Resistant staph case sets off public fears for hospital
How ICP eased staff, public concerns
Intense clinical and media interest in the first staph strains showing vancomycin resistance can quickly lead to misguided public fears that a "plague" has descended on the community, an ICP reported recently in San Diego at the annual conference of the Association for Professionals in Infection Control and Epidemiology.
Fortunately, her experience with just such a scenario reveals that education efforts can allay such overblown concerns among the public and health care workers, says Lori Boschetto, BSN, CIC, director of infection control and employee health at Our Lady of Lourdes Medical Center in Camden, NJ. Last year, a patient there was confirmed by the Centers for Disease Control and Prevention to be the second case of infection with vancomycin intermediate-resistant Staphylococcus aureus (VISA) in the United States. In a poster presentation at APIC, Boschetto described the events that resulted in a flurry of media coverage and the educational efforts that allayed public and staff concerns. It began with the hospital lab identifying intermediate vancomycin resistance in an isolate from a previously admitted patient.
`They were afraid, like it was a plague'
"We were notified by our microbiology department and we really didn't believe her at first," Boschetto tells Hospital Infection Control. "But she was pretty sure of what she saw and had repeated the test numerous times."
Having just dealt with the first confirmed U.S. case in Michigan, the CDC subsequently confirmed the suspicions in Camden and began assisting in the investigation, she notes. (See HIC, October 1997, pp. 145-152.)
"There were a lot of rumors going around in the [local] media," she says. "They were quite concerned, and I felt strongly that we had to do some public education."
That was particularly apparent when Boschetto heard that some of the co-workers of a relative of the patient were not reporting to work.
"They didn't want to be around that person," she says. "They were afraid, like it was a plague. They didn't know if they were going to catch it and bring it back to their families. It's amazing what lack of knowledge does to people. It sets them in a frenzy."
To end such misconceptions, Boschetto spearheaded an education campaign and the hospital held a press conference to try to defuse some of the speculation.
The effort included development of a patient/staff education handout that includes tips for VISA patients discharged to home care. (See handout summary, p. 109.)
"The handout would be really helpful to infection control practitioners who haven't dealt with this bug yet," Boschetto says. "It is a good tool to educate their staff and family members."
The staff educational sessions resulted in the culturing of some 148 health care workers and other possible contacts of the patient including physicians, residents, students, and emergency response workers, she notes.
"We told them we did not want them to leave the room without having all of their questions and concerns addressed - and that no question was dumb," she says. "In the end, my big pitch to them was that we could help as an institution to understand this organism better by submitting cultures of hand and nares and helping the CDC with this investigation. Of the people who attended the sessions, 96% of them submitted cultures."
VISA may not survive well on surfaces
As with the other U.S. case, no close contacts of the patient or direct patient care providers were positive either in nares or hands for VISA. The findings suggest that the pathogen may not be particularly hardy in the environment, especially when compared to the sustained presence on surfaces found with vancomycin-resistant enterococci (VRE), Boschetto says.
"MRSA does not seem to seem to be very hardy in the environment, and in our institution we have had trouble finding it on environmental surfaces," she says. "And I think because this patient was in isolation for VRE as well, all the dealings that people had with this patient were [under] antibiotic-resistant precautions."
The isolation system used at the hospital for such situations calls for dedicated patient equipment and for workers to don gloves upon entering the room, she adds.
With all the attention given to infection control in light of the case, Boschetto emphasized hand washing as a hospitalwide performance improvement (PI) indicator for 1998. As with other PI indicators in the hospital program, hand-washing compliance is monitored and reported on a quarterly basis by every clinical department in the medical center, she says. The impact is already apparent in the decline in clusters of suspected nosocomial infections, she says.
"That data are coming in and it is amazing," Boschetto says. "We are normally following up a couple of problematic situations a month, and we have only followed up one in the past six months. The fact that this 'bomb' hit drew everybody's attention to how important this situation is."
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