DATE: Friday, May 30, 1997                  TAG: 9705300678

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY PAT DOOLEY, STAFF WRITER 

                                            LENGTH:   90 lines

HOSPITALS SAY MEASURES GUARD AGAINST DEADLY GERMS NO BIG CHANGES ARE PLANNED, EVEN THOUGH MORE RESISTANT STAPH BACTERIA HAVE EMERGED.

Doctors and infection-control managers at local hospitals said they won't make major changes in the way they protect against staph bacteria, despite a report that one strain in Japan is becoming resistant to medicine's most potent antibiotic.

The hospitals already follow guidelines from the Centers for Disease Control and Prevention in Atlanta to keep people safe from the potentially deadly Staphylococcus aureus, they said.

``We have a very active infection-control department,'' said Jacqueline Butler, infection control manager for Sentara Southside Hospitals.

Preventive measures include limiting the use of antibiotics and isolating patients diagnosed with staph. Hospital employees are required to wash their hands frequently, and wear gowns and gloves when necessary, to prevent the spread of infection, Butler said.

On Thursday, the news media reported that a new strain of Staphylococcus aureus bacteria found in a Japanese infant showed a level of resistance to the antibiotic vancomycin for the first time. The 4-month-old child developed a boil while recovering from heart surgery.

The child was treated in October with a combination of medicines - including one not available in the United States, said Dr. William Jarvis, acting director of the CDC's hospital infections program. About three weeks ago, doctors verified that the child's infection showed an ``intermediate'' resistance.

Although the infection was treatable, Jarvis said, it was more resistant than in past cases - something the medical community has anticipated for years.

Dr. Thomas T. Rubio, chief of infectious diseases at Children's Hospital of The King's Daughters in Norfolk, said, ``It's only a matter of time'' until an organism appears that's unstoppable.

``It's going to happen, there's no question,'' he said. ``History has told us this.''

For example, Staphylococcus aureus once was easily treated with penicillin, tetracycline and other common antibiotics. Now, the bacteria sometimes are resistant to all but vancomycin.

Jarvis and other health professionals say a chief culprit in the increasing resistance of bacteria is the overuse of antibiotics.

Staph bacteria are the top cause of hospital infections in the United States, Jarvis said. Hospital-acquired infections kill about 60,000 to 80,000 people each year. About 13 percent of those deaths are caused by staph.

About three years ago, the CDC issued guidelines for use of vancomycin, considered the drug of last resort in treating resistant staph infections, Jarvis said. It also suggested frequent hand-washing and other measures.

Studies show that hand-washing is one of the best ways to prevent transmission of the Staphylococcus aureus bacteria, which can thrive on hands, clothing and medical equipment, Jarvis said. Studies also show that only about 50 percent of hospital personnel wash their hands as needed.

Often, Jarvis said, the steps are part of hospital policy but not carried out.

``It can be difficult to monitor all health-care workers,'' he said.

Yet, hospitals in Hampton Roads say they take the guidelines seriously and follow them.

At Sentara Southside's three hospitals - Norfolk General, Leigh and Bayside - infection-control staff lead workshops, post guidelines and conduct surveys and inspections to ensure compliance, Butler said.

Children's Hospital was one of the first to follow the CDC's guidelines for reduction of vancomycin, Rubio said. The hospital has cut back on its use of the antibiotic 10 percent to 15 percent, he said.

Many people carry Staphylococcus aureus bacteria - sometimes in the nose, hair, groin or armpits, said Bonnie Baldwin, a registered nurse and epidemiologist who oversees infection control at Virginia Beach General Hospital.

But most don't develop an infection, she said. Those at greatest risk are newborns, the elderly and hospital patients with compromised immune systems, such as those with AIDS, cancer, diabetes and other diseases.

The CDC has set up tentative guidelines for a hospital to follow if it suspects an antibiotic-resistant infection, Baldwin said.

The hospital would conduct tests to make sure the infection was resistant to vancomycin. If it was, personnel would make three calls: to the local health department, the state health department and the CDC. The hospital also would place the patient in isolation.

Such a patient likely would be treated with a combination of antibiotics, said Sentara's Butler.

The fear, said the CDC's Jarvis, is that one day a potentially deadly infection will not respond to such treatment.

``The warnings that have been given before need to be taken very seriously,'' he said, adding that many doctors in the United States still prescribe antibiotics at about the same levels as in years past.

``The next bug is going to be much worse,'' he said. KEYWORDS: STAPHYLOCOCCUS AUREUS INFECTION STAPH BACTERIA

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