HOULTON, Maine — When Jerolyn Ireland suffered a seizure one evening in 2012 and was rushed to the hospital only to find out she had a brain tumor, she thought it was the worst experience she’d ever go through.
She was wrong.
The 73-year-old Houlton woman learned that the tumor was noncancerous, but her struggle with a form of staph called Methicillin-resistant Staphylococcus aureus, or MRSA, was just beginning.
MRSA is among the most worrisome infections that hospitals and other health care facilities face, fueled by overuse of antibiotics in the U.S. and worldwide.
Bacteria linger on surfaces, such as surgical instruments, bed linens and door handles, or spread from room to room by unwashed hands and the coughs and sneezes of sick patients.
On any given day, one in every 25 U.S. patients contracts an infection during a hospital stay, according to a March 2014 study in the New England Journal of Medicine. Of those infected, 75,000 died in 2011, the U.S. Centers for Disease Control and Prevention estimates.
More recently, an outbreak of a so-called “superbug” at UCLA’s Ronald Reagan Medical Center exposed the dangers of unsanitary medical equipment, as reported in February by the Los Angeles times. The outbreak, linked to a common but faulty medical scope, led to the deaths of two patients, infected at least five others and may have exposed nearly 180 more.
In Maine, hospitals are increasingly preventing more infections and more closely following safety protocols, according to a new state report. Maine ranks first in the country for hospital safety overall, as measured by the watchdog organization The Leapfrog Group.
But state health officials warn that a dangerous form of strep infection is on the rise, leading to five deaths this year. Called invasive group A streptococcal disease, the infection can be contracted almost anywhere, but often turns up in hospitals and other health care facilities.
Some patient advocates want Maine to do more to prevent and publicize hospital infections. The state reports only some types of infections and releases no data on how many patients are disabled or killed by them, they say.
For Ireland, the brain tumor was the beginning of a long road of illness.
“When you hear brain tumor, of course you think the worst,” said Ireland, who spent more than 40 years as a nurse and had planned to keep working until at least age 75. “But when they told me it was benign, I felt a bit better, I thought I would just have the surgeries and be done with it.”
When Ireland suffered the seizure, she fell out of bed and a heavy bureau fell on top of her, breaking both her shoulders. She needed surgery to repair the injuries and was soon immobilized with both arms in casts.
After the surgery at Eastern Maine Medical Center in Bangor and a stay in a rehabilitation facility, she returned to work.
“I really thought that was the end of it, it was over,” she said. “But then one day I just woke up and noticed that there was a lot of drainage from my surgical site.”
The surgical site had become infected with what would eventually be diagnosed as MRSA.
MRSA has grown resistant to the antibiotics commonly used to treat ordinary staph infections. Many MRSA infections occur in people who have been in hospitals or other health care settings, such as nursing homes and dialysis centers.
Maine’s overall rate of MRSA infections in health care facilities was 28 percent lower than a national baseline in 2014, according to the state report. But Maine changed how it collects MRSA data last year — now reporting cases confirmed by lab tests rather than diagnosed and documented by doctors — making comparisons to prior years difficult. The rates also reflect the presence of MRSA on a patient’s body but may or may not indicate active infections, as in prior years.
Ireland said that at first, her doctor could not see her right away. Then, the infection progressed.
Her son Mark Boutlier, a paramedic, drove her to Bangor to get the surgical site checked out. He left his mother resting in the car while he waited at the pharmacy, only to find out that the doctor had prescribed an antibiotic that cost $1,800.
“We were just floored,” he said. “I could not afford that and neither could my mother. It was just outrageous.”
Ireland eventually underwent five surgeries on her skull and spent three months in Houlton Regional Hospital to completely treat the MRSA. She still suffers from memory loss, seizures and can no longer work.
She lost her home, a lakeside property with a pontoon boat, and now resides in a senior housing complex.
Ireland estimates she owes approximately $200,000 in medical bills. While she had insurance coverage, the remaining medical bills devastated her finances, she said, and affected her son and daughter in-law, Krista.
“It destroyed me money-wise,” Mark Boutlier said. “My name and my wife’s name [were] on her house, so we were responsible for the mortgage. When she was in Bangor, I used up all my sick time and vacation time. I would work all night long and drive down to Bangor to see her. All of our money went for gas and hotels.”
Boutlier said he carried a terrible amount of guilt.
“When I would see that her infection was not getting better, I would blame myself,” he said. “I would think that if I could have afforded that $1,800 medicine, maybe she would be fine by now.”
A doctor later told them that the $1,800 pill would not have worked, even if they could have afforded it, according to Boutlier.
EMMC has not acknowledged that the infection originated with Ireland’s brain surgery.
Ireland’s neurosurgeon believes she acquired the infection from the use of her sleep apnea mask, but she said she never wore it in the months following the surgery, when the infection set in.
“One of the worst things was always being made to feel like this was my fault,” she said. “It seemed like every time I went back, the doctor made me feel like I would not have been in this situation if I had taken care of myself and not gotten MRSA, like it was all my fault.”
Andrew Soucier, a spokesman at EMMC, said MRSA “is an increasingly common type of bacterium which can cause both mild and serious infection, though most people who acquire it never develop any illness as a result.”
“It is easily spread by close contact, in the home, in the community, and sometimes in hospitals and long-term care facilities,” he continued. “At EMMC, patient safety is our highest priority. Our hospital follows all best practices recommended by the Centers for Disease Control and Prevention and other expert organizations to prevent transmission of MRSA and other potential pathogens, and to prevent the spread of hospital-associated infections of all types.”
The state report shows that Maine hospitals continue to improve on safety protocols that prevent the spread of infections, said Jeff Austin, a spokesman for the Maine Hospital Association.
“The fact that we continue to perform at or near the top of national benchmarks is great news,” he said. “The work will never be done, but watching trends is important.”
Bloodstream infections in patients who had central lines, or catheters, placed in major veins are down significantly over five years, he noted.
While patient safety advocate Kathy Day is “thrilled” with Maine’s progress in publicly reporting hospital infections, much more work lies ahead, she said. Many other types of infections — such as carbapenem-resistant Enterobacteriaceae, the superbug implicated in the UCLA outbreak — aren’t included in the report, she said.
Even tracked infections are undercounted, missing cases in which patients contract the illness at the hospital but develop symptoms only after returning home, she said.
“It’s all about transparency,” said Day, a former EMMC nurse who was spurred to action after MRSA sickened her elderly father following a hospitalization in 2008. “Patients have a right to this information so they can make safe choices for themselves.”
Day pushed for legislation requiring hospitals to screen high-risk patients for MRSA, but the hospital association successfully lobbied to rescind it in 2011, she said.
People often harbor MRSA on the skin and in the nose with no symptoms, but the highly contagious bacteria can spread to other patients and wreak havoc if it enters the body through a surgical wound.
Day pointed to the example of a VA hospital in Louisville, Kentucky, that slashed MRSA rates by more than 60 percent over two years by instituting a screening and prevention program. Maine Medical Center in Portland screens all patients upon admission for both MRSA and vancomycin resistant enterococcus, another antibiotic-resistant bug.
“Surgical patients, ICU patients and any others who are facing invasive procedures can benefit from MRSA screening,” Day said. “Patients have no way to know what their hospital or [long-term care] roommates are carrying or are infected with, and that should not be a worry for them.”
Day urges patients to ask their doctor or hospital about any infectious outbreaks and learn how to stay safe.
Maine health officials are monitoring the worrying rise in invasive strep cases, but found no indication that hospitals failed to follow infection safety protocols, said Dr. Christopher Pezzullo, acting chief health officer of the Maine Department of Health and Human Services. Since January, Maine has recorded 33 cases of invasive group A strep — including 15 that arose in a spike between April 1 and the first week of May. Three patients had undergone surgery within a month prior to testing positive for group A strep. Those cases may or may not have spread at hospitals, he said.
The bacteria can lead to life-threatening infections when they invade certain parts of the body, such as muscle or the lungs. Invasive forms of group A strep are relatively rare but can include necrotizing fasciitis, a “flesh-eating” infection, and streptococcal toxic shock syndrome.
Five of the cases in Maine were fatal — two each in Aroostook and Cumberland counties and one in Penobscot County, Pezzullo said.
While Ireland survived her infection, losing her lifestyle and her financial future has been deeply upsetting, she said. She, along with Day, now works to spread the word about hospital-acquired infections to make others aware of the dangers.
“I worked very hard my whole life, and I had everything saved up for retirement,” she said. “And now it is gone. I do not want to be known as someone who can’t pay my bills. The physical and emotional pain this has brought is just terrible.”