I began my quest: A MRSA infection

Kathy Day’s story:
My father had a minor fracture of his ankle, and was in the hospital for 12 days of rehab, and then was home for a day and a half. Then he collapsed, and was brought back to the hospital. On admission, they diagnosed him with pneumonia. After he was in the hospital for six days and after he developed a MRSA urinary tract infection after a catheter insertion, I asked for a sputum culture (I'm a retired E.R. nurse, so I know about these things). It took them a day and a half to get the results, which showed them it was a MRSA infection. We'd been visiting him with no precautions; now they told us to use full precautions – gowns, gloves, and masks.

Dad was in the hospital for a total of 20 more days. He suffered through sepsis, complete loss of energy, appetite, and independence. He got blood transfusions, and very strong IV antibiotics. His treatment caused him thrush, a body-wide allergic reaction and loss of hearing. He had been living independently with my mother at home before. Once his acute care (hospital) was "complete" he was sent to a nursing home. He had become a totally bed-bound nursing home patient because of this, and couldn’t sit up without passing out. After nine weeks in the nursing home, in an isolation room, he became very depressed. In total, he lost a third of his body weight. He never walked again. What happened to him wasn’t so rare, as a month before he’d been admitted, two joint replacement patients had had MRSA in the same small 25-bed hospital, and had died from it.

After this happened to my father, I began my quest for MRSA prevention. I wrote letters to the hospital, did research, and came upon Jeanine Thomas, who was the founder of MRSA Survivors Network in Chicago. She's a real powerhouse! She got a law passed in Illinois. Then I wrote a proposal for Maine, got the necessary support and a sponsor, Representative Adam Goode. We passed a law in June 2009 to screen all high risk patients for MRSA on hospital admissions.

Kathy Day's advice: If someone is at risk for MRSA, e.g., they're elderly, coming from a nursing home, with ongoing health problems, or are about to have implant surgery, request MRSA screening from the admitting physician for their own safety. For an elective admission, it's best to be screened a week or two ahead of time to allow decolonization (to clear the MRSA from the patient's body) through five days of preparation, including showering daily with Hibiclens, and the ointment Mupirocin for the nose, which is a prescription antibiotic. If you test positive for MRSA before entering the hospital, you should be either isolated or cohorted (roomed with someone with a like organism).

There's a higher risk of infection for surgery involving implants, e.g., knee or hip replacements, or cardiac valve replacements.

Read Jeanine Thomas' MRSA story.

I was not a threat to anyone: Tuberculosis miscommunication

Andrew Speaker, a young, newly married personal injury lawyer, had just found out he had a form of tuberculosis that is resistant to multiple drugs that are usually effective. He felt fine – but he knew he’d need a lobe of one lung removed, and would need IV medicine almost every day for two years or so. But he thought at the time, "I was not a threat to anyone – that was the impression I was under."

The Centers for Disease Control told him they preferred that he not leave the country. He may have been told he was contagious or slightly contagious, but not highly contagious.

Andrew flew on a plane to Italy, and then returned to the U.S., later to go to an isolation room in a Denver hospital.

Now this has become the subject of intense publicity and formal investigation about the role of CDC, the Department of Homeland Security and patients about quarantining tuberculosis patients.

It seems from an interview transcript that Andrew had been told of his disease and contagiousness, but downplayed its significance, perhaps from wishful thinking. He is a highly educated person, and his father-in-law is a TB researcher at CDC. Even bright and well-informed people like Andrew sometimes don’t listen well when the stakes are so high and so personal.

Such miscommunication between patients and health care workers and providers often occurs. Perhaps the CDC staff spoke too indirectly, trying to be polite, rather than prescriptive, in saying they “prefer” Andrew should not get on a plane. Their indirect communication may have muddied their message. Or maybe Andrew just didn’t hear them.

Advice: Tape-record your doctor’s appointments so you can be sure to hear everything clearly.

Thanks, Dr. Vicki Rackner.


Read one of our patient compliance stories, or read more from the CNN transcript of an interview from an isolation room in a Denver hospital.