A good start?

I happened to notice today that the WHO has posted an update to its campaign Save Lives: Clean Your Hands, which aims to get 10,000 hospitals around the world to sign on — by May 5, 2010, which is next week — to a global commitment to improved hand hygiene in hospitals.

As of last week, 8,173 hospitals had signed up (1899 in the United States, FYI).

If I sound skeptical, it's because we all know that merely supporting hand-washing (or the gel equivalent) is an easy thing to do. If you asked any hospital in the US, you would hear 100% support for hand-washing — including in the hospitals where healthcare workers miss 50% of opportunities to wash their hands. It's in the granular details of implementation — and the relentless laser-like focus on execution practiced, for instance, by Novant Health Care in North Carolina, whose story is told in SUPERBUG — that change really happens.

Whether this WHO campaign can bring that focus and create that change... we'll just have to see.

The WHO campaign's page includes videos, guidelines, and plans for a global survey to be executed on May 5.

SUPERBUG on BoingBoing!

I was thrilled to see a review of SUPERBUG on the incredibly important blog BoingBoing.net, written by (my friend and fellow Minneapolis author) Maggie Koerth-Baker.

It's so exciting to see people completely get the book, and twice that when it is people you know.

Sample quote:

Superbug is not about an entomological caped crusader.

It's more like a grown-up version of Scary Stories to Tell in the Dark.

The bug in question is MRSA, an antibiotic-resistant bacteria that kills more Americans every year than AIDS. Superbug is the story of how we created our own monster-under-the-bed, how it spreads through hospitals and communities, and why it's damn near impossible to control. If you have a cut or a pimple while reading this book, you are pretty much guaranteed to freak yourself out. And I mean that in the best possible way.

Antibiotic resistance in food — some governments pay attention

Folks, I told you Tuesday about a Congressional hearing on antibiotic resistance, featuring NIAID Director Dr. Anthony Fauci and CDC Director Dr. Thomas Frieden. Not much new was said, but it's encouraging that the hearing was held at all. (Fauci testimony here, Frieden here.)

Coincidentally, constant reader Pat Gardiner of the UK alerted me to a gathering being held on the same day in Ireland, by the quasi-government agency SafeFood—which reports to the North-South Ministerial Council of Ireland, which deals with whole-island issues under the Good Friday agreement, which is more about the Irish political structure than you probably ever wanted to know.

The conference was titled Antimicrobial resistance and food safety and featured government officials and academic researchers from across Ireland. Here's the agenda, and here's the press release with the names of key speakers. Even more important, here are links to a report on antibiotic resistance in food that Safefood released in advance of this conference: executive summary and whole thing.  I especially recommend from p.25 in the big report for an accessible discussion of the connections between ag antibiotic use and human health. Key quote among many:

The majority of the evidence acquired through outbreak and epidemiological investigations of sporadic infections, field studies, case reports, ecological and temporal associations and molecular sub-typing studies support the causal link between the use of antimicrobial agents in food animals and human illness. A few papers have questioned this but these have not survived detailed scrutiny.

 It's refreshing to see a government body engage seriously with this emerging issue, which we've been talking about for, well, years now, on this blog (sometime this month we passed our 3-year anniversary). I wish, wistfully, that the government doing the discussing was ours.

A blog reaction so perfect I want to print the whole thing...

(...but I won't, because it's not fair use or good blogger behavior. But I want to!)

Melissa Graham of Chicago had a great corporate life — and then she re-evaluated, became a chef and caterer, and began organizing in Chicago for sustainable local food, farmers' markets, and a family-friendly food system. She blogs at the food and food-policy blog The Local Beet. And she's written a reaction to SUPERBUG that not only completely gets the book, but is emotional and thoughtful and moving besides.

She says, in part:

Before reading Superbug, the question of confinement raised animals was an ethical one for me – whether the misery inflicted upon animals and, for that matter, the humans working in those facilities by the putrid conditions outweighed the need to eat cheap meat. Even the environmental degradation resulting from the inevitable careless management of CAFOs seemed a distant and intangible casualty. For me, Superbug has changed the argument from one of ethics to a moral imperative. In every hamburger of unknown origin, I see Tony Love’s face or even worse that of Carlos Don IV.

Carlos was another healthy kid who left on a school trip to the mountain and returned with a 104°F fever. The first doctor diagnosed Carlos with walking pneumonia so his mother kept him home bundled and hydrated until she realized that he was beginning to hallucinate. She rushed Carlos to the hospital and the doctor’s ultimately diagnosed his condition as MRSA. A long slow death march ensued during which Carlos’s lungs dissolved and clotting choked off the blood to his lower intestines, legs and arms. In two weeks, he was dead.

After reading Carlos’s story late in the evening, I woke a bewildered little locavore from a dead sleep to scrub his hands clean. I hugged him as tightly as I could.

...[recently] I had the pleasure to hear Ruth Reichl speak and she implored the audience to stop eating confinement raised animals. As she put it, if everyone stopped buying them and eating them, the practice would be history. Knowing what I now know, I think it’s our moral duty.

To give the post the traffic it deserves, please go here.

Quick alert: Congressional hearing Wednesday

Constant readers, I'm on the road again: Georgia Center for the Book tonight in Decatur, 7:15 p.m. But if you can't make that, take a look at this: The Energy and Commerce Subcommittee of the US House of Representatives has announced a hearing for Wednesday on "Antibiotic resistance and the threat to public health."

This is not a hearing on PAMTA, but apparently a broader hearing on the whole issue, featuring two VIPs: Dr. Anthony Fauci of NIH and Dr. Tom Frieden of the CDC. To my eye, this indicates that official, policy interest in this issue is (finally, at last) ramping up.

The hearing page is here and the preliminary memo on it is here.

SUPERBUG interest from collegial fellow bloggers

I haven't been posting it all here — because, you know, that's why the book has its own website — but SUPERBUG has been getting lots of positive press and reviews. (Yay us.)

But a piece over the weekend was especially meaningful to me and I wanted to call it out: Flu blogger and DailyKos diarist DemfromCT featured the book on his DailyKos page. (And, behold the power of networks: 178 comments this morning. Wow.)

Liz Borkowski at The Pump Handle kindly reproduced Dem's post.

This builds, of course, on early, consistent and indefatigable support from flu blogger Mike Coston of Avian Flu Diary.

As the book's acknowledgments say (p. 218!), I am so grateful for our blog community's support. Sincere thanks to all.

Catching up to MRSA news (not about me)

Constant readers: I'm looking forward to having the breathing space to get back to in-depth blogging. Meanwhile, though, news is zipping by — so here's a quick list of recent things worth reading.

"Cows on Drugs" — a superb history of the 30-year-old fight to get unnecessary antibiotics out of food animals. Note, written by a former commissioner of the Food and Drug Administration, not exactly a wild-eyed radical:

More than 30 years ago, when I was commissioner of the United States Food and Drug Administration, we proposed eliminating the use of penicillin and two other antibiotics to promote growth in animals raised for food. When agribusiness interests persuaded Congress not to approve that regulation, we saw firsthand how strong politics can trump wise policy and good science.Even back then, this nontherapeutic use of antibiotics was being linked to the evolution of antibiotic resistance in bacteria that infect humans. To the leading microbiologists on the F.D.A.’s advisory committee, it was clearly a very bad idea to fatten animals with the same antibiotics used to treat people. But the American Meat Institute and its lobbyists in Washington blocked the F.D.A. proposal.

 Antibiotic resistance in your kitchen, playroom, car... — After years of begging from health advocates, the FDA and EPA are taking a second look at the chemical compound triclosan, an antibacterial that is put into, well, almost anything you can name: soaps, hand sanitizers, cutting boards, toys. Triclosan is suspected of interfering with hormone regulation in the body, and also increases resistance in organisms in our environment. (When I ask you to use hand sanitizers that contain only alcohol or salts, not antibacterials, triclosan is one of the things I'm thinking of.) The FDA will report its findings in a year. I'd rather see it happen sooner, but it's a great move.

No progress on hospital-acquired infections — The Agency for Healthcare Research and Quality, part of the Department of Health and Human Services, has published its 2009 National Healthcare Quality Report. The news is not good. To quote the agency's own language: "Very little progress has been made on eliminating health care-associated infections." This is all hospital-acquired infections, not just MRSA, but MRSA is a leading organism. The ugly details:

• Post-operative bloodstream infections up 8%
• Post-operative catheter-associated urinary-tract infections up 3.6%
• "Selected infections due to medical care" up by 1.6%
• Bloodstream infections as a result of central lines unchanged.

(NB, three professional organizations — the Infectious Diseases Society of America, the Society for Healthcare Epidemiology of America, and the Association for Professionals in Infection Control — put out a statement in response to this report saying it "presents an outdated and incomplete picture on healthcare-associated infections (HAIs) in our healthcare system." The gist of the statement seems to be that they've got better numbers coming... soon. When there's actual data, I'll let you know.)

SUPERBUG on Capitol Hill

Constant readers, I've been shamefully absent from the blog, but with reason, since I've been traveling promoting the book. There was a pretty interesting opportunity this week that I wanted to tell you about: I was asked to be part of two Congressional briefings in Washington, DC Wednesday, addressing the overuse of antibiotics in agriculture and the contribution that makes to the emergence of resistant organisms such as MRSA. I went specifically to tell the story of the emergence of MRSA ST398, which we've been talking about for years here.

The briefings (FYI, "hearings" are for Congresspersons, "briefings" are for their staff) were cosponsored by the Pew Charitable Trusts, Union of Concerned Scientists, American Public Health Association, Infectious Diseases Society of America, and the nonprofit Keep Antibiotics Working.

Here's Pew's announcement, here's the UCS version, here's a write-up from the Washington Examiner, and here's a longer one from the site Spectrum Science.

SUPERBUG is on NPR's Science Friday!

With a cast of other people much more distinguished than me.

See the program page, and access the audio when it's posted, here.

My name in lights, sort of

Huge appreciation to the friendly folks at Eagle Eye Book Shop in Decatur, GA, who had me in to speak last night, and who also very kindly supplied books for the panel discussion at Danya International yesterday afternoon. Many thanks to all for your support!

Surfacing. (Whew.) And some great reaction.

Well, constant readers, it's been an amazing two weeks. SUPERBUG was published, and ate my life. I've been on NPR's Fresh Air, and on 21 (22?) other radio stations so far, with more radio, and TV, to come.

I'm starting to plan the next phase of the book campaign. If you work at a hospital or medical school, or are a student, contact me: Wherever you are, I'll come talk.

This week I'm headed out for some tour appearances in Atlanta: at Georgia Gwinnett College on Wednesday, and on Thursday, at the offices of Danya International in the afternoon, and then at Eagle Eye Book Shop in Decatur Thursday night. If you need more details, email or tweet me!

The book has gotten some wonderful reviews and, what matters more to me at this point, blog reactions, because the blogs signal to me that real people are really engaging with the story. I've put excerpts and links up on the book's site on this page.

Here's one that just came in over the transom that just floored me. It's from Rep. Louise Slaughter, Congress's only microbiologist, author of PAMTA, the legislation intended to bring some direction and control to agricultural use of antibiotics:

Maryn McKenna’s Superbug provides a heart-rending and enlightening portrait of the spread of Methicillin-Resistant Staphylococcus Aureus (MRSA). Commonly imagined to be a disease that only affects elderly hospital patients, McKenna’s book shows that no area of the United States is untouched. Thirty percent of high school athletic programs in one survey reported MRSA. In another study, 80 percent of farms and 40 percent of pigs had MRSA. The consequences are horrific. In 2005, 94,360 invasive MRSA infections occurred in the United States, with almost 19,000 deaths.

In the United States, the response to MRSA has been largely uncoordinated, and left to individual institutions, schools, and health care centers. American hospitals have tried a range of responses. Some hospitals have tied executive pay to staff hand-washing rates; others isolate patients with MRSA. Nationwide educational campaigns reduced antibiotic prescription rates temporarily, only to see them rise again. The pipeline for new antibiotics dried up due to economic disincentives for drug companies to invest in short-course medications like antibiotics. The medical system has not yet been able to contain antibiotic resistant pathogens like MRSA.

The problem is just as dire on American farms. Limited action has been taken to reduce misuse of antibiotics in agriculture. While the FDA did ban agricultural usage of the powerful antibiotic fluoroquinalone, farms still regularly use powerful antibiotics as ‘growth promoters’ in daily feed for animals.  This year, I introduced legislation, HR 1549, the Preservation of Antibiotics for Medical Treatment Act, which would take additional steps to protect seven medically-critical classes of antibiotics for human usage against MRSA and other antibiotic resistant pathogens. Maryn McKenna’s book is a powerful call to action. 

- Louise M. Slaughter, MEMBER OF CONGRESS