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-
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
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.
To date, 25 states have done just that. The
quality of data may vary from state to state
and even facility to facility, but the first re-