Texas Hospitals don't have to make cases of deadly infection public

The antibiotic-resistant bacterium called MRSA is infecting more victims across the country, but most states, including Texas, are not tracking it.
The so-called "superbug" kills more people than AIDS, according to a recent report by the Centers for Disease Control and Prevention, which estimates that 18,700 people nationwide died of invasive MRSA in 2005. AIDS claimed about 17,000 lives in this country that year, the CDC reports.
The report resulted from the first federal study to track methicillin-resistant Staphylococcus aureus, a form of staph that has haunted health professionals for the past few years but grabbed the public's attention only recently after several students in different parts of the United States died from a strain they caught in the community.
The infection traditionally has spread only in health care settings, and 85 percent of the more serious cases still originate there, according to the CDC. But now that it has made its way into the community, MRSA (pronounced MUR-suh) is becoming a household word.
Most hospitals track infections transmitted within their own grounds; a spokeswoman at one Houston hospital said it would be negligent not to keep that data. But few hospitals are willing to make the information public, either through the media or to their patients.
And they don't have to.
Unlike a long list of illnesses, including chicken pox, syphilis and Lyme disease, MRSA isn't a required reportable condition in Texas. So while hospitals may know their infection rates, the public often can't get that information.
"There's just a concern about public reporting and whether it would be interpreted correctly," said Dr. Rajiv Jain, director of the Veterans Affairs national MRSA initiative, which involves testing every admitted patient for the infection. Jain believes more in-depth tracking is needed.
Hospital administrators are reluctant to release infection-rate data, partly because they're worried that the public will use it to compare them with other hospitals that track the infection differently or that serve patients with different risk factors.
But without data, some patient advocates say, it's difficult to hold hospitals accountable.
New law, but no fundingThe Texas Legislature this year approved a law that requires reporting of health care-associated infections, although it doesn't specifically target MRSA. Like most laws adopted in about 20 other states in recent years, the new rules focus on the nature of an infection, not the type of bacteria that caused it. So while some infections caused by MRSA would be counted, they wouldn't be recorded as MRSA.
The law requires that three types of hospital-acquired infections be reported: surgical-site infections, respiratory syncytial virus — which causes pneumonia — and certain bloodstream infections. But since the law doesn't include funding for the project, state health officials are struggling to figure out how to pay for it.
"It's still not clear what funding is going to be available and if it's going to be sufficient to make things work," said Dr. Tom Betz, manager of infectious disease surveillance and epidemiology for the Texas Department of State Health Services. "If we can't do this right, we probably shouldn't do it at all."
While some health professionals, including Jain, say states should track MRSA specifically, others say that wouldn't do much good, partly because the staph infection can manifest in so many forms. Infections on the skin, which can look like pimples or boils, can be treated fairly easily and become potentially fatal only if the infection spreads to the bloodstream or infects a surgical wound.
Origin hard to determineThen there's the difficulty of determining the mode of transmission: Hospitals can't always differentiate between infections that originate in their facility or in the community.
"To track just MRSA by itself, that doesn't make a lot of sense," said Dr. Sheldon Kaplan, chief of infectious disease services at Texas Children's Hospital and professor of pediatrics at Baylor College of Medicine. "There are lots of (other) hospital-acquired types of infections that are just as serious."
That's no consolation for Cary Yates, a Missouri City man whose 29-year-old son Shawn died in March from community-acquired MRSA. It took doctors several days to properly diagnose Shawn Yates, a father of two, and then it was too late, his father said.
"The medical community must take this seriously," said Yates, a banker. "They must hold themselves accountable and responsible and report these numbers so we can have an open dialogue to try and cure this disease or at least recognize it."
Bexar County to be firstBexar County, which includes San Antonio, soon will become the first in the state to track the infection. Under a state law approved in June, all clinical labs in the county will be required to report MRSA infections as soon as January. Lawmakers say the tracking system may later be expanded to the rest of the state if it's successful.
"The whole goal of getting the data is to get a baseline, so you can identify risk factors and then recommend measures to reduce those rates," said Dr. Bryan Alsip, assistant director of clinical and population-based services for the San Antonio Metropolitan Health District.
Bexar County has agreed to fund the pilot program. But for hospitals strapped for money and staff, tracking yet another condition could pull resources away from patient care, said Dr. Ed Septimus, medical director of clinical integration for The Methodist Hospital System in Houston.
"No one's against transparency," said Septimus, who serves on the board of directors for the Infectious Diseases Society of America. "But it has to be done fairly and correctly."