Ky. Voices: Better monitoring needed in a post-antibiotic era

July 11, 2013 

Cortney Beldon Hensley who died at the Laurel County Detention Center March 9, 2013.

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Few remember the time when consumption (tuberculosis) slowly suffocated many, blood poisoning (septicemia) was a sure death sentence and the "old person's best friend" (pneumonia) quickly took the life of the elderly.

In modern times, we rest assured that a cure from an infection is just a dose away. Or so it used to be. Rapidly, we are entering an age when antibiotics are becoming ineffective for a growing number of infections.

Recent reports are shedding light on the epidemic of the superbug MRSA (methicillin-resistant staphylococcus aureus), the lack of control over the severe infections caused by the superbug C. difficile and the emergence of a virtually untreatable deadly bacteria, CRE (carbapenem-resistant enterobacteriaceae).

Will we be saved by our health care industry? It is beginning to appear unlikely. Unfortunately, the United States has worse statistics than Northern Europe on containing many of these dangerous organisms. In the U. S., we know how many cows are in each county. But we do not have this level of detail on health care infections. Mandatory reporting of bacteria that are developing resistance is needed to determine how effectively they are being controlled and where they are coming from.

This is underscored by the tragic case of Cortney Beldon Hensley, who died of MRSA at the Laurel County Detention Facility. The Laurel County jail had six cases of MRSA in 2012 and fewer than 10 cases so far this year.

Since data are not available to the public, we do not know if MRSA outbreaks were reported. The MRSA strain that infected Hensley had not been previously detected in the jail. MRSA can live for well over a month on environmental surfaces, making "outbreaks" prolonged and sometimes intermittent affairs that have varying definitions.

In another instance, a Louisville reporter was able to collect better data on these deadly infections than that reported to the Kentucky Department for Public Health. A Courier-Journal reporter discovered that the almost untreatable bacteria, CRE, was all too common in Louisville's hospitals, with more than 20 cases in the last two years. One of the sources may have been nursing homes, which calls for health department investigation. Outbreaks were not reported in Lexington; however, being a close neighbor, the experience in Louisville is probably a harbinger of things to come.

Infection control regulations in Kentucky are outdated. Many dangerous infections plaguing our communities are not required to be reported. Instead, it is up to the health care provider to decide if and when to report them. And the federal requirement that hospitals keep an infection control log was eliminated by the Centers for Medicare and Medicaid Services last year as obsolete. Oversight agencies thus have incomplete or no data to monitor.

The result: Only three confirmed outbreaks of bacterial infections were reported by Kentucky hospitals in 2012. Only one outbreak of MRSA and no outbreaks of C. difficile were reported. This outdated system places the public at risk and is unacceptable.

Since bacterial outbreaks can have their roots in the community and span several types of facilities, a coordinated effort is needed. Healthcare trade organizations do not have the resources or ability to effectively address this problem.

The health care industry often points to hand hygiene as the most important factor. But in addition, a comprehensive approach composed of many types of interventions is needed for control of these infections.

In a recent CRE epidemic at a National Institute of Health hospital, comprehensive and extensive measures had to be implemented, including facility-wide patient testing, isolation, gloves, gowns, robotic cleaning units and the construction of new ICU isolation rooms, along with strict patient and staff hygiene.

The CDC recommends surveillance of all CRE contacts, isolation and, if possible, a dedicated room and staff. "If possible" does not mean if convenient. It means the facility should attempt to move heaven and earth to make it happen.

Unfortunately, some facilities (nonprofits included) are profit-driven and are reluctant to adopt effective protocols if it costs money. Many fight any type of central government control.

However, a concerted, coordinated effort led by the state health department is needed to control this unnecessary epidemic. Public reporting is an integral component of this effort and would serve to both motivate and coordinate the public and to help hold the health care industry accountable.

Dr. Kevin T. Kavanagh of Somerset is a physician and board director of Health Watch USA. Daniel M. Saman is a doctor of public health and Health Watch USA's chief epidemiologist.

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