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Infection workers battle bugs, bad habits

Hospital infection experts say they wonder how they’re supposed to beat back the MRSA superbug when they can’t get their colleagues to wash their hands.
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Stopping the spread of a potentially deadly drug-resistant staph infection has riveted the attention of the nation’s hospitals and nursing homes, especially after a year of headlines and public panic, a new survey of infection prevention workers shows.

But frontline experts gathered here for a national conference said they wonder how they’re supposed to beat Methicillin-resistant Staphylococcus aureus — known as MRSA — when they can’t get their colleagues to wash their hands.

“They’ll know somebody is watching and they still won’t wash!” said Kathy Bryant, a registered nurse and infection control director at Spartanburg Regional Hospital in Spartanburg, S.C.

Bryant was among more than 2,000 infection experts who responded to a MRSA survey by APIC, the Association for Professionals in Infection Control and Epidemiology. The agency was the first to note last year that the prevalence of MRSA was at least eight times higher than previously estimated.

About three-quarters of respondents to the APIC survey said their hospitals and health care centers have done more to educate staff members and implement stricter procedures for tackling MRSA in the year since the so-called superbug became a household word.

But more than half of the respondents said that health facilities aren’t doing nearly enough to reduce the risk of the drug-resistant bacteria linked to more than 94,000 infections and nearly 19,000 deaths in the United States in 2005. They also called for increased staffing and greater resources to meet the demand of public scrutiny over hospital-acquired infections.

In particular, the infection experts said more effort is still needed to address basic precautions such as adequate hand hygiene among doctors, nurses and other health workers and to ensure that housekeeping procedures guarantee that the environment is sanitary.

“It’s the areas where they have the greatest issues in compliance,” said Kathy Warye, APIC’s chief executive officer. “It needs to become a routine part of care instead of an interruption in care.”

Less than half of U.S. health workers wash as often as they should, multiple studies indicate, and frustration over that figure was evident among the more than 4,000 infection experts gathered for APIC’s annual conference.

“It doesn’t matter if it’s God himself or the governor or whoever, you have to wash up,” said Rebecca Peters, an infection control staffer at York Hospital in York, Pa.

Infection preventionists, as they like to be called, say they face a range of resistance in trying to implement standards. Some health workers blame too little time, too many patients and inconvenience for their failure to wash correctly every time. Low-paid housekeeping staffers may not understand correct cleaning procedures or fail to implement them consistently, Bryant said.

Even her local fire marshal got in the way of good hand hygiene by limiting the number and placement of hand sanitizer dispensers for fear that the alcohol-based gel could be a fire hazard, Bryant added.

Some infection workers said they’ve made great strides by implementing new programs that empower workers at all levels to suggest improvements and flag mistakes.

“You find out who’s doing it right,” said Donna Fellerman, a registered nurse at Johns Hopkins Hospital in Baltimore. “You value your housekeepers as much as your doc.”

Even so, it’s slow going changing a culture to make infection control procedures mandatory for everyone, said Peters, who spent 25 years as technician in a microbiology lab.

“You have a lot of hospitals where docs just don’t want to do it,” she said.

So when she recently observed a doctor perched on the bed of a patient with active MRSA with no gloves and no gown, Peters didn’t hesitate to intervene. Although he thanked her for the reminder, the doctor didn’t like being rebuked, Peters said.

“But he probably didn’t do that again,” she added.