Most of us have heard the old adage that a hospital is not a healthy place to be. But I've rarely seen that point made better than in this week's coverage of a report (paywall) from NIH, detailing a strain of drug-resistant bacteria at a National Institutes of Health hospital that infected 17 patients and killed six of them before being (hopefully) eradicated.
As a compelling story by Brian Vastag at The Washington Post made clear, the staff at NIH's Clinical Center too draconian measures last summer after discovering that a patient was infected with a version of Klebsiella pneumoniae that shrugged off existing antibiotics. They isolated the patient and her caretakers. As more patients became ill, they erected a quarantine unit, demanded every staffer go through a rigorous disinfection procedure, hired monitors to make sure that doctors and nurses were following strict rules. Equipment and clothing that couldn't be sterilized was thrown away. They used hydrogen peroxide vapors to sterilize rooms. And still the bacteria spread.
As Gina Kolata wrote in The New York Times, it became a matter of medical detective work. The NIH scientists used sophisticated tools at their disposal, rapid genetic sequencing that allowed them to quickly map the genome of bacteria from the original infection and trace its spread over a six month period. The tests clearly linked the lethal infections back to the first patient, who had survived. The work also showed the astonishing durability of the bacterium – it was found in a respirator that had been bleached twice. It was discovered in sink drains, even after disenfectants had been poured through. The hospital eventually ripped out the existing plumbing and replaced it.
The Associated Press story (here in The New York Post but picked up by more than 100 publications) described it as a CSI-like saga, revealed by an unsually candid report. Most patients aren't aware of the risk, the story noted, because health care facilities are cautious about publicizing the problem: "Infections at health care facilities are one of the nation's leading causes of preventable death, claiming an estimated 99,000 lives a year. They're something of a silent killer, as hospitals fearful of lawsuits don't like to publicly reveal when they outfox infection control — yet no hospital is immune."
In a case like this, though, I think we understand the risk best through such detailed case studies in which one receives a clear picture of a scientists battling to understand and defeat a formidable opponent. The NIH report, published in Science Translational Medicine, underlines the need for good public health information. And so does the clear and careful journalism that followed.
— Deborah Blum