Most hospitals follow CDC guidelines, which have not explicitly recommended routine active surveillance cultures to identify and isolate patients with superbugs, even though more than 140 studies have shown that MRSA and VRE can be controlled this way, Farr says.
Interestingly, the CDC advises routine HIV screening of adults, adolescents and pregnant women in health care settings, but does not recommend universal testing for MRSA, which kills more people than HIV.
Meanwhile, physicians say that it is tough to get health care workers to take even the simplest precautions such as scrubbing their hands between patients. Patients will no doubt be stunned to learn surveys show that compliance with such rules now hovers at only around 50 percent on average at medical institutions in this country.
"We have the knowledge to prevent these, and what has been lacking is the will, the energy, the pressure to do it," says former lieutenant governor of New York, Betsy McCaughey, chair of the nonprofit Committee to Reduce Infection Deaths (RID). But the climate is changing fast, she adds.
"Hospitals are moving into a new legal environment," she says. "As long as it was believed that hospital infection was the inevitable risk you faced in the hospital and nothing could be done about it, hospitals were protected from lawsuits." But that is no longer the case as more and more people come to recognize that these infections are mostly preventable.
The law itself has begun to change. U.S. Rep. Tim Murphy (R–Pa.) has proposed the Healthy Hospitals Act of 2007, which would require hospitals to publicly report their infection rates as well as provide economic incentives to those that successfully reduce their rates. Since 2003 19 states have passed legislation requiring hospitals to report their infection rates: Colorado, Connecticut, Delaware, Florida, Illinois, Maryland, Minnesota, Missouri, New Hampshire, New York, Ohio, Oregon, Pennsylvania, South Carolina, Tennessee, Texas, Virginia, Vermont and Washington. These laws vary dramatically: some states impose penalties as high as $1,000 per day for hospitals that fail to comply, whereas others have almost no enforcement power, says Lisa McGiffert, manager of Consumer Union's StopHospitalInfections.Org, a project aimed at getting states to publish infection rates of hospitals and other health care facilities. (The site provides recent information on hospital infections and an online forum where over 1,800 victims have shared their experiences. It also encourages citizens to sign petitions and write letters to hospitals and government officials.) Reporting infection rates "stimulates activity," McGiffert says. "Once a bill passes in a state, hospitals start getting better," she says, noting that it's still too early to see a cause-and-effect relationship.
But Michael Bennett, president of the lobbying group Coalition for Patients' Rights (CPR), says that "hospitals have a huge disincentive to accurately report their infections," and "there are countless ways that a reporting system can be gamed." Reporting laws are good, Bennett says, but "there is no data that I'm aware of that suggests reporting has lowered infection rates or the numbers of infections."
RID's McCaughey says that hospitals need to take the problems seriously and not skimp when it comes to forking out funds to do the job properly. In addition to saving lives, she notes that "We can show hospitals that they can be more profitable by preventing infections." She estimates that hospital infections add at least $30.5 billion a year to the nation's health care tab in hospital costs alone—enough to pay for the entire Medicare (Part D) prescription drug program. According to a recent article in The Lancet, "virtually all published analyses that have compared the cost of screening of patients on admission and using contact precautions with colonized patients" show that "the costs of caring for patients who become infected with MRSA are much greater than the costs of screening programs."