Dangerous bacteria attacking some older patients in Florida

[Guest guest]

Dangerous bacteria attacking some older patients in Florida

hospitals, CDC warns

By McVicar

South Florida Sun-Sentinel Health Writer

Posted April 6 2006

http://www.sun-sentinel.com/news/local/southflorida/sfl-

rxhospitals06apr06,0,3072609.story?coll=sfla-home-headlines

ine Hall of Boca Raton developed a high fever and was

hospitalized to determine the cause. Doctors figured out that she

had an infection caused when the family cat nipped her on the ankle,

and successfully treated it with antibiotics.

She was in the hospital for 10 days, then released temporarily to a

nursing home to get her strength back, but a few days later was

readmitted to the hospital with another high fever.

LocalLinks

Hall died seven months later after a long battle with at least three

bacterial infections that developed in the health-care setting. She

spent time in a hospital and a nursing home in Palm Beach County,

and a long-term care hospital in Broward County.

One of the serious infections was caused by bacteria called

clostridium difficile, which produce toxins in the intestinal tract

causing severe diarrhea. The bug predominantly attacks people 65 and

older who have been treated with an antibiotic.

According to the federal Centers for Disease Control and Prevention,

the bacteria -- nicknamed c. diff -- has been showing up in

hospitals in a more virulent strain causing serious illness and an

increase in deaths. Florida is one of 16 states where hospital

outbreaks have been reported.

" There are literally thousands of cases, " said on, a

field epidemiologist with the Florida Department of Health.

A review of hospital discharge data from the Florida Agency for

Health Care Administration for 2003, the most recent year for which

data are available, found more than 17,000 diagnoses of c. diff,

on said.

" Deaths of patients with this particular disease tend to be going

up, not only in Florida but all over the country, " he said.

Hospital-acquired infections account for an estimated 2 million

infections, 90,000 deaths, and $4.5 billion in excess health-care

costs annually, according to the CDC.

Several of the most common have become resistant to the antibiotics

that used to easily wipe them out, including MRSA -- methicillin-

resistant Staphylococcus aureus -- and VRE, vancomycin-resistant

enterococcus.

Hall had both, along with c. diff. She died June 7, 2004, at age 76,

at home in hospice care, never having recovered.

Her husband Don said except for c.diff, which he was told was the

result of antibiotics killing the good bacteria in her intestines,

the names of the other hospital-acquired infections were never

mentioned.

" They would use terms like `the white count is up,' or `it's a line

infection' [meaning an infection got into her body at the site of an

intravenous line.] For the consumer, it's a tour de force. You have

to go out and get a damn medical degree to figure out what's going

on. "

Hall, who asked that the facilities that cared for his wife not be

identified, learned abouthis wife's infections from her medical

records after her death.

C. diff is harder to eradicate from health-care settings than some

other bacteria because it can live on surfaces for a long time. If a

health care worker is cleaning a patient with severe diarrhea and

gets the spores on clothes, the bed rail or the curtain around the

bed, it can be transferred to other hands and be ingested.

In healthy people, it stays inactive, held in check by naturally

occurring bacteria. But an antibiotic can kill normal bacteria in

the intestines, allowing c. diff to change into a form that produces

toxins.

Treatment is an antibiotic called Flagyl, generic name

metronidazole. If that doesn't work, another heavy-duty antibiotic,

vancomycin, is given orally.

Betsy McCaughey, chairman of the Committee to Reduce Infection

Deaths, said patients need to be vigilant during a stay in the

hospital and not be afraid to ask health care workers to disinfect

their hands before touching them.

" The danger from these infections is worsening because,

increasingly, they cannot be cured with commonly used antibiotics, "

McCaughey said.

The state has a Web site -- www.floridacompare.gov -- where

consumers can compare hospital infection rates, and officials at

local hospitals say they are extra vigilant on the issue of hospital

infections.

" [The state] data are from 2004, and since then we have spent a lot

of time and effort to reduce hospital infections. We take it very,

very seriously, and we've instituted a multitude of initiatives, "

said Diane Aleman, CEO at North Ridge Medical Center in Fort

Lauderdale.

Ava Dobin, nurse epidemiologist in the North Broward Hospital

District, said hand hygiene has always been stressed for staff, and

signs are going up in patient rooms to remind patients and visitors

to clean their hands often. Patients are screened for infections,

including c. diff, when they are admitted.

" It's an organism that should never spread, with good handwashing,

and the room is wiped down [with disinfectant] every day, " Dobin

said.

Barbara , a past president of the Association for

Professionals in Infection Control and Epidemiology, said hand

hygiene is key. Alcohol hand rinse works best, but in a room where a

patient has c.diff, caregivers should wash their hands first and

then use the alcohol rinse, said , who is in charge of

infection control at Baptist Hospital in Miami.

, who recently returned from a cruise, said the cruise line

has a policy of making sure all passengers use alcohol hand rinse,

to prevent the spread of common infections such as the Norwalk

virus, which causes diarrhea.

" They wouldn't let us on the ship without using the alcohol hand

rinse. When you went into the dining area, the girl would not give

you your tray and silverware, until she saw you use the alcohol hand

rinse, " said. " If we could only do that in hospitals. "

McVicar can be reached at nmcvicar@... or 954-356-

4593.