AARP Bulletin - March 2009

merican hospitals are treating sicker patients with more complex, invasive techniques—and helping people live longer. But every year in these same facilities some 90,000 Americans pick up infections that kill them.

Hard-to-treat superbugs are an increasing problem as widespread use of antibiotics produces new germs that are drug-resistant— and few new medications are in the pipeline. In the 1970s only a tiny percentage of hospital staph infections were MRSA. By 2004 MRSA accounted for two out of three staph infections, usually attacking patients with weakened immune systems or those using catheters, intravenous lines or ventilators.

Clostridium difficile also is a rising threat. Few Americans had heard of this intestinal bug until November, when a study showed its prevalence is as much as 20 times higher than previous estimates. Sponsored by the Association for Professionals in Infection Control and Epidemiology (APIC), the study looked at C. diff cases in nearly 650 U.S. health care facilities on a single day between May and August 2008. Findings suggest that on an average day, nearly 7,200 hospitalized patients—13 of every 1,000—are colonized or, more often, infected with C. diff, and about 300 patients will not survive it. The young and older patients are especially vulnerable. Infection often follows the use of antibiotics, which strip the gut of certain bacteria, allowing C. diff to proliferate there.

80-year-old father in late 2004 after he was hospitalized for a urinary tract infection. Sent to a rehabilitation facility to regain his strength, Walter Wiatr instead developed uncontrollable diarrhea and lost his appetite. That, Watnoski learned, was thanks to an organism called Clostridium difficile (C. diff). She moved him to another facility. But soon a painful red swelling appeared on his neck, the sign of another infection—this time it was methicillin-resistant Staphylococcus aureus, or MRSA, a bacterium that’s spread by person-to-person contact and is resistant to common antibiotics. Two months after his initial hospitalization, Wiatr, who’d been independent and healthy, was gone.

“He went downhill so fast, I still can’t believe it happened like that,” his daughter says. A

rhea, the bug is easily spread everywhere—
onto hands, bed rails, sheets, IV poles. “The
primary mode of transmission,” says William
Jarvis, M.D., lead author of the prevalence
study, “is person-to-person transmission on
the hands of health care workers or contami-
nated equipment.”
Research has shown that health care work-
ers clean their hands effectively only about
half the time, and the hardiness of the C. diff
spores adds a twist to the challenges they face.
At one time the U.S. Centers for Disease Con-
trol and Prevention (CDC) routinely recom-
mended cleaning the
hands with alcohol-
based rubs. But alco-
hol won’t kill C. diff—
it takes a scrubbing
with soap and warm
water to eliminate the
spores. Similarly, only bleach will kill spores on
surfaces; but the APIC study found that even in
an outbreak, about a third of institutions don’t
clean with bleach.

These facts underline the urgent need for all health facilities to adopt the best practices to stop the spread of germs—sanitizing rooms and equipment; washing hands thoroughly; inserting catheters in sterile conditions; monitoring for dangerous organisms; and taking special precautions with patients who carry them.

The proliferation of superbugs is a daunting problem, but one that has the attention of consumer advocates, insurers, federal and state governments, as well as hospitals and health care providers.

How to beat the superbugs:

; Follow the money. Hospital-acquired infections cost an estimated $20 billion a year, according to the CDC, and a lot of human suffering. For example, the knee replacement Margaret Day, of Fort Lauderdale, Fla., had in 2006 would have been a great success—except for the C. diff infection that kept her in the hospital 20 days, some spent semiconscious in the ICU. This ordeal was not only costly for Medicare and the hospital, it also cost Day, an active 88-year-old, thousands of dollars a month in medicine and for help at home during her recovery.

On Oct. 1, Medicare stopped paying for
complications arising from certain infec-
tions (but not C. diff ) and conditions that
result from hospital care and are “reason-
ably preventable.” The government wants
hospitals to make safety measures job one,
says Nancy Foster, vice president for quality
and patient safety policy at
the American Hospital As-
sociation. “Hospitals have
heard that,” she says, and
are adopting new strate-
gies to protect patients.
Some private insurers,
including CIGNA, WellPoint and United
Healthcare, are following Medicare’s lead on
not paying for medical errors in hospitals.

C. diff is easily
spread everywhere—
onto hands, bed rails,
sheets, IV poles.

; Name names. Consumer advocates say that public scrutiny can prod health facilities into action. “Hospitals begin to be more aware and evaluate their processes as soon as the state passes a law that says they’re going to have to report infection rates to the public,” says Lisa McGiffert, head of Consumers Union’s campaign against hospital infections.