This is the first installment in an occasional series about antimicrobial resistance, which is one of the planet’s most challenging public health threats.
Maybe you don’t worry much about MRSA. Or maybe you’ve never heard of it, let alone reported on it. If you are on the healthcare beat, though, maybe it’s time.
Infections of methicillin-resistant staphylococcus aureus—MRSA—come at people in all sorts of ways. A boy playing football, say, gets scratched by a cleat. Next thing you know, he’s in the emergency department with a raging infection on his leg. Or, someone scratches the inside of his nose and ends up with a most painful condition. More dangerous, however, is when MRSA hits inside a hospital or nursing home. Highly contagious, it can make people really sick. And for patients who are immune-compromised or otherwise medically vulnerable, it can be a killer.
Staphylococcus aureus (staph) is a bacterium that lives naturally on our skin. It doesn’t typically pose a problem unless a break in the skin allows it into our bodies (the nose is a common gateway) and even worse, into our bloodstreams. Methicillin is one of several antibiotics in the penicillins class of drugs, which, since the 1940s, has been widely and successfully used to treat staph infections.
Antibiotic/antimicrobial resistance, meanwhile, is a phenomenon that we humans have created by overusing or improperly using methicillin and many other common antibiotics. That abuse—let’s call it what it is—has resulted in the “super bugs” that we’re always hearing about: Bacteria have become resistant to the drugs we’ve been using against them for more than 80 years. And now we’re in trouble, working double time to find ways of saving ourselves from these mutating microscopic marauders.
Want to know how serious a problem MRSA is? There are thousands of books, articles, personal narratives, and organizations devoted to the scientific, societal, and social aspects of the threat. For an educational kick-start, check out Maryn McKenna’s 2010 page-turner, Superbug: Fatal Menace.
McKenna’s passion for MRSA coverage didn’t end with her book. She regularly writes about antimicrobial resistance and related topics. Recently, she was one of a handful of reporters who covered a recent study in the New England Journal of Medicine, which found that the best way to prevent MRSA bloodstream infections in the intensive care unit was to bathe all ICU patients with chlorhexidine soap—routinely used in most hospitals—every day, and to rub antibiotic ointment inside their noses.
This may not seem like a bombshell, but it addresses an ongoing clinical conflict that is central to this study: Do we screen everyone for MRSA and treat him or her accordingly? Or, as the NEJM study suggests, should we just act on the assumption that everyone is vulnerable and should be protected ahead of time?
In her story for Wired last week, McKenna did a great job of explaining in plain English why MRSA is important and how it affects us all, how there are those two schools of thought about dealing with it, how the study was done, and how, as a high-quality randomized clinical trial, it is relevant to real-world clinical practice. She even posted the actual study protocol, the business plan of the research, so to speak, which provides every possible detail about why, how, where, and on whom the study was conducted. It’s a rare treat for those of us who like to delve into the nitty-gritty of clinical research and sometimes, is valuable in investigative work. This is how medical-study reporting should be done.
And while their pieces may not have the depth of McKenna’s work, other reporters deserve kudos for tackling the subject. Sherry Jacobson did a short-and-sweet piece in The Dallas Morning News. NPR’s Rob Stein added his take to the Shots blog. And despite the canned video news release clip from the Centers for Disease Control, Lena H. Sun’s wrap-up in The Washington Post covered the bases, and ends with a particularly pleasing note: “In many hospitals, nurses already wash patients using cloths containing mild soap.”
Yes, we do. And we also have been using chlorhexidine wipes and soaps for years. And we also will sometimes want to stick a Q-tip with antibiotic ointment up your nose, just a little, so don’t fidget.
Sibyl Shalo Wilmont covers healthcare policy issues for The Second Opinion, part of CJR’s politics and policy desk, the United States Project. Follow the project’s work on Twitter @USProjectCJR and follow her @nursesibyl.