Fighting the super bug 

An agitated vet called to sound an alarm about the John L. McClellan Memorial Veterans Hospital in Little Rock, where he'd been a patient. “They're sending people home with staph!” he said. “They've got staph all over the hospital!”

Staph on the loose sounds pretty scary (even if you're not sure what staph is), and it develops that there's some truth in what the man said.  But, according to a spokesman, the hospital's practices are not cause for alarm, and are in fact aimed at controlling the spread of staph. Our caller was doubtless told that at the hospital. He was not reassured.

Staph is short for staphylococcus, a kind of bacteria that can cause disease. The species of staph under discussion here is Methicillin-Resistant Staphylococcus Aureus, also called MRSA. Sometimes it's referred to as a “super bug.” And sometimes, very rarely, it can cause a serious, rapidly spreading skin infection that gets it referred to as “flesh-eating bacteria.” Only a handful of flesh-eating cases have been reported, medical authorities say. Try to forget about it.

But even the more common MRSA can cause serious infection, sometimes life-threatening if left untreated. And, as the official name suggests, MRSA is resistant to antibiotics used to kill other kinds of staph.

“MRSA was first identified in the 1960s and was mainly found in hospitals and nursing homes,” according to a veterans hospital brochure. “This occurred because antibiotics were being given to people when they weren't needed, and patients weren't taking antibiotics as directed. In the late 1990s, a new type of MRSA was identified. This type of MRSA is becoming more common among children and adults who do not have medical problems.”

You can get MRSA the same way you can get a cold, such as touching someone or something that has the bacteria on it and then touching your eyes and your nose. You can reduce your chances of getting it by washing your hands often. Some antibiotics actually spread MRSA, so you may increase your chances of getting it if you take antibiotics a lot, take them without a prescription or don't follow directions when taking them, such as stopping early or missing doses.

If you get MRSA, there are two ways you can have it. One is an active infection, usually on the skin, such as a boil, a sore or an infected cut. The other is to be a carrier (“colonized”), having no symptoms yourself but with MRSA bacteria living on your skin and in your nose that can spread to other people. MRSA is transient; it can go away and come back.

Four years ago, a veterans hospital in Pittsburgh concluded, reasonably enough, that it could better control the spread of MRSA if it knew who had MRSA, and where they got it. So the hospital began keeping records. Q-tips were used to swab inside the nose of every patient - those being admitted, no matter the reason for admission, and those leaving. A patient with an MRSA infection was treated with antibiotics. People who were only colonized weren't treated but were put in rooms by themselves or with other patients who had MRSA, and were cared for by hospital personnel wearing gloves and sometimes gowns. They left the hospital with advice on preventing the spread of MRSA. Eventually, the Veterans Administration in Washington decided that the Pittsburgh study was useful and that all veterans hospitals should do the same. McClellan is the only hospital in Little Rock that tests every patient for MRSA, according to the spokesman.

“We're doing it every day,” Laurie T. Driver said. “We send our numbers in monthly.” Driver is a public affairs specialist with the Central Arkansas Veterans Healthcare System.

From September through December 2007, 13.2 percent of the patients admitted to the hospital were found to have the MRSA bug in their nose. Of the patients who were discharged, 1.2 percent who hadn't had MRSA when they came in had it when they left. They got the bug in the hospital, in other words. Only one patient who got MRSA in the hospital developed an infection.

Unless strict precautions are taken, it's comparatively easy to acquire MRSA in a hospital. That's because hospitals are full of people who're particularly vulnerable to MRSA – the elderly, those who've had surgery, those with weakened immune systems, those with serious underlying health problems. Nursing homes are even worse.

The advice given on preventing MRSA infection is very much like the advice your mother gave you, and she'd never heard of MRSA:

“Clean your hands. Use soap and warm water. Clean your hands before touching or eating food. Clean them after you use the bathroom, take out the trash, change a diaper, visit someone who is ill, or play with a pet. … Cover your mouth and nose when you sneeze or cough. … If you are sick, stay away from other people.” And one your mother probably didn't tell you – “Make sure health care providers clean their hands and wear gloves.”

Antibiotics exist that can be used against MRSA, but as our caller learned while he was in the hospital, veterans hospitals are adamant that the antibiotics will be given only to patients who are actually sick or who've had surgery, not to people who are merely colonized. This is intended to prevent MRSA from becoming resistant to the current treatments, the hospitals say.

“This country has abused antibiotics for years,” Driver said. “The more we use antibiotics, the more the germs keep mutating, becoming resistant. And if you just have a runny nose, you're going to get better in 72 hours anyway.”



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