Bills aimed at fighting bacteria in hospitals

Friday, Feb. 24, 2006

Maryland lawmakers, alarmed by the rising number of deaths from antibiotic-resistant bacteria in hospitals, have introduced two bills to stem the tide.

‘‘It’s a major, major problem in hospitals today,” said Sen. Paula Hollinger (D-Dist. 11) of Pikesville, a former nurse and chairwoman of the Senate Health, Education and Environmental Affairs Committee. ‘‘We’re on our last antibiotic and bacteria are resistant to it.”

According to the Centers for Disease Control and Prevention, about 2 million people every year contract infections in hospitals and of those 90,000 die from them. Of the bacteria that cause those infections, 70 percent are resistant to at least one of the drugs used to treat them.

Hollinger has introduced a bill requiring hospitals and nursing homes to screen patients for antibiotic-resistant bacteria and implement hand-washing and other hygiene protocols recommended by the Society for Healthcare Epidemiology of America.

Hollinger said her nursing training emphasized hand hygiene as crucial to stemming the spread of microbes.

‘‘The first rule was wash your hands, wash your hands, wash your hands,” she said.

Failure to follow appropriate hand hygiene is the leading cause of the spread of antibiotic-resistant organisms, according to the CDC.

Under the screening protocol, when patients test positive for a resistant strain of bacteria, they would be separated from other patients and special hygienic measures would be taken to keep the infection from moving to other patients and hospital workers.

The surveillance program would focus on two widespread and deadly strains of bacteria usually referred to as MRSA and VRE. A program similar to the one being proposed by Hollinger at the University of Pittsburgh Medical Center was found to reduce MRSA infections in its intensive care unit by 90 percent.

MRSA is a strain of staphylococcus aureus that is resistant to a variety of powerful antibiotics, including methicillin and vancomycin. It is often found on the skin and in the noses of healthy people. But when it gets under the skin through scratches or surgical wounds it can cause boils and deep tissue infections that persist for months. Infections that get into the blood stream or the lungs can be fatal.

‘‘MRSA is in every hospital in the United States, just lurking there,” said Lisa McGiffert, senior policy analyst for Consumers Union, a New York consumer advocacy organization.

The other organism the program would focus on, VRE, is a bacterium typically found in the stomach that has evolved a resistance to vancomycin. VRE is a hardy species that can travel from patient to patient on the hands of hospital workers, the method of transmission that experts say is the primary way disease spreads through hospitals.

The principal of survival-of-the-fittest best describes how bacteria evolve resistance to antibiotics. Some bacteria are naturally resistant to antibiotics and thrive and multiply after their weaker competitors are killed.

Repeated and improper use of antibiotics is one of the major reasons for the development of resistance, according to experts. Taking antibiotics for a viral infection such as a cold or flu, for example, does nothing to fight the infection, and encourages the development of antibiotic-resistant strains of bacteria.

Sometimes patients improperly medicate themselves, taking an antibiotic they were given for an earlier infection but did not finish — a practice that also encourages antibiotic resistance. But doctors also contribute to the problem by bowing to pressure from patients and improperly prescribing antibiotics.

One study cited by the CDC found that doctors were more than five times more likely to prescribe antibiotics to a child if they perceived that the child’s parents expected the medication.

According to McGiffert, the growing problem of antibiotic-resistance has cast some much-needed light on the issue of the spread of disease in hospitals.

‘‘This has been a problem in the health care system that has been hidden from the public,” she said.

The other bill, introduced by Del. Shane E. Pendergrass (D-Dist. 13) of Columbia, would require hospitals to publicly disclose the numbers of patients who get an infection from being in the hospital.

Consumers Union supports the bill, which would require hospitals to include that information on the hospital report cards that are already required by state law.

Pendergrass said she learned from her father, a bacteriologist, that hospitals could be dangerous places.

He once told her when she was pregnant to get out of the hospital as quickly as possible after her baby was born to avoid infection, she said.

Pendergrass said consumers need a way to learn how many people have contracted diseases in a particular hospital.

‘‘If you have a choice to go to a hospital that has infections and one that doesn’t, which one would you go to?” she asked. ‘‘It gives me, as the consumer, access to information about hospitals and a way to compare them.”

Supporters of Pendergrass’s bill, including the Maryland Hospital Association, believe it will encourage hospitals to adopted practices that reduce the spread of disease among health care workers and patients.

‘‘Hospitals look at how they compare to their peers,” said Pegeen Townsend, the association’s senior vice president. ‘‘Nobody wants to be at the bottom.”

Rita Smith, is a nurse and director of the infection control program at Suburban Hospital Healthcare System in Bethesda.

‘‘Better hand hygiene will help you be safe from a lot of things,” Smith said. More and more programs are ‘‘rolling out on hygiene” in recent months, she said, while hospitals are experiencing more cases of antibiotic-resistant bacteria infections.

Smith said she had not read the legislation on stricter hygiene protocols, but under Hollinger’s bill, each hospital would need to swab the nostrils, underarm, groin and rectum of every patient for infections before admission. There is no national or state standard for testing for antibiotic-resistant infections yet, Smith said, but ‘‘a few hospitals are now collaborating on studies of their intensive care unit patients by screening them with nasal swabs before and after the ICU.”

Also, many antibiotic-resistant infections do not originate in hospitals, she said. ‘‘So, you have to also ask, ‘What about community-acquired MRSA?’” Smith said.

In the past three years, there has been a sharp increase in the number of patients admitted to hospitals with drug-resistant infections that they had acquired in their homes, workplaces or other places such as gyms and locker rooms, according to Venkat Mani, director of infectious disease control at Southern Maryland Hospital in Clinton.

Hospital costs for an MRSA infection, including hospital stay and drugs, total about $17,000, Mani said.

One bioscience executive who favors the Maryland legislation is Henrik S. Rasmussen, senior vice president for clinical, medical and regulatory affairs at Nabi Pharmaceuticals of Rockville and Boca Raton, Fla.

Nabi is testing a vaccine to be used by hospitals to control MRSA infections. Rasmussen said similar laws in England have ‘‘worked to some extent” to control MRSA in hospitals. Ten percent of patients in hospitals in England contract a drug-resistant infection, according to the World Health Organization.

‘‘I don’t think anyone thinks you can curb the rise [of the hospital infections] by following guidelines of washing hands,” Rasmussen said. ‘‘It will not be enough. Every third health care worker in this country has staph aureus in their noses.”

The long-term answer, he said, is improved medications and vaccines.

Staff Writer Steve Berberich contributed to this report.