MDR Bug Has Hospitals Seeking Help From State Health Services
By Emma Perez-Trevino, The Brownsville Herald, Texas
May 18–By some accounts, dozens of people in Cameron and Hidalgo counties have been infected by a contagious multidrug-resistant bug that primarily strikes extremely ill patients with weak immune systems.
The medical community has requested both guidance and intervention of the Texas Department of State Health Services in containing the event.
TDH has scheduled a symposium in Brownsville at Valley Regional Medical Center for Friday, from 9 a.m. to 4 p.m. in response to, “an Acinetobacter baumannii event,” the draft agenda states.
Furthermore, a group of state and county health officials and staffs from hospitals, long-term care facilities and nursing homes has been organized to begin active surveillance of what could be an increase in either infections or detection.
“The idea is to try to get a handle on it,” TDH spokesman Doug McBride told The Brownsville Herald Friday.
TDH also issued a state health advisory April 30 to the medical community, including doctors, hospitals, long-term facilities, and ambulance services. The advisory noted an increase in infections and/or colonization in hospitals, acute care facilities and long-term care facilities on the border.
In Brownsville, Valley Baptist Medical Center-Brownsville spokeswoman Terri Retana and Valley Regional Medical Center infection control coordinator Honeyland Sosa confirmed that there are patients with the bacteria, but would not provide the number that have been seen at the facilities, since when, and how many are now in isolation.
McBride also did not have a count, but said that the state was advised last month of what appeared to be an increase in cases.
At Valley Baptist-Brownsville, Retana said in a written statement that the facility has seen an increase in patients with the bacteria admitted to the hospital.
“Part of this appears to be an actual increase in the number of cases, and part because with the observed increase in cases, the hospital began testing for the bacteria on all patients coming from other patient care settings, particularly long-term care, and those with a prolonged stay in intensive care,” Retana wrote.
TDH noted in its health advisory that the bacteria has been reported worldwide and is now recognized as one of the most difficult health-care associated infections to control and treat.
Patients who have been infected are in isolation.
While the hospitals’ patient occupancy rate rises, the facilities that referred the patients-who might have already been infected-to the hospitals are refusing to take them back, the Herald also learned. “We are at a stalemate,” said Dr. Lorenzo Pelly who also is the director of performance improvement for Valley Baptist.
“No one seems to have a handle on the problem,” said Pelly, who requested specific recommendations from the state in order to meet the challenge.
Pelly said that just recently, a hospital in Houston attempted to transfer three patients infected with the bacteria to Brownsville. “They never told us until we asked,” Pelly said.
“I wonder if we’ve been getting multi-drug resistant (MDR) patients from other hospitals all along without being told. That goes to the issue. The issue is how many times have they sent patients that are MDR?” Pelly said.
“Should they have to take them back?” Pelly said, further illustrating the challenges and need for state intervention.
Both state and local officials found it difficult to determine if the bacteria has caused any deaths.
Pelly did note that “exemplary, extreme and effective,” isolation, precautionary and preventive measures are in place.
“Valley Baptist has worked very closely with the Texas Department of State Health Services and the Cameron County Department of Health and Human Services to classify, identify and contain this pathogen,” Retana said in her statement.
She noted that the hospital is taking every possible precaution that includes an aggressive approach of early identification, strict infection control measures, strict isolation and deep cleaning of all room surfaces and supplies.
Sosa also said that Valley Regional is working closely with county health officials and taking every precautionary measure.
In 2003, there was an outbreak at Johns Hopkins Hospital during a two-month period when 11 patients were infected. The source was traced to high-pressure, water-pumping tools used to wash and clean wounds, Infectious Disease News reported in 2005.
Johns Hopkins has continued research and studies and reported in 2007 that it found that patients who had been in nursing homes, either admitted to Hopkins directly from a long-term care facility or transferred from home or another community hospital, were 12 times more likely than other patients to be carriers. Rates were higher, 22 times, among patients who were wheelchair or bed-bound.
Hopkins further noted that as a result, The Johns Hopkins Hospital would begin to test all patients who had spent time in a nursing home at the outset of their hospital admission, while also using isolation precautions until their test results are known.
The press statement also noted that outbreaks have become a widespread problem in the last decade and that the Joint Commission on Accreditation of Healthcare Organizations found in 2006 that 70 percent of the bacteria that cause infections for two million hospitalized Americans each year are resistant to at least one of the drugs most commonly used to treat them.
“Unless these test results are negative for superbugs, patients are treated as potential carriers. They will receive care only in designated, confined treatment spaces or separate rooms,” Johns Hopkins Medicine further stated in an April 16, 2007 press release.
Pointing to recent national news that hospitals are not prepared to deal with terrorist attacks, Pelly said that hospitals are, “even less ready to deal with potential terrorist microbiological attacks.”
>Well-known, but relatively uncommon cause of health-care associated infections.
>Outbreaks of infections typically occur in intensive care units and healthcare settings housing very ill patients.
>The bacteria causes a variety of diseases, ranging from pneumonia to serious blood or wound infections. The bacteria might also “colonize” or live in a patient without causing infection or symptoms, especially in tracheotomy sites or open wounds.
>It poses very little risk to healthy people, but people who have weakened immune systems, chronic lung disease or diabetes could be more susceptible to infections. Hospitalized patients, especially very ill patients on a ventilator, those with a prolonged hospital stay, or those who have open wounds are also at greater risk for infection.
>It can be spread by person-to-person contact; contact with contaminated surfaces, or exposure in the environment. It can either cause or contribute to death in very ill patients.
>Treatment of infections attributed to the bacteria has become increasingly difficult due to its resistance.
>The organism lives in soil and water and survives for extended periods in the environment, tolerating wet and dry conditions.
>The organism can survive for months on clothing and bedclothes, bed rails, ventilators and other surfaces, including sinks and doorknobs, making its transmission extremely difficult to control.
Source: Centers for Disease Control and Prevention and Johns Hopkins Medicine’s department of hospital epidemiology and infection control.
>Early identification of carriers and infected patients through surveillance cultures.
>Interfacility/agency sharing of infection status prior to transfer and discharge.
>Implementation of infection-control measures including hand-hygiene, strict contract-isolation precautions, and the use of dedicated equipment and staff.
Source: Texas Department of State Health Services
Infection control/transmission prevention
The multidrug-resistant Acinetobacter baumannii bacteria
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