Hospital MRSA - should healthcare institutions be forced to report it?

I'll be moderating a panel exploring that contentious issue at the Association of Health Care Journalists' annual meeting in March. On the panel:

• Carmela Coyle, senior vice president for policy, American Hospital Association
• Betsy McCaughey, Ph.D., CEO and chair, Committee to Reduce Infection Deaths
• Carole Moss, executive director, Nile's Project
• Chesley Richards, M.D., M.P.H., deputy director, Division of Health Care Quality Promotion, U.S. Centers for Disease Control and Prevention

A number of states have passed laws in the past few years that require public disclosure of hospital-acquired infections, and a half-dozen have added provisions that specify reporting HA-MRSA. It seems like a no-brainer: Shame is a great motivator.

But some citizen-advocates are concerned that clever or well-funded institutions will be able to game the system. And some researchers who have evaluated infection-reporting regimes warn that surveillance often misses patients and reporting regimes are not standardized from state to state.

New MRSA article in Annals of Emergency Medicine

Well, that was fast: Here's a second article out of the book research, in the News & Perspectives section of the medical journal Annals of Emergency Medicine, where I am a "special contributor."

Brief synopsis: Emergency rooms are early-warning sites for detection of community-associated MRSA. Alert personnel there see the bug in all its manifestations, from minor skin infection to major invasive disease. They have been among the earliest voices warning everyday physicians of the need to change prescribing habits. They also, as the article discusses, may be at risk from the bug.

The story starts with an anecdote from one of my many post-Katrina reporting trips to New Orleans (stay tuned for a big story coming on that next month!):

The patient, a man in his 20s, walked into the emergency department (ED) on an autumn afternoon complaining of pain from a fist-sized lump under the right corner of his jaw.
The residents who had rounded on him recited their findings. He was not febrile. He was having no dental pain. The lump was thick-walled and unyielding and its outer temperature matched the nearby skin. Peter Deblieux, MD, director of emergency services at Louisiana State University Interim Hospital, asked for a syringe to aspirate it. ...
Deblieux masked the syringe with his free hand—the patient had confessed he was terrified of needles—slid the needle in, and smoothly pulled back. The cylinder filled with a creamy, cloudy substance streaked with red.
“It’s pus,” Deblieux said disbelievingly. “I was not expecting that.”
Ten years since it was first recognized as a significant pathogen, community-associated methicillin-resistant Staphylococcus aureus, CA-MRSA, still retains the element of surprise.

Full text is here.

The New England Journal of Medicine has put the full text one of the most important papers about MRSA in ERs (Moran GJ, Krishnadasan A, Gorwitz RJ, et al.. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–674) online for free.

MRSA article in Health magazine

After a long wait, some freelance articles that I've written on MRSA while researching the book have finally begun to be published! Here is the first, in Health magazine: an "as-told-to" by a Boston-area woman who struggled for more than a year with recurrent skin infections that just kept coming back:

The Truth About Staph
by Jilly Jackson* as told to Maryn McKenna
One woman’s harrowing tale of dealing with a dangerous infection called MRSA. How she got it and how it spread.
When I heard that high schools were closing and teenagers were dying because of the MRSA superbug, I felt lucky. Since the middle of 2006, I’ve had methicillin-resistant Staphylococcus aureus six times and somehow managed to avoid the worst: I’ve never been hospitalized and don’t fear for my life.

Link here and sidebar here.
Also, a CNN.com version — which has generated some great new leads for me! — here.