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THE GERM LURKS IN UNEXPECTED PLACES:
The patient’s TV remote // A visitor’s handbag // The doctor’s gown // A nurse’s computer keyboard // A thousand other spots from which it could be erased but isn’t—and so kills tens of thousands of Americans each year.

A Killer Called Staph

By Wendy Orent // Winter 2006
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Alan THornton/Getty Images (Sink); Dennis Kunkel/Phototake (Staph)

T he 84-year-old patient, “Mr. S.,” has been transferred from a nursing home in Atlanta to one of the city’s large public hospitals. He lies in bed, barely conscious, wearing a diaper and a urinary catheter. An IV delivers heparin to ward off blood clots, and a solution of dextrose and water to prevent dehydration. His leg has been amputated below the knee, a result of the diabetes. He shivers while his student nurse, “Christian,” perspires in the overheated room. Mr. S. retains enough awareness and gentility to thank the young man who has spent 40 minutes helping him coax down bits of food.

Christian wears a disposable gown and double gloves but no mask, a fact that makes him uncomfortable. Mr. S.’s skin is sloughing off because of two infections—MRSA, or methicillin-resistant Staphylococcus aureus, and VRE, or vancomycin-resistant Enterococci. Both infections, but especially the first, are rampant in U.S. hospitals, and they’re very hard to cure.

Before leaving the room, Christian sheds his gown and gloves, dumps them into the biohazard disposal unit and rubs his hands thoroughly with disinfectant. Outside, before going on to his next patient, he stops off at the bathroom to scrub his hands with hot, soapy water.

In this single instance, the relentless chain of transmission that has made MRSA a lethal threat in most U.S. hospitals has presumably been broken by the attentiveness of one young man. But Christian is only a student. He isn’t yet subject to the intense pressures that send nurses in his big-city hospital dashing from one patient to the next, caring for 10 when four is supposed to be the limit. Nor is he a harried physician who, striding quickly through the corridors on morning rounds, may not notice that his gown has brushed against a patient’s bed and does not realize that he could be transmitting an infection from the last patient to the next, even if he touches neither.

Carried from person to person in a thousand ways, MRSA and other hospital-borne infections exact a monstrous toll. According to the U.S. Centers for Disease Control and Prevention (CDC), each year these virulent bugs afflict 2 million patients and take some 90,000 lives. Those who survive may suffer debilitating illnesses for months or years.

Though rates of MRSA infection in many European hospitals have dropped to almost undetectable levels, multidrug-resistant staph is widespread in the United States. It doesn’t get the media attention of avian flu, SARS or Ebola, but it is a far deadlier and more insidious threat—all the more so because the spread of staph infections in hospitals is a product of the way medicine is practiced in this country.

“If God wanted to send us a plague to expose the weaknesses of American medicine, that plague would be MRSA,” says Peter Perreiah, managing director of the Pittsburgh Regional Healthcare Initiative (PRHI), a 42-hospital collaborative that has worked to eliminate the MRSA scourge. According to Perreiah, MRSA has become “a leading cause of hospital-acquired infection” in the United States. “Preventing it is about fixing our health-care system,” he says.

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A Brief History of Staph

Joseph Lister

Charting the progression of today’s hospital terror.

MRSA by the Numbers

Some countries have the problem well in hand; others don’t.

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hed-dossier

1. The Doctors’ Plague: Germs, Childbed Fever, and the Strange Story of Ignác Semmelweis, by Sherwin B. Nuland [Norton, 2003]. A moving account of Semmelweis’s fierce campaign to eliminate one lethal kind of hospital-acquired infection, puerperal fever, before germs were even recognized as the agents of disease.

2. Hospital Infection: From Miasmas to MRSA, by Graham A.J. Ayliffe and Mary P. English [Cambridge University Press, 2003]. An excellent introduction to both the history of hospital-acquired infections and the present problems, including the evolution of antibiotic resistance.

3. Evolution of Infectious Disease, by Paul W. Ewald [Oxford University Press, 1994]. An indispensable text for anyone who wants to understand how bacteria like S. aureus evolve to become deadly threats.

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