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Hospitals Trying to Track, Limit Killer Bacteria With AM-Antibiotic Resistance, Bjt

October 15, 1994

NEW YORK (AP) _ The quiet of the intensive care unit is disturbed only by the soft chatter of the staff and the hum of machines keeping people alive.

Some patients are on respirators, many barely able to move under the tangle of tubes and intravenous lines.

In this unit, at Columbia Presbyterian Medical Center, the patients are getting the best treatment medicine has to offer.

But they also could be facing risks like never before. Hospitals are the cradle of the growing threat of bacteria resistant to antibiotics, and the sickest of patients now are the most vulnerable.

Five percent to 10 percent of all people get infections when they are hospitalized. Each surgical cut is a breach in the body’s most important defense, the skin, and the sicker the patient, the more vulnerable the person is to infection.

Hospital-borne disease is a major contributing factor in 60,000 deaths each year, according to the federal Centers for Disease Control and Prevention. In many cases, bacteria and infection are the last push to death.

Bacteria lurk everywhere - on clothing, walls, blankets, medical equipment. Hospital workers can pass them on by hand. Some bacteria cling to plastic and travel up tubes inserted into the body.

So, doctors say, in the quest to treat cancer and AIDS and debilitating diseases, the weakest patients also are facing greater risks with the emergence of resistant bacteria in hospitals.

″The level of infection now is unacceptable,″ said Dr. Alexander Tomasz of New York’s Rockefeller University. ″We must have enforcement of infection control: nurses washing hands between patients, wearing and changing gloves.

″There are strict rules now, but the suspicion is they are not being followed.″

Tomasz and Dr. Richard Roberts, chief of infectious diseases at New York Hospital-Cornell Medical Center, helped found the Bacterial Antibiotic Resistance Group.

The group wants the city’s hospitals to help it track strains of bacteria that have developed resistance to at least some antibiotics - enterococcus, staphylcoccus and pneumococcus.

The group has the support of the city’s health department, but its surveillance program is voluntary and it’s too soon to say if it will be successful.

Tomasz acknowledges that some hospitals may be reluctant to participate because disclosing problems with resistant bacteria could jeopardize their reputations.

Tomasz and Roberts say what is needed in large part is a rededication to practices pioneered by Florence Nightingale: good hygiene and monitoring infectious diseases in hospitals.

″We must encourage people to wash their hands between patients. It’s not done as well as it should be,″ Roberts said.

Hospitals also are trying to isolate patients with resistant bacteria by putting them in rooms by themselves, placing a tremendous strain on some facilities.

″My understanding is that resistance is so prevalent in some places that they don’t have enough rooms for these patients,″ Roberts said.

Kathleen Jakob, an infection control specialist, instructs Columbia Presbyterian’s staff about problems with resistant bacteria.

″This is an emerging problem that doctors and nurses didn’t learn about in school,″ she said.

Her department examines bacteria from the lab to identify any patients with resistant bacteria. Nurses and doctors wear gowns, gloves and masks when treating a patient, then take off the gear before moving on. Medical equipment is specially cleaned and, in some cases, the hospital will limit the staff members allowed to treat the patient.

Until the 1920s, hospitals were known as crowded poorhouses of rampant disease and infection. Indeed, the middle class and wealthy were treated at home.

Resistant bacteria could give hospitals a bad name again, and eventually make choosing a hospital a consumer issue - especially if superstrains of enterococcus, which are resistant to the ″last resort″ antibiotic vancomycin, share their DNA with other microbes. Bacteria are capable of this, and many doctors think it only a matter of time before staphylcoccus or pneumococcus pick up this shield.

Then the problem of resistance would be exponentially worse because staph and pneumococcus are extremely common, in hospitals as well as in the community at large.

″In the future, somebody is going to find out that a hospital has a problem and sue,″ said Dr. Stuart B. Levy of Tufts University and the author of ″The Antibiotic Paradox: How Miracle Drugs are Destroying the Miracle.″

″I know hospitals that have problems, but I’m not going to identify them,″ he said. ″The sooner somebody can get out of the hospital, the better. There are times when home is safer for a patient.″

S-10-15-94 1100EDT

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