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.
The genus Staphylococcus consists of several related species, of which two, S. aureus and S. epidermidis, are human pathogens. These spherical bacteria, which cluster in irregular bunches (Staphylococcus is derived from staphyle, the Greek word for a bunch of grapes), frequently colonize the skin and nostrils of their human hosts.
Only the severely immunocompromised fall victim to S. epidermidis, which is normally harmless. But S. aureus, named for the golden-yellow colonies it grows on agar and other media for growing bacteria, can infect otherwise healthy individuals, attacking a range of human tissues. Any cut or abrasion may allow S. aureus an entrance. Sometimes only a small pimple results; at other times, S. aureus produces boils (a hair-follicle infection), abscesses, impetigo (a potentially serious, spreading skin condition) or cellulitis (another skin infection). Staph infection in the bloodstream produces often-fatal septicemia; osteomyelitis (infections in the bone) may not be fatal but can persist for decades.
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