Isle experts urge vigilance in fight against ‘superbug’

Several efforts are under way to find out why the state has higher infection rates

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The death in Hawaii of an entertainer from a drug-resistant staph infection has local officials emphasizing extra vigilance to keep the bug from spreading in public restrooms and school locker rooms.

What was unusual about the death of singer Rhonda Bryers Sept. 28 and a student in Virginia last month is that the infections were acquired in community settings rather than in a hospital, officials said.

A recent Centers for Disease Control study found that methicillin-resistant staph A contributed to the deaths of almost 19,000 people in 2005 -- more than the death rate from AIDS.

Hawaii has the highest rate of MRSA infections of any state, according to survey information presented to the Association for Professionals in Infection Control and Epidemiology.

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Hawaii infectious disease specialists hope recent news about "superbug" deaths in Hawaii and across the country will spur health-care providers and people to take greater precautions.

Healthy habits The U.S. Centers for Disease Control and Prevention advises: » Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand cleaner. » Keep cuts and scrapes clean and covered with a bandage until healed. » Avoid contact with other people's wounds or bandages. » Avoid sharing personal items such as towels or razors. For more information, see www.cdc.gov/ncidod/dhqp/ ar_mrsa_ca_public.html.

Last week, the Honolulu medical examiner confirmed that entertainer Rhonda Bryers died Sept. 28 at her Aiea home of septic shock from a drug-resistant Staphylococcus aureus bacteria.

Last month, a Virginia high school student died of a methicillin-resistant staph A infection, prompting closure of the whole school system for a thorough cleaning.

What is notable about both of these cases is that they appear to be examples of superbug infections that were acquired in the community, rather than in a hospital setting.

A recently released Centers for Disease Control study found that MRSA contributed to the deaths of almost 19,000 people in 2005 -- more than the death rate from AIDS.

"The thing people want to label as 'superbug' has been around for years" in hospital and other long-term health care facilities, said Dr. Sarah Park, deputy chief for disease outbreak control for the state Health Department.

But there is not just one superbug, Park said. There are many strains of staph bacteria that develop different qualities.

Methicillin resistance refers to a group of antibiotic drugs that includes penicillin, amoxicillin and oxacillin.

Superbugs acquired in hospitals can be more dangerous because they are more resistant to more types of antibiotics, Park said. That makes them harder to treat. Hospital-acquired bugs also are attacking people who are already sick and who might have intravenous lines or catheters providing pathways inside the body.

Superbugs that kids might pick up at school or anyone might catch from contact with an infected person could appropriately be called "cousins" of the hospital-based bugs, Park said.

The so-called community-acquired MRSAs are actually better at getting from person to person -- surviving on surfaces like computer keyboards or countertops. But if they cause infections, they are usually limited to the skin and generally respond well to common antibiotics. Those aspects make the community-acquired superbugs much less likely to be life-threatening.

"There are millions and millions of bacteria on everybody's body," said Dr. Alan Tice, an infectious-disease specialist and University of Hawaii professor. "And the majority of these probably are our friends and protect us from the bad bacteria."

Even staph bacteria are not all bad, Tice said. A study of college students a few years ago found that one in three had staph bacteria present, with no symptoms at all. Less than 5 percent of those staph bacteria are superbugs in most populations.

"Not every person who has MRSA on them is going to get an infection," Park agreed.

But Hawaii is in the unenviable position of having the highest rate of MRSA infections of any state, according to survey information presented in June to the Association for Professionals in Infection Control and Epidemiology.

That study of 187,058 hospital and long-term health care patients nationwide found 46 of 1,000 patients sampled had the superbug. Hawaii's rate was almost double that, at 91 patients per 1,000.

Native Hawaiians and other Pacific islanders have a higher rate of superbug infections within the Hawaii population, but it is not clear why, Tice said.

Homeless people have higher rates of superbug infection, which is believed to be tied to sanitation issues, Tice said. The Lions Club is providing homeless people safety kits of soap, razors and toothbrushes to discourage sharing of those items, which can pass an infection.

Others at risk include athletes, who can get cuts or scrapes that make them vulnerable to infections; young children, whose immune systems are not fully developed; and older people, especially if they have other health problems.

Trying to figure out why Hawaii has higher infection rates and what to do about it is at the forefront of several efforts.

» The state Health Department will begin tracking MRSA in a way that will allow public health professionals to count cases and see trends.

The department has collected data from the state's two main medical labs since 2000, spokeswoman Janice Okubo said. But the database is unwieldy and reporting not uniform. Accurately and consistently getting useable information from it will require improvements in reporting and data organizing, she said.

» Tice and two cooperating scientists -- Steven Seifried, UH professor of cell and molecular biology, and Matt Bankowski, Diagnostic Laboratory Services' clinical director for microbial infectious disease -- have formed a Staph Institute. They taught college-level summer programs on staph infections the past two years and plan a larger conference in July that will be open to health care professionals from Hawaii and the mainland.

Meanwhile, the U.S. Veterans Affairs Department has taken a proactive stance nationwide, treating all new hospital patients as if they had infectious MRSA until testing proves otherwise, Tice said.

Whether other hospitals go to that model remains to be seen, Tice said. One helpful tool could be quicker test results, telling doctors if a patient has an superbug in hours instead of days, he added.

State Schools Superintendent Pat Hamamoto sent a memo about MRSA to administrators on Oct. 30 reminding them to emphasize basic hygiene at schools, especially in locker rooms. It included a Health Department pamphlet that called for frequent hand-washing and keeping cuts and scrapes clean and covered.

Dee Helber, Department of Education specialist for health service programs, suggested the memo after seeing several news accounts of MRSA problems at schools on the mainland, she said.

Helber said parents and teachers have called her with questions. School staff have stepped up use of 10 percent bleach solutions or other disinfectants for mopping floors and cleaning locker rooms, she said.

"Some may be overreacting a bit, but they are just really concerned," Helber said. "They want their kids to be safe."

Tice noted, "It's very unusual that a person dies, as, unfortunately, that entertainer did." Bryers, who was known professionally by her first name, Rhonda, might have had a viral illness that set her up for a bacterial infection, he said.

A high temperature, 101 degrees Fahrenheit or higher, is a warning sign that calls for a doctor's attention, Tice said.

For skin infections, the warning could be redness, swelling, pain, drainage or a reddish streaking away from the wound, Tice said.

In particular, pain or redness that seems out of proportion to the size of the wound could be a warning. If in doubt, see a doctor -- do not wait another week, he recommends.

But prevention is the first line of defense, Tice added. "It gets back to common-sense hygiene: Wash your hands, use Kleenex, take bath or shower every day or so, change clothes, be careful of your environment, don't share towels or razors."