California would have one of the most sweeping laws in the nation for tracking "superbugs" in hospitals and other settings under legislation that state Sen. Elaine Alquist (D-Santa Clara) plans to introduce this month.
This time, the hospital lobbyists who persuaded Gov. Arnold Schwarzenegger to veto a similar bill in 2004 will be up against a highly visible advocate. Riverside County resident Carole Moss has campaigned almost nonstop for such a law since the day in April 2006 that her 15-year-old son, Nile, died from a drug-resistant form of a staphylococcus bacterium.
In 2005, the year before Nile's death, an estimated 94,000 Americans suffered serious infections from methicillin-resistant Staphylococcus aureus, or MRSA, according to a recently published study by the national Centers for Disease Control and Prevention. About 19,000 died. The study found that 85% of these infections were from exposure to MRSA in hospitals and other healthcare settings.
Yet until Nile's death in an Orange County hospital, Moss had never heard of MRSA or realized that hospitals could kill as well as heal.
"Hospitals aren't clean and safe," Moss said. "This is the big secret that we've got to get out."
Alquist's bill would require hospitals and nursing homes to make public their infection rates, a measure that state hospitals opposed in 2004.
California Hospital Assn. spokeswoman Jan Emerson said the association could not comment on the bill, which is still in draft form, without seeing it first. In the past, hospital lobbyists argued that public reporting would leave them vulnerable to lawsuits over infections that patients may have contracted elsewhere.
MRSA is transmitted through skin-to-skin contact. Openings in the skin such as cuts or scrapes, contaminated items and surfaces, crowded living conditions and poor hygiene can aid its spread. Washing hands frequently and covering wounds are among the simplest preventive measures.
A strain of the bacterium known as community-associated MRSA has been cropping up in recent years in jails, among athletic teams, and in gyms and spas. Well-publicized outbreaks in middle schools and high schools last fall alarmed parents across the country.
Only invasive infections -- of the bloodstream, lungs or vital organs -- are potentially life-threatening. These are most likely to occur in hospital settings, where needles, catheters and open surgeries provide an entry point for bacteria.
About 20 other states have recently enacted public reporting laws for hospital-acquired infections, according to Lisa McGiffert, director of Consumer Union's Stop Hospital Infections Campaign, a nonprofit group that advised many of those states. More are expected to do so this year because of increased awareness of MRSA. Few states have laws as comprehensive as the one Alquist plans to introduce, McGiffert said.
Under the proposed legislation, California would join four other states in requiring hospitals to screen high-risk patients, such as those in intensive-care units, for MRSA upon admission. The bill would add MRSA to the list of communicable diseases that physicians and laboratories must report to county and state health departments for monitoring. It would impose anti-infection protocols and require hospitals to inform patients about the risks of infections.
"Healthcare needs to get focused on prevention and not just treatment," Alquist said.
Debby Rogers, vice president of quality and emergency services for the California Hospital Assn., said hospitals already are taking steps to contain MRSA. Last year, the association backed a compromise bill that requires hospitals to tell the state whether staffers were following guidelines to prevent infections, such as using sterile methods to insert catheters and administering antibiotics before surgery. Schwarzenegger signed that bill.
Hospitals prefer guidelines to mandates, Rogers said, because what works in one setting may not work in another or may have unintended consequences.
Moss doesn't trust hospitals to police themselves.
"They've had all of these years to do it voluntarily," she said. "Unless it's a law and unless there's a penalty, then people will just continue with the status quo."
Hospitals had been a regular part of Nile Moss' childhood. He was born with hydrocephalus, an excessive amount of the cerebral spinal fluid that ordinarily cushions and protects the brain. Neurosurgeons inserted a shunt to relieve the pressure, saving his life. Speech and other therapies and frequent check-ups followed. At 10, he had brain surgery again, to remove the shunt.
Nile continued to go to Orange County clinics and hospitals for his care even after the family moved to Riverside County. A month before he died, he had been to three hospitals for a series of annual exams. When he developed a headache and high fever that April, his parents took him to a children's clinic in Mission Viejo. Although unable to confirm a diagnosis, a doctor prescribed antibiotics for strep throat and sent Nile home.
A day later, Nile's fever spiked again, and he began to have trouble breathing. He was admitted to Children's Hospital of Orange County at Mission Hospital and died in the pediatric intensive-care unit early the next morning.
The death certificate listed pneumonia and a severe bloodstream infection. It wasn't until days after he died, when tests done in Nile's waning hours came back positive, that Moss first heard of MRSA.
Looking back, Moss does not know which, if any, of the hospitals Nile had been in that month could have been the source of the pathogen. But she believes that if all hospitals had been required to screen patients upon admission -- or if she had known enough to insist that tests be done -- her son might still be alive. Since 2004, a test has been available that can give results in hours, allowing the speedy administration of the few antibiotics that are still effective against MRSA.
Rather than filing lawsuits, Moss founded the nonprofit Nile's Project to push for reforms and educate other parents. She sought out Alquist because of the senator's success at sponsoring a bill allowing the state to fine hospitals for serious lapses in patient care.
"Carole is the perfect citizen advocate," Alquist said. "She has the passion, knowledge, and clarity to turn her family's tragedy into meaningful public policy changes that will help save others."