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Beth Israel faulted for staph outbreak in mothers, babies

The Massachusetts Department of Public Health has ordered Beth Israel Deaconess Medical Center to devise an immediate plan of correction for its infection control systems by Monday. The Massachusetts Department of Public Health has ordered Beth Israel Deaconess Medical Center to devise an immediate plan of correction for its infection control systems by Monday.
By Patricia Wen and Liz Kowalczyk
Globe Staff / April 10, 2009
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Over the past six months, 18 mothers and 19 newborns have become sick with a dangerous bacterial infection soon after being released from Beth Israel Deaconess Medical Center, triggering a state investigation that uncovered serious problems with the hospital's infection control practices.

Ten of the infected patients became so ill that they required hospitalization. Two of those had serious complications.

The most recent of the staph bacterial infections, a type resistant to many common antibiotics, was identified earlier this week.

State authorities have asked the US Centers for Disease Control and Prevention for help in determining what caused these infections, which are generally spread by skin-to-skin contact. Based on research from similar outbreaks in maternity wards in other cities, a CDC investigator said the cluster at Beth Israel Deaconess is probably related to someone - such as a healthcare worker, patient, or visitor - who brought the bacteria into the hospital, and the institution's hygiene practices failed to stop it from spreading.

The Massachusetts Department of Public Health ordered the hospital to come up with "an immediate plan of correction" for its infection control systems by Monday. It is also forcing Beth Israel to undergo a hospitalwide inspection of many of its operations as a condition of its continued participation in the federal Medicare insurance program.

Paul Dreyer, director of the state's Bureau of Health Care Safety and Quality, said he did not think the problem warranted more urgent steps, such as temporarily halting the hospital's delivery of babies.

"This is a very small number of cases out of 5,000 deliveries" a year, he said. "And there were no deaths. In terms of actual harm to patients, we didn't think it rose to that level of concern."

State public health officials began investigating the outbreak in December after being notified of the problem by the hospital. They later found what they called "serious deficiencies" in infection control. The outbreak began in November.

Paul Levy, the chief executive officer of Beth Israel Deaconess who has made transparency of medical errors and problems a cornerstone of his tenure, declined a Globe request for an interview yesterday. He said through his spokesman that he would wait to comment until after the hospital completes its report to the state.

Levy, however, did issue a message on his blog to all hospital staff yesterday, notifying them of the latest cases associated with methicillin-resistant Staphylococcus aureus - the formal name for the type of staph known as MRSA. He included a memo written by members of his top staff that explained the recent problem and efforts to strengthen infection control practices, including "hand hygiene and sterilization."

The memo said most problems were "superficial skin infections and breast infections" that have been "successfully treated, in most cases with antibiotic creams or pills."

One father, who said his newborn son and wife became sick from MRSA shortly after leaving Beth Israel Deaconess, disagreed with Levy's blog posting that suggested all cases were resolved. He said his wife is on antibiotics at home after being hospitalized on intravenous antibiotics.

The father, who asked to remain anonymous to protect his family's privacy, said his son was born in January, after the hospital was aware that there was a problem involving the MRSA bacteria. He said he wished he had been told what symptoms related to MRSA to look for when they were discharged, rather than be "kept in the dark."

The pediatrician alerted them to a problem after noticing several red marks the size of a pencil point on his son's genital area, he said, and within days, the tiny marks turned into "blisters filled with pus."

His son's case cleared up with oral and topical antibiotics, he said, but his wife was later diagnosed with the same infection and hospitalized at Beth Israel Deaconess in February. It was then, he said, that staff informed him there had been a "MRSA outbreak."

Investigating the cause of such clusters can be tricky. Staph bacteria are carried on the skin of about 30 percent of healthy people, and the MRSA strain on about 2 percent of healthy people. They often sicken only those with weakened immune systems or who contract an invasive form through cracks in the skins or punctures.

MRSA infections - which can become deadly because MRSA responds to a limited number of powerful drugs - are on the rise nationwide. More than 278,000 hospitalizations related to MRSA were recorded in 2005, more than double 1999, according to a national report based on CDC data.

Dr. Rachel Gorwitz, medical epidemiologist at the CDC , said this outbreak in Boston is similar to ones over the past five years in maternity wards in hospitals in New York, Chicago, and Los Angeles. In these cases, she said, investigators determined that all infected patients had contracted a strain of MRSA that is less common in hospitals and more prevalent in the community.

Some officials caution that Beth Israel Deaconess alone may not be responsible for the outbreak. Dr. Anita Barry, director of the infectious disease bureau at the Boston Public Health Commission, said she was told that the infected patients at the hospital had, on average, showed symptoms 12 days after discharge, leading her to think that many may have contracted the bacteria in their communities.

She also said that testing of hospital staff yielded no specific person who was infected. On the other hand, MRSA specialists said, some carriers will intermittently test negative. The 37 affected patients came from throughout the Boston area. Their only shared experience appears to be staying at the hospital.

Patricia Wen can be reached at wen@globe.com and Liz Kowalczyk can be reached at kowalczyk@globe.com