As parents phoned school officials with worries about staph infections, Maryland lawmakers and health officials pledged renewed efforts yesterday to rid hospitals of drug-resistant bacteria that might be causing up to 19,000 deaths a year nationwide.
Their actions came in the wake of a national study indicating that the incidence of invasive methicillin-resistant Staphylococcus aureus, known as MRSA, is twice as high as doctors previously estimated.
State Sen. Lisa A. Gladden, a Baltimore Democrat, said she plans to reintroduce a bill requiring hospitals to test incoming patients at risk for the bug. Similar legislation has died twice in the face of opposition from the Maryland Hospital Association.
"We need to stay on this until people begin to see this as the health crisis that it is," Gladden said.
The agency that reviews Maryland hospitals plans to propose regulations requiring them to screen intensive- care patients for MRSA and report results to regulators beginning next year.
Those tests could be performed with a nasal swab when patients are admitted and during their treatment, said Pamela W. Barclay, director of the Center for Hospital Services at the Maryland Health Care Commission.
At the state health department, officials said they hope to expand the number of hospitals they monitor for MRSA and tighten overall infection-control regulations.
MRSA is a potentially lethal bacterium that has developed strong defenses against antibiotics such as penicillin, amoxicillin and oxacillin.
People typically carry MRSA in their noses without developing symptoms but can transmit it unknowingly by wiping their noses and touching a surface later touched by someone else.
Infections can occur in community settings such as gyms and locker rooms, but they're common in hospitals and other health care facilities, where victims are weaker and the strain of MRSA is more virulent.
Researchers reported in yesterday's Journal of the American Medical Association that MRSA made an estimated 94,000 Americans seriously ill and killed almost 19,000 in 2005 -- compared with 17,000 deaths from AIDS.
The news alarmed parents who were already concerned about reports of staph infections in schools in Anne Arundel County and other jurisdictions.
But John M. Colmers, Maryland's secretary of the Department of Health and Mental Hygiene, said there's no reason for parents to panic. The invasive strain of MRSA that attacks vital organs and was the focus of the national study is far more dangerous than the topical cases being reported in many schools.
"Some of the school problems can become invasive, but that's very rare," he said.
Baltimore City and Harford County officials said they have no reports of school-based MRSA cases. Nor have Baltimore County school officials, although many parents have been calling schools.
"Given the recent media attention and coverage, people want to be informed and aware," said Kara Calder, the Baltimore County schools spokeswoman.
The system's school nurses treat all skin infections as though they could be communicable -- they cover the infected skin, advise the student to see a doctor and follow up with the student, she said.
To help prevent the spread of skin infections, school nurses regularly remind athletic directors and coaches to screen students for infections and to clean equipment after each use, Calder said.
Carroll County health officials said they have received a number of reports of antibiotic-resistant staph bacteria. Marge Hoffmaster, supervisor of health services for the Carroll schools, said she and other school officials might create some basic guidelines to be followed as precautionary measures.
Anne Arundel County has had more than 50 reports of staph infections in 13 public schools, including nine high schools, said Elin Jones, a spokeswoman for the county Department of Health. Only one case of MRSA has been confirmed, she said.
There is no way to determine whether -- or how -- these cases could be linked, she said.
In Howard County, health officials have instructed school administrators to conduct regular, daily cleaning and disinfecting of "common surfaces" such as tables in libraries, lockers and desks in classrooms.
Howard school officials also plan to send a letter to parents in the wake of a second case of staph reported in less than a week at Wilde Lake High School in Columbia.
"We're in constant contact with the health department," said spokeswoman Patti Caplan. "We're taking it seriously. This is not unique to a school setting, but we want to make sure we do everything we can to lessen the chance of students contracting this in our settings."
Publicity over the study is likely to reignite a legislative fight over attempts to force hospitals to increase screening of patients who might carry MRSA.
Gladden plans to renew her efforts to require testing of incoming patients who might be at risk for MRSA -- such as those coming from nursing homes.
But at least two similar attempts have died in committee because of opposition from the Maryland Hospital Association.
Nancy Fiedler, a spokeswoman for the MHA, said that group is committed to reducing hospital infection rates but opposes statewide mandates requiring the testing of all hospital patients for MRSA. It's better to let hospitals come up with their own solutions, she said.
"The idea that 'you must take this approach' limits the hospitals individually from having the ability to develop programs that work for them," she said.
However, proponents note that testing every patient on admission has cut down on infection rates in Denmark and the Netherlands. Those who test positive get their own rooms, and personnel take special hygiene precautions around them.
Such precautions would probably work in Maryland, but costs could prove prohibitive, some experts say. "If we could afford it, yes, I think it would be a great idea," said Mark E. Shirtliff, an assistant professor of biomedicine who studies MRSA at the University of Maryland Dental School.
Maryland health officials said they will expand monitoring MRSA to hospitals and labs beyond Baltimore City. Baltimore had the highest MRSA rate of the nine regions in the federal study published yesterday; officials said that might be the result of data concentrated on an inner-city population.
"We don't really know why that is yet, but one of the possibilities is the high number of intravenous drug users in the city," Colmers said.
dennis.obrien@baltsun.com
Sun reporters David Kohn, Sara Neufeld, Lauren Brown, Madison Park, John-John Williams IV, Arin Gencer and Gina Davis contributed to this article.
Two types of MRSA infections
Community-associated
Where it tends to spread:
In crowded places with poor hygiene, such as prisons, gyms and locker rooms.
How it spreads:
Community-associated MRSA usually attacks via broken skin, a cut or a small scratch.
Appearance:
The infection "often looks like a spider bite," said Dr. Margaret Toth, chief quality officer with the Delmarva Foundation.
Symptoms:
As the infected area enlarges, victims may suffer fever and chills.
Progression:
If left untreated, the infection sometimes spreads to blood, lungs, bone or other tissue.
Health care-associated
Where it tends to spread:
In hospitals and other health care facilities, usually among patients who are sicker and more vulnerable. "Generally it's people who have some kind of chronic condition," Toth said.
How it spreads:
Health care-associated MRSA also attacks via broken skin, a bedsore, a cut or a small scratch.
Appearance:
Usually linked to post-surgical wound infection or bloodstream infection.
Symptoms:
As the infected area enlarges, victims may suffer fever and chills. This strain often causes pneumonia.
How to prevent MRSA
Improve hygiene by washing hands frequently with soap and water as well as using anti-bacterial gels. Wash clothes, towels and sheets regularly.
[David Kohn]