On Friday, Kathy Day will bury her father, John McCleary, with a graveside service in Millinocket. McCleary, who was 83 years old when he died in January, was a lifetime resident of the Penobscot County mill town. The pneumonia that killed him was caused by an organism known as methicillin-resistant staphylococcus aureus, or MRSA.
MRSA is commonly associated with hospitals, nursing homes and other institutional settings. It is on the rise across the nation, often does not respond to antibiotic treatment, and is responsible for thousands of deaths every year. A 2007 study by the Association for Professionals in Infection Control and Epidemiology found that for every 1,000 patients treated in U.S. hospitals, as many as 46 would test positive for MRSA. Some cases cause no illness, while others, like McCleary’s are life-threatening.
Day says it’s time Maine took steps to reduce MRSA’s deadly toll.
When he fractured his leg on Sept. 26 of last year, McCleary checked into Millinocket Regional Hospital. He was discharged Oct. 7 but came back to the hospital two days later with a fever.
“He never stood up or walked again,” Day said in an interview earlier this week. Her father succumbed to pneumonia on Jan. 9 at an area nursing home. Doctors said her father had most likely picked up the infection during his initial hospitalization, she said.
Day, retired from her career as a registered nurse, channeled her shock and grief into working with Rep. Adam Goode, D-Bangor, to draft comprehensive legislation requiring all Maine hospitals to test all patients for MRSA upon admission. Any patients found to be carrying the bacterium, whether they were ill or not, would be isolated from noncarriers and treated aggressively to “decolonize” the organism.
As originally worded, the bill, which has since been substantially amended, would have required all hospital staff members to use personal protective gear such as gowns, gloves and paper masks when in the presence of MRSA carriers. It also would have initiated rigorous standards for hand-washing and disinfecting any surfaces and equipment that come in contact with MRSA patients. In addition, it would have required hospitals to educate all staff, patients and former patients about the highly transmissible disease.
It also would have required hospitals to report all cases of MRSA to the Maine Center for Disease Control and Prevention, regardless of whether the affected patient was carrying MRSA at admission or developed it while hospitalized, and regardless of whether the organism was causing any symptoms.
Day said the language of the original bill was based on legislation adopted in a few other states, including Pennsylvania, where rates of hospital-acquired MRSA have dropped significantly. The hospitals of the U.S. Department of Veterans Affairs also have instituted routine testing, she said, and have experienced a sharp reduction in cases.
The Maine legislation drew broad public support as well as the endorsement of the Maine State Nurses Association.
But hospitals raised numerous objections. Efforts on Wednesday to reach a spokeswoman for the Maine Hospital Association were unsuccessful, but Dr. Josh Cutler of the Maine Quality Forum, a branch of the state’s Dirigo Health Agency, said the detailed requirements contained in the bill were characterized as burdensome and ineffectual.
In particular, he said, hospitals felt that the requirement to go public with their MRSA rates would paint an inaccurate picture of the overall quality of care patients receive and the effectiveness of each hospital’s infection control practices. And Cutler said those concerns are valid.
“If you want to measure one thing [hospitals could do to reduce the incidence of hospital-acquired infections], it should be the staff’s compliance with hand-washing,” he said. Nationwide, compliance with hand-washing recommendations by hospital workers, including nurses, runs a dismal 30 percent, he said.
Goode’s legislation, LD 1038, was amended to require hospitals simply to track MRSA rates among their “high-risk” patients. Defining that high-risk population will fall to the Maine Quality Forum with input from the Maine State Nurses Association and a special seat at the table for Kathy Day.
A second bill, sponsored by Rep. Linda Sanborn, D-Gorham, would require individual hospitals to report on their infection control policies and on their compliance with those policies. Both measures have been endorsed by the Legislature’s Health and Human Services Committee and are awaiting debate in the House and Senate.
Goode said he is “completely satisfied” with the amended version of his bill. “I am ecstatic that we’re screening the high-risk patients,” he said earlier this week.
Day isn’t so sure. After all her hard work on the issue, “the minute we agreed to [the amendment] I felt like a train had run over me,” she said. “Screening high-risk patients is just one step. Active detection and isolation are what works.”
Still, she said, a little progress is better than none. “The goal is to help save lives, pure and simple,” she said.