Sunday, July 25, 1999 — Nerith Shore News — 3

north shore news

GUNDAY FOCUS

NEWS photo Brod Ledidgo

DR. Brian O'Connor, regional medical health officer for the North Shore Health Region: “1 can tell you right now that every hospi-
tal in Vancouver has got (the antibiotic-resistant ‘super bug’) in it right now, and probably just about every long-term care facility.”

Michas! Becker

News Editor
michael@nsnews.com

LAST month Lions Gate Hospital
(LGH) closed off a medical ward on
the fourth floor when staff discovered
an outbreak of an antibiotic-resistant
“super bug.”

Germs can be bad news at the best of times,
but when words like “outbreak” and “super bug”
are bandied about by hospital staff, people tend to
pay attention.

_ The nasty germ in this case is something called
Methicillin. resistant Staphyloceccus aurcus
(MRSA).

MRSA has been linked to deaths in unhealthy
people elsewhere and has bedevilled staff in
European and North American hospitals for
years,

According to LGH pathologist Dr. Janis
Scholey, the hospital became aware of two initial
cases on the fourth floor at the beginning of June.

On June 13 hospital spokesman Clay Adams
reported that seven patients had tested positive as
carriers of MRSA. By June 18 Adams was saying
that 2] cases of patients carrying MRSA had been

.. identified. Ar the time Adams said the outbreak
had peaked June 15.

But Scholey said the outbreak eventually

. plateaued at 30 patients. Twenty per cent of those

ople. would have had infections. Some were still
: being treated as of July 13.

There have been prior MRSA outbreaks at
LGH. Two summers ago there was an outbreak
in the hospital’s intensive care unit. Said Schoiey,
“It was brief and small and we were able to get a
handle on it quickly.”

About five years ago an MRSA outbreak
struck on thésusgical floor at LGH.

“Bur the numbers were not as big as this par-
ticular one we just had,” Scholey said.

Infection rates vary depending on the nature
of the ward. In the case of an outbreak in a med-

, ical ward, of those patients affected, somewhere in
the neighbourhood of 20% would be infected and

80% would be colonized (carriers).

Infections are more of a problem in a surgical

ward. Said Scholey, “Many of the patients have

wounds and intrusive devices. Of a group affect-
ed on such’a ward, up to 40% would have been
infected and 60% would be colonized. The situa-
~ tion varies irom ward to ward, Intensive care area

” js another place where MRSA infection rates will

be high.”

While MRSA generally lives unobtrusively on

"people and surfaces in hospitals and elsewhere, an

outbreak in a medical institution becomes a threat

LG

Preventive measures

THE following simple precautions will
protect you and help to prevent spread of
MRSA and other germs from person to
person.

Thorough hand washing is the single
most effective measure that can be taken
by all. Hands should be washed well with
soap and water and dried thoroughly with
a dean towel, disposable paper towels or
hor air drier:

R before cating or drinking;

before dealing with grazes, scratches or
cuts;

B after giving personal care to someone,
for example changing diapers, assisting to
wash;

@ after houschold tasks, for example bed-
making, handling the washing, dusting;
Bafter using the toilet;

B after blowing your nose.

Where possibie take frequent baths or
showers and wash hair regularly.

Do not touch or squeeze spots or pim-
ples with your fingers.

Keep cuts covered with a dressing until
they appear dry.

— Source: Dorset Health Authority

to those in weakened health conditions and a
chalienge to health-care providers who must cope
with the fallout.

Dr. Brian O’Connor is the regional medical
health officer for the North Shore Health Region.
It’s his job to deal with public health issues.

Said O’Connor, “This is not an issue that is
particular to Lions Gate. I can tell you right now
that every hospital in Vancouver has got MRSA in
it right now, and probably just about every long-
term care facility.

“You definitely want to keep your hospital
infection rate down from whatever bacteria. You
don’t want to have someone coming in, perfectly
healthy, having 2 sucgical procedure and ending
up with a post-operative infection. Even if it’s just
delayed healing, there are complications.”

O’Connor said hospital staff'and patients alike
expressed concerns regarding persona! health

* implications during last menth’s outbreak. “The

way I’ve explained it to people, it’s unfortunate
that this has been called a super bug. It’s not a
particularly super bug. It’s the same Staph-aureus
that’s probably been around since the beginning
of time that causes the same infections to the
same degree with the same degree of virulence.

It’s super because it’s resistant to a number of
antibiotics.”

He said heaith-care workers in acute institu-
tional settings do not particularly need to be con-
cerned about getting MRSA — it’s not some-
thing they’re going to be taking home.

But said O'Connor, “The issue here is they
need to be sure that they engage in good hand-
washing and personal hygiene. They pose a
gecater risk to the patients. If they move from ong
patient who may be colonized or infected with
MRSA and they move to another patient and they
haven’t washed their hands, it can live for a peri-
od of time on their skin.”

O’Connor added that people associated with
those who are either colonized or infected with
staph-aureus need not avoid physical contact with
the person. Hand-washing and attention to
hygiene remain the first line of defence against
spreading the germ.

Scholey notes there were massive outbreaks of
Staphylococcus aureus in hospitals during the
1950s. By then, the bacteria had become peni-
cillin resistant. Methicillin became the next level
of defence. “The Methicillin resistant bug (relat-
ed Cloxacillin and Oxacillin antibiotics inclusive)
is getting smarter,” she said.

Scholey said the hospital tests all cases of
Staphylococcus aurcus to see if they are sensitive
or resistant to Methicillin.

A risk-assessment program was launched sev-
cral years ago at LGH to check for MRSA. “We
ask patients if they have been ins other hospitals or
facilities within the last several months. If they
have, we check them. Some people may know
they have it.

“Last year we found that less than 3% of our
Staph-aureus were resistant to Methicillin. So in
our hospital population, in a non-outbreak sce-
nario, we have a very low incidence of resistance
to this antibiotic,” said Scholey. The pathologist
said the rates of resistance arc “extremely vari-
able” from region to region across Canada.

“Resistance levels always start out higher in
the U.S. and then the east (of Canada) and then
it travels west,” she said.

Although it has never been measured, Scholey
expects the rate of MRSA carriers within the gen-
eral community would be in the neighbourhood
of less than 3%.

Scholey and O’Connor said they are not aware
of any deaths attributed to MRSA outbreaks in
the hospital and health region.

The hospital is attempting to quantify the
extra costs incurred due to last month’s outbreak.
Costs increase because infected people need to be
isolated, additional protective measyres must be
taken by medica! personnel, more nursing time is
required and cleaning costs increase.

Antibiotics
losing in
germ warfare

Michael Becker

News Editor
mickacl@nsnews.cem

AMONG competitive world
germs, Methicillin resistant
Staphylococcus aureus (MRSA) is a
real winner.

It is a good example of the genetic phe-
namenon of natural selection — survival of
the fittest.

Staphylococcus aureus tends to live in the
lower colon of humans. The principal area of
colonization elsewhere in people is in the
nose and the perineum (between anus and
genitals).

The germ is actually carried in the noses
of 20% to 40% of healthy people. It is com-
monly found on skin and usually doesn’t
cause much trouble there.

Burt when skin happens to be broken, the
germ may lead to boils, wounds and other
infections.

Hospital or long-term care patients are
particularly vulnerable to infection with the
germ because they are sick or have surgical
wounds.

Patients are at risk duc to the potciitial of
transmission of organisms such as MRSA
from the hands of medicai staff or contami-
nated health-care equipment.

Those most at risk for MRSA include
patients with weak immune systems, burn
patients, intubated patients, those with
catheters, surgical wounds, or dermatitis.
There is also risk to those with prosthetic
devices, heart valves, and postoperative
wound infections. '

Additional risk is posed by prolonged
hospital stay, extended therapy with muluple
or broad-spectrum antibiotics and proximity
to those colonized or infected with MRSA.

MRSA acts in the same way as ordinary
Staphylococcus aureus. It does not cause dif-
ferent or more serious infections, but MRSA
infections are .nore difficuic to treat. There
are fewer antibiotics to treat then: with.

Dr. Murray Abramson is an infectious dis-
ease physician who conducted a study for
Duke University Medical Center on health
costs of MRSA. According to Abramson,
when was introduced in the 1940s it was an
effective antibiotic against almost all strains
of Staphylococcus aureus. By 1997, 99% of
the germ was resistant to penicillin.

In 1981, according to Abramson, about, -
5% of Staphylococcus aureus in hospitals was
methicillin resistant. ‘Ten years later the per-
centage had risen to 38%. . :

Abramson told a conference of his peers
that by 1997 about half were resistant to the .
antibiotic at many medical institutions in
North America.

Treatment is now limited to Vancomycin
and Imipenem.

Hospital patients. with MRSA. must be:
isolated and strict precautions must be imple-
mented to prevent spread to others.

The Centres for Disease. Contro] and
Prevention, an’ agency of the U‘S.
Department of Health and Human Services.
estimates that more than 2 million Americans
each year acquire in-hospital, .infections.
Some 60,000 to 80,000 die. Staphylococcus
aureus is responsible in most ‘cases. ;

Meanwhile according to the Duke study,
researchers found that the average hospital:
stay due to MRSA was 12 days longer, com-
pared to four days longer for methicillin-sus-
ceptible Staphylococcus aureus (MSSA). The
average cost per patient duc to MRSA infec-
tions was $27,082, compared to $9,661 for
MSSA- infected patients.

According to the World Health
Organization, the widespread use of antibi-
otics outside of the medical setting is com-
pounding the challenge humans face from:
hardy microbes. . ee

Antibacterial agents are widely used in
agriculture for livestock and crop production
and in fish farming. These additional uses
serve to encourage the emergence of germs
resistant to estabiished treatment. :