard of OSHA or the Joint Commission checking hospital filters as parts of their inspections; I do know that many of us take a Zyrtec prophylactically before going on shift. Airborne transmission has been studied in Japan but is seemingly overlooked, or more likely discounted, here.
The pious talk at infection control seminars still leads back to hand washing, hand washing, and more hand washing -- with little attention to environmental habitats where these little monsters can colonize.
As nurses we are tasked with containing bacteria resistant to antibiotics, and we have to take our share of responsibility both for underestimating mutant bugs and also for placing our blind faith in the Joint Commission.
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