Op-Ed

Ky. voices: Dr. Kevin Kavanagh says hospitals should act as Ky. falls on key infection ranking

Salato's eagle, left, died of a drug-resistant infection; at right, the posting that informed visitors of the eagle's death.
Salato's eagle, left, died of a drug-resistant infection; at right, the posting that informed visitors of the eagle's death.

By Kevin Kavanagh

At least twice a month we take our granddaughter to the Salato Wildlife Education Center in Frankfort. She loves animals, and the center is just the right size for a 3-year-old. She always runs to the first exhibit, which is also her favorite, the bald eagle.

Last month, the exhibit was empty and a note explained why: The eagle had developed an eye infection with a drug resistant bacteria and died.

The symbolism was striking. Superbugs are devouring our nation and even taking down the symbol of American greatness.

One of the most prevalent superbugs is MRSA which causes the deadly staph infection. Until recently, Kentucky had one of the highest rates of staph bloodstream infections in the nation. New data from the Centers for Disease Control's National Healthcare Safety Network show that our MRSA bloodstream infection rate has worsened; Kentucky is now dead last among the 50 states in controlling this deadly disease.

Kentucky's rate of infection is more than four times that of Vermont, the state with the lowest rate.

And let us not forget that data from the Center for Disease Dynamics, Economics & Policy indicate that the United States has the third worst rate of MRSA in staphylococcus aureus cultures in the industrial world. Only Malta and Israel are higher. The U.S. rate is 25 times higher than Northern Europe.

This is a far cry from the optimistic tone of a letter from the health care industry to state senators in Frankfort in January 2012, reporting "a dramatic 70 percent decrease in the hospital MRSA infection rate from January 2009 to December 2010" in Kentucky.

The most recent federal data showing Kentucky has the nation's highest rate of MRSA bloodstream infections is from July 1, 2013 to June 30, 2014. It is only available for 30 of Kentucky's 93 hospitals.

Two, Baptist Health Lexington and St. Elizabeth Medical Center, were top rated with better than expected results. But four outliers had poorer than expected results: The University of Kentucky, the University of Louisville, Saint Joseph London and Lourdes Hospital in Paducah.

Over the years, officials from UK, U of L and Saint Joseph Healthcare Systems have testified against legislative initiatives backed by Health Watch USA to control MRSA.

Saint Joseph Health System's chief medical officer testified on Feb. 10, 2011 before the Kentucky House Health and Welfare Committee against expanded public reporting of health-care associated infections by the Kentucky Department of Health. His testimony helped defeat a bill that would have enabled expanded collection of data and set the stage for better standards in infection control.

After testifying against infection-control reforms in Kentucky, the Saint Joseph official went on to become the chief clinical officer at the Texas hospital where an Ebola outbreak spread to its medical staff.

Many now agree that if the U.S. had enacted better and more specific standards for infection control, the Ebola outbreak in this country and ensuing infections of nurses might have been avoided. The lack of comprehensive data hindered the development of these standards.

London, the Laurel County seat, was also at the center of a Dec. 16, 2013 investigative report in USA Today entitled "Dangerous MRSA bacteria expanding into communities."

Unfortunately, based on what I think is faulty research, many institutions have gotten away from the technique of "seek and destroy" to confront these dangerous superbugs. Health Watch USA has published numerous manuscripts in the peer reviewed medical literature on this issue and we foresee a revitalization of surveillance.

A questionable trend aimed at confronting this epidemic is using the antiseptic chlorhexidine on every ICU patient every day. Two major drawbacks of this approach are the promotion of bacterial resistance and chlorhexidine's questionable effectiveness in the prevention of the two most common superbugs, C. difficile and MRSA.

I am sure that Kentucky's MRSA outliers will be quick to point out that they take care of riskier patients. But keep in mind the federal data are risk adjusted.

Kentucky's hospitals need to ask themselves if they should not be expanding their surveillance and isolation/decolonization techniques for MRSA. The Veterans Administration has had excellent results utilizing universal surveillance for MRSA and isolation of carriers. Maybe it is time to adopt this technique statewide.

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