Pa. aims at staph infections

Melissa Morris is exactly the kind of frontline medical worker Gov. Rendell needs for his ambitious initiative to improve the public's health.

Morris is passionate about preventing infections. For nearly a year, the nurse manager has helped spearhead an effort inside Albert Einstein Medical Center in North Philadelphia to reduce the outbreak of infections that are resistant to antibiotics.

Hospital-acquired infections - a hot topic and one that Pennsylvania hospitals are tackling with zeal - come in various forms. The target in Morris' crosshairs is a drug-resistant germ that often accompanies patients from home to the hospital, where it infects other patients and then travels with them back into the community to do more damage.

It is a vicious cycle - and one that Rendell, in signing a new law today, says he is aiming to break, or at least slow down.

Under the new legislation, hospitals will be required to test for resistant bacteria in the highest-risk patients as well as all those admitted from nursing homes, a major source of infections. Staffers in contact with contagious people also must be tested.

Rendell knows, however, that the success of his plan depends less on government mandates than on the active engagement of health-care workers such as Morris.

He was "blown away," he said, by the culture of safety he witnessed while visiting the Veterans Affairs health-care system in Pittsburgh, which has garnered national recognition for its program to fight what is known as MRSA.

"Everyone had bought into it, from the doctors to the janitors," the governor said in an interview. "I want that same type of enthusiasm about preventing hospital-acquired infections in every hospital in Pennsylvania."

The new law pushes hospitals to meet benchmarks. It rewards - with higher reimbursements - those that improve.

Many in the Philadelphia region are already attacking the problem.

At Chester County Hospital, for example, all patients in intensive care and its cardiac-care units are screened. Extra precautions then can be taken with patients found to be "colonized" with the organisms, limiting the spread of MRSA, or methicillin-resistant staphylococcus aureus.

Staphylococcus aureus is a common bacterium that often lives harmlessly on the skin or in the nose. When it gets into the body - usually through a cut or surgical incision - it can cause an infection. The result ranges from minor skin lesions to life-threatening bloodstream infections, pneumonia, or organ damage.

Methicillin, a synthetic form of penicillin, is a prime drug used against staph. But its effectiveness began to diminish within a decade of its introduction in the late 1950s. By 1997, about 40 percent of staph infections in hospitalized patients were resistant to methicillin.

The infection bill and another that Rendell will sign in a ceremony this morning at the University of Pennsylvania School of Nursing are the first pieces of his broad "Prescription for Pennsylvania" to make it through the General Assembly.

Besides going after MRSA and other resistant bacteria, the law, to be phased in over several years, requires most hospitals to install software to better track infections. Hospitals, nursing homes and day-surgery centers must have state-approved infection-control plans in place.

The law also requires infections contracted by patients during their care to be reported through the U.S. Centers for Disease Control and Prevention. Those data then will be collected by the agencies in Pennsylvania responsible for patient safety and quality of care - the Department of Health, the Patient Safety Authority, and the council known as PHC4.

"If you compare it to any other state in the union, this is a giant step forward," Rendell said.

The new reporting requirements will enable the state, patients and hospitals to compare their infection rates with institutions here and in some parts of the country that voluntarily report to the CDC.

"We have come up with something that is in the patients' best interest," said P.J. Brennan, chief medical officer of the University of Pennsylvania Health System. "The net effect of all of this is to put greater resources into hospitals to create more information on which they can act to prevent infections."

The public reports on hospitals also are likely to be more timely and provide patients with more robust information to help them decide where to go for care, Brennan said.

PHC4 - the Pennsylvania Health Care Cost Containment Council - began collecting reports on hospital-acquired infections in 2004. It issued the nation's first hospital-by-hospital report on infection rates in November.

That study found 19,154 patients contracted infections in 2005 during care in hospitals throughout Pennsylvania.

At Einstein in North Philadelphia, the after-intensive-care unit where Morris works as a nurse manager cut its rate of drug-resistant infections by 50 percent over the last three months - despite having nearly a quarter of its patients test positive for the bacterium, said Jeff Cohn, chief quality officer at the medical center.

Cohn attributes much of that improvement to implementing caregivers' ideas, such as putting gowns and gloves in cabinets outside patient rooms.

Einstein now tests for drug-resistant bacteria on seven units and expects to expand the program to every patient at the hospital within a year.

For Morris, the work is not about just doing what administrators order. Two years ago, she saw close-up the extra surgery, drugs and pain that a resistant skin infection inflicted on her son after an outpatient surgery.

"I have 16 patients in my unit," Morris said. "Any one of them is at risk, and I wouldn't want any of them to go through that."

Here are key parts of the governor's "Prescription for Pennsylvania" - and where they stand.

Cover all Pennsylvanians

Purpose: Make affordable insurance available to state's 767,000 uninsured; subsidize lower-income people.

Status: Governor seeks to have General Assembly take up legislation in the fall.

Heath-care associated infections

Purpose: Reduce antibiotic-resistant and hospital-acquired infections.

Status: Passed; to be signed into law today.

Smoking ban

Purpose: Ban smoking in public places statewide.

Status: Failed in the legislature.

Chronic care

Purpose: Improve care of the chronically ill to prevent unnecessary hospitalizations.

Status: Implemented via executive orders.

"Scope of Practice"

Purpose: Improve access by expanding "scope of practice" for non-physicians such as nurse practitioners.

Status: Passed; to be signed into law today.

Pay for performance

Purpose: Use reimbursements to punish and reward hospitals based on quality of care and patient safety.

Status: Governor expects to take up in the fall.

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