No mercy with the weak – MRSA on a disabled girl

Tevet 7, 5775

Whenever we see our society being confronted with chronic infections they react with archaic behavioural patterns: Rejection This gave leprosy its German name »Aussatz« ( [de] Aussetzen – [en] exposure ). Highly contagious infections are handled on the basis of national infection protection acts like the Infektionsschutzgesetz IFG in Germany. Lighter infections are handled by society itself. Infected people are met with relentlessness.

The handling of people with chronic infections is dismaying and characterized by fear. This fear reminds to the fear HIV-positive people meet practically everywhere. Some 30 years ago, HIV-patients were confronted with naked fear. Even today, many people avoid contact with HIV-patients, even though normal contact is absolutely save. Actually it’s quite similar with MRSA. A very basal provision can save you: Wash your hands! You usually don’t get it from the infected patients  – you grab it yourself. You get it from insufficiently cooked meat or from cattle in feed lot operation. And you get it, when your immune system is down or your skin flora is down. The germ only becomes dangerous, when two things come together:

  • you carry the germ
  • you undergo surgery and the germ enters the wound.

A little over two years ago my daughter, Lea, had a bigger surgery on her spine because she had a massive and progressive scoliosis. This surgery was a massacre and so Lea had to stay in the clinic for many weeks. Thanks to the surgeons technique, she at least was spared to lie in the body cast for weeks. After she left hospital, she had lost her ability to eat, so now she is exclusively nurtured via PEG¹. When she was back home, “we”² discovered a massive urinary tract infection and we soon found out, no antibiotic would help. Lea has MRSA³ and this type actually was resistant against everything. Lea couldn’t tell us about her pain, because she cannot speak and she was also treated with heavy pain killers, but now that she was at home again, the problem became obvious.

Again it took weeks until Lea was well again, but even though the urinary tract infection was gone for the time being, she still carried the MRSA.

One question about it, I am just asking to support this story, is if Lea caught this germ while in hospital?!
We’ll never know. All we know is that now she carries this MRSA, while her parents and her brother are free of MRSA.

We are good-natured people. Honesty means a lot to us and so it was only normal to us, that we told the care facility about the trouble, since Lea wasn’t there for months. But then hell broke loose for Lea. It got so far, that the remedial teachers only touched Lea with exam gloves. She was treated as if she had Ebola or Tuberculosis. Because of that infection, the staff treated Lea, as if she was highly infectious and as if she posed an immediate danger to every person around her.

The manager of care facility agrees with us, that between 25% and 30% of all people in these care facilities carry MRSA (I would go so far, that it’s around every 4th German wherever you go). So if everybody in the care facility was tested, at least 25% would be tested positive. Even every 4th remedial teacher would be tested positive.

The difference is, that we know about Lea and we don’t know who else.

Despite of all common sense, those responsible in the care facility continue to tell us, that they are relying upon an external consultancy which is in charge of hygiene in the facility. They established general guidelines and these guidelines were absolutely clear.
So even Lea is not highly infectious, she is treated as if she had tuberculosis or typhus.

From late September on I spent 6½ weeks together with Lea in the Clinic for Neuropediatrics in Vogtareuth⁴. Lea was about to celebrate her 18th birthday and it became due to transfer her from the pediatric dept. to the dept. for adult neurology. We also used this opportunity to have a substantial rehabilitation block for her, but of course in this clinic we also had our troubles. At the beginning Lea was tested and she was tested positive. So we were isolated and had our own room and a lot of restrictions, since this hospital is performing a lot of surgery. That’s okay. Here we have a reason: Vogatreuth is a surgical clinic and really nobody wants the problem of MRSA during recovery from surgery.

We took the opportunity to start a serious attempt to decontaminate Lea. It’s a little work with a multiple disabled young lady. I washed her hair every day in the morning with a disinfectant washing lotion, washed her whole body with that lotion, applied a special cream into her nose, spilled her mouth three times a day with a not so tasty disinfectant and treated the entry hole for her PEG-tube with another disinfectant, changed all the clothes and all the bed linen.
That’s what came in addition to our daily routine.

After five days of decontamination we had two days break and then she was tested for three days, but we already knew after the first test result, that we weren’t successful. Lea was again tested positive.

So we started another attempt and decontaminated another five days, but again we failed. The problem, that persisted was the entry hole of her PEG-tube. Actually Lea is not infectious as long as you don’t lick this part of her body. As long as you treat Lea normally, nothing can happen.

You wanna be sure?
So why don’t you just wash your hands?
Not happy only washing your hands?
Disinfect your hands!

Last Christmas Lea was excluded from the Christmas party in the care facility and next the respite care gave notice, that they see themselves unable to take Lea over the weekend – all because of MRSA.

How is MRSA transmitted?

In most cases MRSA is transmitted directly through interaction from person to person – mainly via the hands.
Both, MRSA diseased as well as only infected are infectious.
MRSA can be transmitted via contaminated objects, such as door handles or handrails.
And now imagine how many people don’t wash their hands after visiting the restroom. Too many only make their hands wet but use no soap. Then they touch the same door handle as those who didn’t wash their hands at all.
And of course the infection can make its way from infected cattle to humans. This can be a danger for farmers or to you, if you don’t cook meat sufficiently.

MRSA mainly developed its resistance because of the excessive use of antibiotics in industrial livestock farming and through insufficient administration of antibiotics by physicians – mainly family doctors. In Thailand, for many years prostitutes swallowed their daily dose of antibiotics just to avoid STDs (sexually transmitted diseases) and it wasn’t better in many other countries. The administration of antibiotics is a persisting problem. Patients and physicians appear to be unconvincible.

The Robert-Koch-Institut (the institute for disease control of the German federal ministry for health) is probably the most reputable institution in Germany to say something about MRSA. They definitely don’t underestimate MRSA and they recently published updated guidelines for the prevention and controll of MRSA strains⁵. (Note: RKI states that the prevalence on MRSA in rehabilitational institutions in Germany was at 1.2%, while in France it was between 16.1 and 20.5% – When we asked a physician at the clinic for Neuropediatrics in Vogtareuth, she told us, that she counts some 25% infected among the newly admitted patients). The publication⁵ also lets us know that among the employees in health care, the infection rate varies between 0.3% and 7.9%.
And then, after 11 pages of really dry stuff it starts to become more interesting. Now the publication tells us that the probability of transmission is a joint probability⁶ that composes of many factors like

  • the number of transmission possibilities and their particular transmission probabilities
  • the transmission probability correlates with a number of factors which influence the release of germs respectively their impact
  • the pressure of colonisation (i.e. the proportion of colonized to non-colonized persons)
  • the density of germ population
  • the pathway of the infection
  • the target of infection and finally
  • the medical history respectively co-morbidity

So we see a multitude of options to keep an MRSA infection contained, but all this will be in vain if we don’t apply them to those MRSA carriers who remain unidentified.

Excluding a girl who is known to carry the infection will be totally useless unless all other persons in the care facility are tested and those who are infected will be identified and treated accordingly.
But exclusion is the easiest way if you don’t understand the mechanics of infections. Over and over again, this is not a setback but a depressing apparentness of the state of literacy in our society.
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1) http://en.wikipedia.org/wiki/Percutaneous_endoscopic_gastrostomy
2) Well, we are divorced and it’s complicated.
3) http://en.wikipedia.org/wiki/Methicillin-resistant_Staphylococcus_aureus
4) http://www.schoen-kliniken.com/ptp/kkh/bhz/faz/neuropaedriatrie/
5) http://www.rki.de/DE/Content/Infekt/Krankenhaushygiene/Kommission/Downloads/MRSA_Rili.pdf?__blob=publicationFile
6) http://en.wikipedia.org/wiki/Joint_probability_distribution