Healthcare Hygiene magazine November 2019

under the microscope By Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc HAIs: Everything Changes When It Happens to You T he Centers for Disease Control and Prevention (CDC) estimates that 1 in 25 hospital patients get a health- care-acquired infection (HAI). Research suggests that a growing number of HAIs are caused by pathogens that are outsmarting the antimicrobials typically used to fight them. These are known as antibiotic-resistant germs, sometimes referred to as superbugs. Antimicrobial resistance (AMR), in my professional opin- ion, is one of the most critical public health and healthcare issues of the 21st century. They have devastating effects on physical, mental/emotional, and financial health. In addition, they cost billions of dollars in added expenses to the healthcare system. The World Health Organization (WHO) predicts that by 2050, AMR will have a $100 trillion economic impact globally as a mortality of 10 million people. If one does the math, this means that approximately one new AMR infection will occur every three seconds. At this pace, AMR/HAIs will surpass cancer as the No. 1 killer by 2050. When I answered the phone at home one evening in late December 2007 and heard the voice of a worried woman, the genesis of an idea for my future research path began to take shape. She was concerned about her husband, she said. The retired Utah couple had traveled over the holidays and the husband, a cancer patient, developed sores on his torso. They went to the emergency room, where a doctor diagnosed a staph infection and prescribed antibiotics but ordered no lab tests. The man’s condition worsened, so he went to his family doctor. After an examination and some laboratory tests, the doctor determined that the man had methicillin-resistant Staphylococcus aureus (MRSA) — an infection that cannot be treated with most typical antibiotics. Studies show that about 1 in 3 (33 percent) people carry S. aureus bacteria in their nose, usually without any illness and approximately 5 percent of patients in U.S. hospitals carry MRSA in their nose or on their skin. I remember it like yesterday – such a vivid reminder of the confusion, concern, and plight of these individuals dealing with such a difficult healthcare problem. The wife of the patient from Utah had some basic knowledge about MRSA from media coverage and she was very concerned about what had happened to her husband at the emergency room given his immunocompromised state because of the cancer. She just wanted to know why this had happened and whether she or anyone else they had been in contact with should be concerned about transmission. MRSA first emerged as a serious infectious threat in the late 1960s as the bacterium developed resistance to penicillin. Vancomycin has been used as treatment for MRSA, but now 10 even vancomycin-resistant strains are emerging. Although the Staphylococci bacteria, including MRSA, commonly colonize the skin of healthy people, often posing little to no threat, these bugs are quick to exploit any opportunity to invade wounds, nasal passageways, or mucosal membranes where they can rapidly produce infections that can become life threatening. Fortunately, we are doing better in the war on HAIs. Progress in the latest report is based on information from the National Healthcare Safety Network (NHSN) on central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), surgical site infections (SSIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections, and Clostridioides difficile events. Nationally, among acute-care hospitals between 2016 and 2017, report highlights include:  About 9 percent decrease in CLABSIs  About 5 percent decrease in CAUTIs  About 3 percent decrease in VAEs  No significant changes in abdominal hysterectomy SSIs  No significant changes in colon surgery SSIs  About 8 percent decrease in MRSA bacteremia  About 13 percent decrease in C. difficile infections Concerning HAIs such as MRSA, I feel particularly dedicated because of my interaction with the people I’ve interviewed and advised (including my family and friends). It is with this knowledge that I often tell my students (future medical laboratorians and nurses), family, and public that if you do nothing else when a physician or other healthcare worker prescribes you an antibiotic empirically or tells you it’s “just a regular staph infection,” be sure to demand a culture/ID and antibiotic susceptibility test. It just may save your life or that of a loved one. We can and must be better. If not, we all fail. We fail ourselves. We fail each other. And, we especially fail those patients who need our voice and advocacy – even those who don’t know what questions to ask. Rodney E. Rohde, PhD, MS, SM(ASCP)CM SVCM, MBCM, FACSc, serves as chair and professor of the Clinical Laboratory Science Program at Texas State; associate director for the Translational Health Research Initiative; as well as associate dean for research in the College of Health Professions. Follow him on Twitter @RodneyRohde / @TXST_CLS, or on his website: http://rodneyerohde.wp.txstate.edu/ november 2019 • www.healthcarehygienemagazine.com

Healthcare Hygiene magazine November 2019 | Page 10