[Pharmwaste] Solution to killer superbug found in Norway

DeBiasi,Deborah Deborah.DeBiasi at deq.virginia.gov
Mon Jan 11 10:04:04 EST 2010


This philosophy would certainly make our waters cleaner!
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http://news.yahoo.com/s/ap/20091231/ap_on_he_me/when_drugs_stop_working_
norway_s_answer
Solution to killer superbug found in Norway
By MARTHA MENDOZA and MARGIE MASON, Associated Press Writers Martha
Mendoza And Margie Mason, Associated Press Writers Wed Dec 30, 9:04 pm
ET 
OSLO, Norway - Aker University Hospital is a dingy place to heal. The
floors are streaked and scratched. A light layer of dust coats the blood
pressure monitors. A faint stench of urine and bleach wafts from a pile
of soiled bedsheets dropped in a corner.
Look closer, however, at a microscopic level, and this place is
pristine. There is no sign of a dangerous and contagious staph infection
that killed tens of thousands of patients in the most sophisticated
hospitals of Europe, North America and Asia this year, soaring virtually
unchecked.
The reason: Norwegians stopped taking so many drugs.
Twenty-five years ago, Norwegians were also losing their lives to this
bacteria. But Norway's public health system fought back with an
aggressive program that made it the most infection-free country in the
world. A key part of that program was cutting back severely on the use
of antibiotics.
Now a spate of new studies from around the world prove that Norway's
model can be replicated with extraordinary success, and public health
experts are saying these deaths - 19,000 in the U.S. each year alone,
more than from AIDS - are unnecessary.
"It's a very sad situation that in some places so many are dying from
this, because we have shown here in Norway that Methicillin-resistant
Staphylococcus aureus (MRSA) can be controlled, and with not too much
effort," said Jan Hendrik-Binder, Oslo's MRSA medical adviser. "But you
have to take it seriously, you have to give it attention, and you must
not give up."
The World Health Organization says antibiotic resistance is one of the
leading public health threats on the planet. A six-month investigation
by The Associated Press found overuse and misuse of medicines has led to
mutations in once curable diseases like tuberculosis and malaria, making
them harder and in some cases impossible to treat.
Now, in Norway's simple solution, there's a glimmer of hope.
---
Dr. John Birger Haug shuffles down Aker's scuffed corridors, patting the
pocket of his baggy white scrubs. "My bible," the infectious disease
specialist says, pulling out a little red Antibiotic Guide that details
this country's impressive MRSA solution.
It's what's missing from this book - an array of antibiotics - that
makes it so remarkable.
"There are times I must show these golden rules to our doctors and tell
them they cannot prescribe something, but our patients do not suffer
more and our nation, as a result, is mostly infection free," he says.
Norway's model is surprisingly straightforward.
* Norwegian doctors prescribe fewer antibiotics than any other country,
so people do not have a chance to develop resistance to them.
* Patients with MRSA are isolated and medical staff who test positive
stay at home.
* Doctors track each case of MRSA by its individual strain, interviewing
patients about where they've been and who they've been with, testing
anyone who has been in contact with them.
Haug unlocks the dispensary, a small room lined with boxes of pills,
bottles of syrups and tubes of ointment. What's here? Medicines
considered obsolete in many developed countries. What's not? Some of the
newest, most expensive antibiotics, which aren't even registered for use
in Norway, "because if we have them here, doctors will use them," he
says.
He points to an antibiotic. "If I treated someone with an infection in
Spain with this penicillin I would probably be thrown in jail," he says,
"and rightly so because it's useless there." 
Norwegians are sanguine about their coughs and colds, toughing it out
through low-grade infections. 
"We don't throw antibiotics at every person with a fever. We tell them
to hang on, wait and see, and we give them a Tylenol to feel better,"
says Haug. 
Convenience stores in downtown Oslo are stocked with an amazing and
colorful array - 42 different brands at one downtown 7-Eleven - of
soothing, but non-medicated, lozenges, sprays and tablets. All workers
are paid on days they, or their children, stay home sick. And drug
makers aren't allowed to advertise, reducing patient demands for
prescription drugs. 
In fact, most marketing here sends the opposite message: "Penicillin is
not a cough medicine," says the tissue packet on the desk of Norway's
MRSA control director, Dr. Petter Elstrom. 
He recognizes his country is "unique in the world and best in the world"
when it comes to MRSA. Less than 1 percent of health care providers are
positive carriers of MRSA staph. 
But Elstrom worries about the bacteria slipping in through other
countries. Last year almost every diagnosed case in Norway came from
someone who had been abroad. 
"So far we've managed to contain it, but if we lose this, it will be a
huge problem," he said. "To be very depressing about it, we might in
some years be in a situation where MRSA is so endemic that we have to
stop doing advanced surgeries, things like organ transplants, if we
can't prevent infections. In the worst case scenario we are back to
1913, before we had antibiotics." 
--- 
Forty years ago, a new spectrum of antibiotics enchanted public health
officials, quickly quelling one infection after another. In wealthier
countries that could afford them, patients and providers came to depend
on antibiotics. Trouble was, the more antibiotics are consumed, the more
resistant bacteria develop. 
Norway responded swiftly to initial MRSA outbreaks in the 1980s by
cutting antibiotic use. Thus while they got ahead of the infection, the
rest of the world fell behind. 
In Norway, MRSA has accounted for less than 1 percent of staph
infections for years. That compares to 80 percent in Japan, the world
leader in MRSA; 44 percent in Israel; and 38 percent in Greece. 
In the U.S., cases have soared and MRSA cost $6 billion last year. Rates
have gone up from 2 percent in 1974 to 63 percent in 2004. And in the
United Kingdom, they rose from about 2 percent in the early 1990s to
about 45 percent, although an aggressive control program is now starting
to work. 
About 1 percent of people in developed countries carry MRSA on their
skin. Usually harmless, the bacteria can be deadly when they enter a
body, often through a scratch. MRSA spreads rapidly in hospitals where
sick people are more vulnerable, but there have been outbreaks in
prisons, gyms, even on beaches. When dormant, the bacteria are easily
detected by a quick nasal swab and destroyed by antibiotics. 
Dr. John Jernigan at the U.S. Centers for Disease Control and Prevention
said they incorporate some of Norway's solutions in varying degrees, and
his agency "requires hospitals to move the needle, to show improvement,
and if they don't show improvement they need to do more." 
And if they don't? 
"Nobody is accountable to our recommendations," he said, "but I assume
hospitals and institutions are interested in doing the right thing." 
Dr. Barry Farr, a retired epidemiologist who watched a successful MRSA
control program launched 30 years ago at the University of Virginia's
hospitals, blamed the CDC for clinging to past beliefs that hand washing
is the best way to stop the spread of infections like MRSA. He says it's
time to add screening and isolation methods to their controls. 
The CDC needs to "eat a little crow and say, 'Yeah, it does work,'" he
said. "There's example after example. We don't need another study. We
need somebody to just do the right thing." 
--- 
But can Norway's program really work elsewhere? 
The answer lies in the busy laboratory of an aging little public
hospital about 100 miles outside of London. It's here that
microbiologist Dr. Lynne Liebowitz got tired of seeing the stunningly
low Nordic MRSA rates while facing her own burgeoning cases. 
So she turned Queen Elizabeth Hospital in Kings Lynn into a petri dish,
asking doctors to almost completely stop using two antibiotics known for
provoking MRSA infections. 
One month later, the results were in: MRSA rates were tumbling. And
they've continued to plummet. Five years ago, the hospital had 47 MRSA
bloodstream infections. This year they've had one. 
"I was shocked, shocked," says Liebowitz, bouncing onto her toes and
grinning as colleagues nearby drip blood onto slides and peer through
microscopes in the hospital laboratory. 
When word spread of her success, Liebowitz's phone began to ring. So far
she has replicated her experiment at four other hospitals, all with the
same dramatic results. 
"It's really very upsetting that some patients are dying from infections
which could be prevented," she says. "It's wrong." 
Around the world, various medical providers have also successfully
adapted Norway's program with encouraging results. A medical center in
Billings, Mont., cut MRSA infections by 89 percent by increasing
screening, isolating patients and making all staff - not just doctors -
responsible for increasing hygiene. 
In Japan, with its cutting-edge technology and modern hospitals, about
17,000 people die from MRSA every year. 
Dr. Satoshi Hori, chief infection control doctor at Juntendo University
Hospital in Tokyo, says doctors overprescribe antibiotics because they
are given financial incentives to push drugs on patients. 
Hori now limits antibiotics only to patients who really need them and
screens and isolates high-risk patients. So far his hospital has cut the
number of MRSA cases by two-thirds. 
In 2001, the CDC approached a Veterans Affairs hospital in Pittsburgh
about conducting a small test program. It started in one unit, and
within four years, the entire hospital was screening everyone who came
through the door for MRSA. The result: an 80 percent decrease in MRSA
infections. The program has now been expanded to all 153 VA hospitals,
resulting in a 50 percent drop in MRSA bloodstream infections, said Dr.
Robert Muder, chief of infectious diseases at the VA Pittsburgh
Healthcare System. 
"It's kind of a no-brainer," he said. "You save people pain, you save
people the work of taking care of them, you save money, you save lives
and you can export what you learn to other hospital-acquired
infections." 
Pittsburgh's program has prompted all other major hospital-acquired
infections to plummet as well, saving roughly $1 million a year. 
"So, how do you pay for it?" Muder asked. "Well, we just don't pay for
MRSA infections, that's all." 
--- 
Beth Reimer of Batavia, Ill., became an advocate for MRSA precautions
after her 5-week-old daughter Madeline caught a cold that took a fatal
turn. One day her beautiful baby had the sniffles. The next? 
"She wasn't breathing. She was limp," the mother recalled. "Something
was terribly wrong." 
MRSA had invaded her little lungs. The antibiotics were useless. Maddie
struggled to breathe, swallow, survive, for two weeks. 
"For me to sit and watch Madeline pass away from such an aggressive form
of something, to watch her fight for her little life - it was too much,"
Reimer said. 
Since Madeline's death, Reimer has become outspoken about the need for
better precautions, pushing for methods successfully used in Norway.
She's stunned, she said, that anyone disputes the need for change. 
"Why are they fighting for this not to take place?" she said. 
____ 
Martha Mendoza is an AP national writer who reported from Norway and
England. Margie Mason is an AP medical writer based in Vietnam, who
reported while on a fellowship from The Nieman Foundation at Harvard
University.


Deborah L. DeBiasi 
Email:   Deborah.DeBiasi at deq.virginia.gov (NEW!)
WEB site address:  www.deq.virginia.gov 
Virginia Department of Environmental Quality 
Office of Water Permit Programs 
Industrial Pretreatment/Whole Effluent Toxicity (WET) Program 
PPCPs, EDCs, and Microconstituents
www.deq.virginia.gov/vpdes/microconstituents.html 
Mail:          P.O. Box 1105, Richmond, VA  23218 
Location:  629 E. Main Street, Richmond, VA  23219 
PH:         804-698-4028 
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