Much like the scarlet “A” pinned on Hester Pryne’s chest, bright signs mark the rooms of infected patients at Kent Hospital in Warwick, Rhode Island. They warn staff and visitors that the person inside is in isolation, instructing all who enter to wear face masks, surgical gloves, and protective gowns over their clothing.
No, these patients don’t have leprosy or the newest outbreak of the flu. They have something just as virulent and much harder to control; these patients have MRSA.
MRSA (methicillin-resistant Staphylococcus aureus) is a “superbug,” one of several antibiotic resistant bacteria that run rampant in hospitals. Primarily spread through hand contact by hospital employees, MRSA is a type of staph bacteria that doesn’t respond to treatment by common antibiotics, like penicillin.
Last year, Medicare and Medicaid decided not to pay hospitals for “complications acquired after admission that are considered preventable,” which means that when a hospital infects a patient with MRSA, the hospital has to absorb the cost. To avoid the potentially bank-breaking costs, hospitals are taking the not-so-subtle advice from the federal insurance companies and cleaning up their acts. “There’s a real push from a quality standpoint from the government,” said Anesthesiologist Dr. Jared Barlow.
Patients after surgery are especially vulnerable to infection. If a person who had total joint replacement surgery became infected with MRSA, they could need to get their prosthetic removed. “Now they’re immobile. We can’t send them home, they don’t have a hip,” said Cathy Insana, registered nurse and perioperative clinical educator at Kent Hospital in Warwick, Rhode Island.
Caring for such a person could run $50,000 or more, Insana said, and now, if a patient gets MRSA in the hospital, Medicare will not pick up the bill.
Insana is part of the Surgical Care Improvement Project (SCIP) at Kent Hospital. A new national project that seeks to minimize all post-surgery complications including the transmission of hospital-based infections liked MRSA. The project supports everything from administering antibiotics to constantly reminding staff to wash their hands before coming in contact with patients.
It’s not just surgical staff that need to pay attention, reminded Insana, “Everybody is fighting MRSA. No matter what hospital setting you’re in, you’re fighting MRSA.”
Not all cases are life-threatening. In people who aren’t immunocompromised, the disease is extremely difficult to detect. Unless a patient has an infection, or is specifically tested for the disease, they could show no signs until months or years later. In fact, 10 percent of people who check in to the hospital will unknowingly leave with an infection they didn’t have upon arrival. Some people live for years with the disease, before they find out that they have it.
Benjamin Phillips, a senior at Bryant College had never even heard of MRSA until he got a phone call regarding his upcoming knee surgery. “The nurse called and said I had M.R.S.A.” he said, spelling out the letters, “No, I said, I’m pretty sure I tore my ACL, not my MRSA. I had no idea what she was talking about.”
Once a patient is diagnosed with a hospital-based infection, they’re put into isolation to prevent the spread of disease. But unless every single person who enters the hospital is tested, a policy some hospitals have recently adopted, MRSA is still going to spread by those unwittingly carrying the infection.
Kent Hospital is a 225-bed hospital, and at any given point there are 25 to 30 people in isolation due to some kind infection. In Rhode Island, once a person is red-flagged with an infection, they need to have three negative test-cultures before they can leave isolation, even after treatment. This is an important procedure, since MRSA can stay in the body for years.
Although these tests have markedly dropped the spread of diseases like MRSA, putting patients in isolation means that there are fewer rooms available in the hospital. “Patients need to sit in waiting rooms and hallways until we can find exam rooms for them,” said Insana. If those patients are unknowingly infected, areas like this can be breeding grounds for disease transmission.
The CDC found a 28 percent drop in severe hospital-based MRSA cases from 2005 to 2008, due mostly to awareness of the disease and vigilance of hospital staff. Still, healthcare workers don’t think the superbug can be completely eradicated. Dr. Barlow said that the staff can aggressively wash their hands, and use the Purell stations located around the hospital, but that infections like MRSA are likely to remain a problem.
“When we put sick people together, that’s what’s going to happen.”