Testing for a dangerous staph "superbug" could help wipe out a germ that likely kills more Americans than AIDS.
Yet few U.S. hospitals do it, and many fight efforts to require it. Why?
Jeanine Thomas, who nearly died from the drug-resistant staph bug, says the reason is simple: "Doctors don't want to be told what to do."
Her personal crusade led Illinois this year to become the first state to order testing of all high-risk hospital patients and isolation of those who carry the staph germ called MRSA.
Powerful doctor groups fought against it. The testing and isolation of patients would be too costly, they said. Many other germs plague hospitals that also require attention. Experts said a more proven approach would focus on better hand washing by hospital staff - a simple measure that is tough to enforce.
Yet, Thomas prevailed. Similar measures passed this year in Pennsylvania and New Jersey. And her national crusade to make hospitals test for MRSA and report their infection rates gained momentum last week after a Virginia teenager's death from the germ and a government report that estimated the bug causes dangerous infections that sicken more than 90,000 Americans each year and kill nearly 19,000.
Suddenly the little-known germ with the cumbersome name, methicillin-resistant Staphylococcus aureus, is getting lots of attention.
On Wednesday, Virginia Gov. Timothy M. Kaine ordered that all pathology labs in the state infections of the germ to state health officials.
Overseas, Denmark, Iceland, Norway, and the Netherlands all test high-risk patients and have reduced their MRSA rates.
Opponents of mandatory testing say these small countries all had low rates of the germ to begin with. Hospitals in larger, more diverse nations like Britain, for example, have long had problems with MRSA.
People in health care settings, like hospitals and nursing homes, are most at risk for MRSA infections. Doctors and nurses who treat staph-infected patients and then do not carefully wash up can spread the germ to other patients. Germ-contaminated medical devices used on people having dialysis or medical procedures also can spread staph. Older patients and blacks are most at risk, according to the recent report by government researchers.
MRSA, pronounced Muhr-suh, has been around for decades and in recent years has spread to schools, prisons and crowded public housing projects. Even healthy people can carry it on their skin. It may look like a pimple or spider bite that does not heal, but it can turn deadly if it enters the bloodstream or morphs into a flesh-eating wound.
About 1.7 million Americans each year develop infections from various germs while hospitalized and almost 100,000 of them die, according to the U.S. Centers for Disease Control and Prevention.
MRSA accounts for only about 10 percent of these infections. Other worrisome bugs include C-difficile (an intestinal infection), vancomycin-resistant Enterococcus (linked with intestinal, skin and blood infections), and drug-resistant Acinetobacter (which can cause pneumonia, skin and blood infections). None of them accounts for more than 10 percent of hospital infections.
MRSA infections have hogged attention, partly because they are on the rise. And, acknowledges the CDC's Dr. John Jernigan, "MRSA likely accounts for a disproportionate amount of illness and death" because of its strength and resistance to mainline antibiotics.
CDC recommendations for fighting drug-resistant bugs list MRSA testing as an option. However, the agency says it is unclear whether that works better than other measures. Those include judicious use of antibiotics, hand washing, and wearing gloves, gowns and other protective gear.
The Joint Commission, an independent, nonprofit group that sets standards for the nation's hospitals, does not have specific rules on how to prevent MRSA.
The commission's Dr. Robert Wise said the organization wants to see evidence that MRSA testing and other measures work. He said the commission hopes to have an answer early next year and then will then decide whether to adopt new standards.
Perhaps the commission will review an experiment done in Pittsburgh. There, the Veterans Affairs hospital tried MRSA testing, and annual infection rates fell from about 60 to 18 cases, said Dr. Rajiv Jain.
The staph bug used to cause "occasional" deaths, but no patient has died since 2005 when testing of all patients began, said Jain, who is with the VA's MRSA prevention program.
In May, the VA began putting a $28 million (19.6 million EUR) testing system in place for all 155 hospitals. But it costs about $32,000 (22,487 EUR) to treat one hospitalized MRSA patient, so "if you reduce infections by 50 percent, you more than recuperate the cost," Jain said.
Thomas had never heard of MRSA until she slipped on ice seven years ago and broke her left ankle. That landed her in a Chicago hospital, where she believes she got the infection.
She developed throbbing pain in her left leg and went to the emergency room, where doctors removed her splint and found the ankle hugely swollen, black and draining pus. Within a week the infection spread inside her body; her lungs, kidneys and other vital organs shut down. She recovered, but her ankle joint was destroyed. She formed a support group and began lobbying for the new law.
Now Thomas is working with advocates in several other states.
"We have a wave happening," she said.