What's the point of Dr's elaborate scrubbing up before surgery when they walk around constantly at all hours of the day on the street in their scrubs? The writer is absolutely correct!!! I live 2 blocks from NY Presbyterian, Memorial Sloan Kettering, a few more blocks from Lenox Hill Hospital & every single day at all hours I see Dr's, lab technicians et a in their scrubs! Simply horrifying & a danger to the public. They all by themselves could cause a number of epidemics. Drs. & hospitals should be fined or punished in some way.
13
In April of this year, the NYT reported on this issue, which included the following:
“Antibiotics and antifungals are both essential to combat infections in people, but antibiotics are also used widely to prevent disease in farm animals, and antifungals are also applied to prevent agricultural plants from rotting. Some scientists cite evidence that rampant use of fungicides on crops is contributing to the surge in drug-resistant fungi infecting humans.”
Allowing farmers and ranchers to take short cuts by using antibiotics and antifungals is actually killing people. Enough is enough! We must stop the use of these substances in any agricultural setting!!!
9
This is an excellent article that shows the secrecy that still exists in the hospital setting. The patient needs data to be and stay informed. The hospital/health care providers concerned about legal reprisals does not share and inform the family and or patient. It is frustrating and concerning that this type of "germ warfare" is accepted under the guise of silence.
4
Understand the drive for transparency, but I disagree with the NYTimes decision on this one. Hospitals are working hard to contain these infections, but the general public has no idea how hard this becomes. It starts with STOP taking antibiotics when they will not help you get over your illness. Second, must wash hands constantly in a hospital, and if not feeling well, wear a mask! Third, if a hospital or nursing home is found to use inadequate measures, then report their name. But this should be on the heels of a failed Joint Commission inspection where the facility has failed to follow standards of practice. Not just the presence of a patient with the infection by C. auris or other 'bug.'
4
My uncle was admitted to one of the hospitals on that list in Brooklyn, stayed for a week, and was recently transferred to a rehab in Brooklyn that is also on that list. My 88 year old aunt wants to visit him. I'm not taking any chances, I'm going to discourage her, and be vigilant when I visit my uncle.
5
The most shocking part of this is the veil of secrecy. Bravo to NY for providing transparency,Education and understanding are the next step.
5
Since the presence of Candida Auris is so prevalent across care facilities and hospitals in NYC, why aren’t all facilities required to perform the deep cleaning process on EVERY bed once a patient leaves or dies, rather than just on the beds of KNOWN Candida A. patients?
8
@Barbara L Miller And constant testing of hospital areas overall, especially if it spreads very easily.
3
This is madness on our part. We have got to throttle back our use, our abuse really, of all antibiotics. There is zero reason to be giving them in feed-stock to livestock and such. And that's just one example. I could point to innumerable others. Farmers sprinkle antibiotics on their fruit trees and the like. The whole of it is CRAZY.
We need to acknowledge and, more importantly, inculcate into our behavior an acceptance that we live within a web of life. It permeates and infuses us. From the tops of every cloud you see in the sky to the smallest corner of your gut, life permeates it all. Like it or not we are entwined with everything living within this terrarium we call the Earth.
Consequently we've got to stop what we're doing, throttle back on our behavior and start living from the viewpoint of balance. Like a gardener we should learn to get along, to work with everything else co-resident on this planet.
Because if we don't we'll create, and from what I'm reading we ARE creating, a monster. One that conforms to a Natural law. It will swivel around to viewing us as lunch, and then it will act accordingly.
John~
American Net'Zen
5
This past spring, my sister showed me an article in the NY Times about Candida Auris. ("To Fight Deadly Candida Auris, New York State Proposes New Tactics" By Matt Richtel May 23, 2019). She gave me a later edition of the day's NY Times, in which the article no longer appeared. With some difficulty, I eventually found it online. A few weeks later I was subjected to an unusual protocol before being allowed to enter the ER at Mt. Sinai: I was given a flimsy mask to wear. Having read about the fungus, and thus knowing how virulent it is and how difficult to contain, the mask was nothing more than a masquerade of prevention. Every doctor I encountered that day, and thereafter, denied knowing about any new fungus. I have no doubt the veil of secrecy has accelerated the spread of infection, and am relieved to know that it is being lifted.
10
It is time we completely redefine cleanliness and what we use to clean things. Antibacterial cleaners need to be a prescription product. We also have to move antibiotics into a controlled substance category where they are just as difficult to prescribe as morphine.
I get doctors are practicing and medicine is not perfected. However we must stop these asinine use of anti-bacterial in general "healthy" populations. We also must stop general use of prophylactic antibiotics. I now have two multiple drug resistant infections because of having to take antibiotics to get my teeth cleaned all because I had joints replaced years ago. These infections will eventually kill me. The better practice would be to not pre-treat but to watch the replaced joints and treat as needed. Other people in my area have similar infections caused by pre-treating and have cancers that have been linked to these infections.
We ruined a great thing and have now poisoned the environment.
5
Every day I take the subway to work, and every day I see hospital staff wearing scrubs underneath their coats going to work - the same scrubs they will wear in the hospital where they work - the same subways where billions of bacteria reign. C. Auris is just the latest addition to the worrisome amount of superbugs and infections one can get during a hospital stay - C.diff has been around for a while, and so have others. Anyone who has been hospitalized in New York knows how perfunctory hygienic procedures are in most cases. Unfortunately, if a person is hospitalized with one ailment, they are likely to get something much worse during their hospital stay.
37
@Nathan my dear wife is a hospital nurse, the first thing done upon arrival to work is for her to change out of her street clothes and into hospital provided and washed scrubs. She wears clothing in thats comfy and easy to change, scrubs.
4
It is long past time for the weak United States food safety system to finally protect us. No more anti-fungals and antibiotics routinely given to farm animals. This must stop!!
6
I work at one of these C. Auris positive facilities in California. We have two confirmed cases at the moment and nothing has been done to further educate the staff on how to handle these residents. Poor hygiene is rampant amongst nurses and nurse assistants, as well as a lack of knowledge of precautions that need to be taken before walking into their room, it’s no wonder it’s spreading. Management at long term care facilities have reputations for being terrible and for good reason. They don’t properly inform staff, they accept any patients without proper health history and they don’t care if their staff is properly trained and maintaining hygienic practices.
8
In a science-denying climate, where evolution (the process responsible for the appearance of drug resistance) is viewed as the work of the devil, we cannot hope to address this situation. This is one of many calamities resulting from our refusal to face facts.
3
The bigger picture of drug resistant illnesses is that over two thirds of antibiotics today are used in the commercial livestock industries for chicken, hogs, cattle, dairy cattle. Thus this over use of antibiotics for livestock has encouraged the emergence of drug resistant organisms that would not have occurred if only a very small amount had been used sparingly for humans. Big pharma makes too much money to stop selling drugs for livestock. I also agree that lack of hygiene in nursing homes and hospitals is the most direct cause of spread.
6
The picture says it all. The patient is in isolation yet her visitor is barely wearing the yellow isolation gown and not wearing gloves! Of course facilities don't make it easy, that yellow gown is too small to appropriately fit the visitor. I know because I am an ICU nurse. My hospital won't spend the $$ to buy isolation gowns that actually fit. The isolation gown must fully wrap around and cover you and be tied in the back. You must wear gloves but also thoroughly wash or gel your hands before and after doning the gown and gloves. Also visitors would balk when asked to leave their purse or belongings outside the patient room. You bring your purse, cell phone or book into the room and then back out to the visitors lounge or back to your home and you've just spread the fungi or bacteria all around. And not all doctors would follow the gowning up policy. Some physicians felt if they weren't going to touch the patient they didn't need to gown up. But as we know the fungi or bacteria can be anywhere and everywhere, including on ceiling tiles. The only time we did a great job was when the hospital geared up for any potential patients exposed to ebola. People took that seriously.
6
The idea that revealing and discussing the issue is tantamount to creating panic is a testament to the ignorance of our citizens and even educated medical personnel. For all our alleged educational strengths as a nation this demonstrates how poorly we have developed critical thinking. Mortality is not prevented by hiding facts and information.
5
Clostridium difficile (C. diff) has occurred for me on three separate occasions. It's a most terrible experience. On a scale from 1 to 10, it's a 20 in terms of feeling utterly horrible and helpless. The symptoms are something you would never imagine could be so awful. The medical community is unbelievably naive when identifying the cause and preventative recommendations for this type of infection. I'm glad to see that it's been identified by the report discussed in this article.
Although, when looking online I can immediately find relevant information about C diff., both GI docs and other medical practicionars provide misleading information with lots of ambiguity.
3
So, why aren’t disposable booties recommended in the training video since it shows the infectious agent to also be present on the floor?
Any concerns about spreading it down the hallway into other patient rooms, the hospital cafeteria, or even home?
No, our hands generally do not come into contact with the floor, but people DO accidentally drop things ono it, including patient gowns, notebooks, pens, etc.
6
In America is very common to see hospital workers,nurses, doctors wearing hospital uniforms in public places such as supermarkets, restaurants etc , with obvious implications about spreading germs .
In Europe it is strictly forbidden and every healthcare worker must change in civilian clothes before leaving the hospital premises and hospital clothing is always washed by the hospital.
21
Even with non-contact interactions like NFC, we touch too many things - including hand-shakes and keypads! (Elevators, checkout/cash points, etc.) This is just the starting point for the flu.
The culture of wearing hospital scrubs to the grocery stores, schools, etc., is appalling. Worse, when they are seen in schools - they will walk straight from an infectious ward to the school or the reverse!
For this, blame the hospitals and OSHA standards that allows people to walk in and out of a hospital in scrubs!
11
What we see in this picture is a man infecting himself by touching his wife with bare hands and not wearing the infection control apparel he was given. He will take this bug home and likely pass it on to every person with whom he shakes hands. He will not be able to "just" wash his hands to be rid of the fungus - it would require something akin to a 3-minute surgical scrub to even come close.
As C. Auris is already endemic in facilities, it is too late for preventive measures. In my days of hospital nursing, I treated every patient as if they had MRSA, for too many times we found out much later that we had been exposed to infection by contact with people whose MRSA had not yet been detected. Universal C. Auris precautions would add immeasurably to the time burden already on staff. This article makes me so glad to be out of hospital nursing; nurses deserve hazard pay just for coming to work!
I do not wish to be cruel or blame the man who naturally wants to comfort his wife, but this photo shows how the bug makes it out of the hospitals and into communities.
145
From one RN to another - that was my first thought upon looking at this picture!
18
@Jamie So right you are. Not only is he not wearing gloves, but the gown he's "wearing" wont protect him from anything. People don't like to be told what to do. I've seen doctors and nurses (and other hospital personnel,) who should know better, do the same.
Administrators look at the cost of equipment and supplies, not at what it might cost if they DONT do something.
"Family friendly" hospitals allow young children the run of the place, crawl on floors, eat in patient rooms. I've seen times when a dozen or more family members crowd into a patient room, or spill over into the hallway.
Medicare now penalizes hospitals for having a high Hospital Acquired Infection (HAI) rate, but still they cut corners. They go after high profile scenarios, while ignoring the every day problems. One Hospital system I am quite familiar with spent tens of thousands of dollars for UV sterilization machines, but do a lousy job on training new employees, including nurses and doctors, on how to properly put on gowns and gloves. And they can't even enforce strict hand-washing; albeit, that is a herculean task.
11
Matt, Andrew... great piece.
There’s more.
Drug resistance is a big issue, but I don't quite get why the Times keeps writing articles about this specific fungus. Sick people on immunosuppression and ventilators acquire weird bugs and die from likely unrelated causes. This shouldn't be too surprising. I'm all for good infectious disease control, but I don't think this is anywhere near the crisis it is being made out to be -- especially in comparison to the likes of MRSA and C. diff.
Seattle Children's Hospital just closed operating rooms again because of Aspergillus mold. Best advice: stay away from hospitals at all costs.
3
I do not trust self-reporting of infections. Are hospital-acquired MRSA infection deaths really declining or are they just not being accurately reported? How do we know without some kind of public health surprise inspection system? With enough frequency to have statistical relevance? And with the expertise to know what they are doing. And with absolutely no conflict of interest and no revolving door. This is scary. Thank you to the New York Times - I have been following your coverage on C. Auris. There is no way a typical hospital is doing the deep cleaning/investment in infection control required.
5
I wish the feds would stop medical facilities from requiring patients to touch computer screens touched by other people in order to get care. They are always smudged and disgusting and undoubtedly carry germs. I also don't want a doctor or nurse touching computers or keyboards before providing patients with services.
9
@Charlie that is why you should be asking your healthcare providers to wash their hands before and after they touch you/provide care.
The general public will only be as safe as the hygeine procedures at the worst run hospitals and nursing homes. Add to this the fact the elaborate procedures set up to lower risk at the best facilities involving such basics as hand washing and ensuring patients are given the right drugs and use them in the right way to completion are never going to be followed in chaotic, professionals and resource strapped developing country hospitals and facilites and you have a recipe for disaster. Imagine an airplane after a "colonized" individual spends six hours on board using the washroom and walking through the plane. You know the air line clean up crew who even in the US in reported cases have left vomit on the seats from one flght to another are not up to the task. This problem will only get worse.
24
These problems will never go away because the lowest level of technician is charged with cleaning hospital and skilled nursing facilities. In my considerable experience as a patient in these facilities during the last six years it is by observation that they cut corners and simply don't understand what they're doing.
They wear gloves thinking the purpose is to protect themselves from me rather than to protect me from the other patients with whom they come in contact with. I make it my special effort to get in and out of a medical facility as fast as possible and wash my hands repeatedly and bathe with CHLORINE solution like Hebaclens.
So far I have survived no fewer than five superbug infections; staphylococcus aureus, c-diff, protius, Etc. instead of being sent to a normal recovery room I persuaded my physician to send me to a facility to be kept in isolation. It became apparent that most hospitals and skilled nursing facilities don't change the sheets every day and they don't wipe down places where people put their hands. the problem is the CNAs. I'm still infected with MRSA and on antibiotics, but I've survived.
6
There is widespread use of the anti fungal Thiram in the agricultural world, usually in the treatment of seeds. I’ve often wondered how this could tip the scales. For every action there is a reaction.
2
Sadly standards have fallen so far that even doctors don’t wash their hands! Accessory “medical” personnel often don’t know why they should and they don’t bother. A number of years ago I brought this up at a meeting including many high level medical professionals and they were not respective to any discussion. When the controversy swirled, the recommendations was not to force doctors and other personnel in hospitals to comply but rather to put the burden on hospitalized patients to demand that hands be washed. Can you imagine the reaction to such a patient! Talk about neglect.
6
So now like with vaping the President will deny there is a problem that the CDC and other govt. orgs can fix, and he will demand a meeting with those involved to make things work! That is all we need. The CDC needs to get their act together now.
1
There has always been a misconception that hospitals are trying to shorten length of stay solely for financial reasons. The great hospitals are actually doing it as much for patient safety as they are for financial reasons. As a wise doctor once said "The only thing that can happen to a patient who stays in the hospital past what is necessary is harm".
5
When I was a nursing student, one of our required courses was microbiology. Part of the curriculum was for us to swab every surface imaginable in the adjoining hospital. You name it..from door knobs to the nurses' station main desk, bacteria especially thrived. Fast forward several decades, and we see that among the new protocols is to refrain from over-using antibiotics and anti-fungals, PRN and SOS being the go-to orders. Yet we are discovering that more is necessary to stop these drug-resistant infections. It goes back to hygiene of the caregivers, including the doctors. Wearing and then discarding gloves is imperative. But also crucial is thorough hand washing including under the fingernails upon leaving a patient's room. Those hand-sanitizers outside each room? Yes, they can be good in conjunction with gloves. But it can not be one or the other. And those sanitizers need to be worked between fingers and all surfaces of the hand. There is something to be said for good old fashioned hand washing.
8
@Kathy Lollock It is such a shame that so many nurses refuse to get the Flu vaccine and become vehicles for the spread of this virus to vulnerable populations in their hospitals.
https://journals.lww.com/nursing/Fulltext/2016/10000/Nurses__most_important_role_this_flu_season__Get.17.aspx
A quote from a previous NYTimes article regarding the room that held a C. auris positive patient is telling:
"Everything was positive — the walls, the bed, the doors, the curtains, the phones, the sink, the whiteboard, the poles, the pump,” said Dr. Scott Lorin, the hospital’s president. “The mattress, the bed rails, the canister holes, the window shades, the ceiling, everything in the room was positive.”
Add to that, ceiling tiles, ventilation systems, nooks and crannies of the floor and any cabinetry in the room, bed wheels that roll down the halls of the facility, into the elevators, taking the C. Auris positive patients to MRI tables, CT scans, cardiology labs, dialysis treatment (places where other people go). And these are not negative pressure rooms, so the particles are floating out into the public spaces.
I believe it is now coming from the community and is not strictly nosocomial (hospital acquired).
19
Anything that deals with medical care in this country is full of issues. If you do not have a advocate who stays with you every step of the way you become a victim of the neglect and lack of quality care by the hospital.
No one want s to go to Hospice, nursing home, the hospital, everyone wants to run from them when they fid out that they need to be hospitalized.
This horrific medical story is of no surprise to anyone who knows how poorly run hospitals are but they certainly charge you a great deal of money to be abused.
6
As a physician that is hospital employed, I find it ironic that a Ct hospital need not be transparent regarding a documented infection with this concerning fungal infection.
While I have no issue with transparency in terms of what I do- hospital systems have a zeal for the ridiculous in relation to transparency with respect to what I do. For example- I don’t get the opportunity to ensure I review a study/lab I ordered and then discuss with a patient followed by release via the patient portal. This has been standard at other systems where I have worked, but not the hospital where i am employed at in ct. I can go on and on with other examples.
Patients have a right to know what is going on at their choice/community hospital.
By the way- I have yet to see a designated responsible party whose job it is to clean all the keyboards we are now chained too. Hospitals are not the cleanest places to be....
26
It would help if meat-eaters would start paying more for the damage they are doing to the rest of us because of their diet. As this article points out, huge amounts of drugs are forced into the animals because they fatten them up, making their flesh just a little cheaper.
It’s time to ban all antibiotic use to fatten up animals in our inhumane, thoroughly unnatural factory farms. If that means meat becomes much more expensive, well, it should be expensive: it’s the flesh of a fellow animal, for crying out loud.
But as long as these people insist on their dirt-cheap fast food burgers, we’re all being harmed by their behavior as the bugs become ever more resistant to the drugs. Way to go, meat-eaters.
30
@EB - fungicides are more commonly used with produce, so that would more likely a contributing influence for fungal resistance. People should think of that when insisting, for example, on buying their fresh berries regardless of season or distance from producer.
Antibiotics are a problem indeed when used for meat production, but we have to face the fact that most of our food production system is, essentially, applying strong evolutionary pressures on multiple classes of pest.
15
@b fagan - Agreed. The best we can all do is, as far as possible, eat vegetarian, eat locally-grown, eat in season, and eat organic. If we have the space, grow our own veggies. Learn to pickle them for later use.
These all sound like pie-in-the-sky ideas, easy to sneer at. But our future depends on our ability to at least try to collectively do these things.
2
Okay. Let’s talk about hospital staffing and bed control. Poor infection control practices are in part related to the hurry, hurry, hurry mentality that pushes staff, including nurses, physicians and ancillary staff to cut corners in all aspects of patient care including infection control practices. Get the patient into an ER bed, then out of the ER ASAP. Housekeeping, forever short staffed,
is expected to complete terminal cleaning rapidly but often there is no waiting period in a “dirty” room before the next patient is placed there. This happens in all areas, my experience is primarily in the ER. Another concern is poor communication even with the EMR, of past infections patients may have had. Patients and families must be vigilant regarding hospital care. Think about how often staff including physicians enter a room without washing their hands.
12
I traveled to NY Presbyterian Lower Manhattan to help my 25 YO son who needed an emergency appendectomy. During my 5! days at his side I observed countless roaches, other dead insects on all windowsills throughout the hospital, discarded food and filth in room corners everywhere, and no accommodations for rest/healing time. They were hoping that he was a statistic, i.e., would be in and out based on the operation, despite all the evidence that his body was in extreme distress. It was the horrible. I’m grateful he got out alive.
32
Hospitals are the absolute best place to get really sick.
27
Get a grip. The list cited in this article is of hospitals that “cared for persons with candida auris infections”. It is not a list of hospitals that are contaminated with C. auris. Would you have preferred that they turned these people away? These hospitals were doing exactly what they are supposed to do by admitting sick patients and caring for them. They should be praised, not criticized for doing so. Remember the flack hospitals got for treating AIDS patients.
9
@srb
We do have a grip however, hospitals are a breeding ground for disease and we all know that. Visit a patient in the hospital and you see nurses walking around who dont clean their hands. You see drs. eating over the food trays and never cover their mouths when they cough. You see corridors that haven't been cleaned in hours. No one is saying turn anyone away, just keep the facility clean, turn patients over so they dont get sores, do your medical job. People who are sick are dependent on the medical staff to do their job.
Maybe you should spent time in real hospitals vs the private ones
11
An interesting and important subject, but poorly covered here, because it's incomplete! Why? Because the list is about hospitals that cared (!) for patients with C. auris infections, not about hospitals in which patients contracted this fungal infection. It's left unclear if treating a patient with that infection automatically means they contracted it there. And, if you're worried about catching this potentially deadly fungus, that's what you really want to know. In fact, a hospital that has a track record of successfully treating patients with C. auris (keeping them alive) who got it elsewhere is actually one of the better ones to go to, because these hospitals know how to handle this, also from a hygiene perspective. So, NYTimes, please clarify - what does this list mean? Thanks!
20
If the pharmaceutical industry answered to the government, instead of the reverse, they could be directed to generate new effective anti-biotics. Washington Consensus Capitalism is an ineffective system in the delivery of healthcare. U.S. society funnels more money per capital than any other country into its healthcare system with morbidity/mortality results that place U.S. citizens near the bottom of developed nations.
6
@john what new antibiotics has the European systems produced to solve the issue? High demand will create the treatments required. US pharma has effectively cured HIV, created a vaccine for ebola, and close to solving Alzheimers.
In 1975 my microbiology professor told us that we were at war with the microbes and that we would eventually lose. He stated that their ability to adapt was greater than ours. This was about the time that drug resistant microbes began to be recognized. How prophetic.
13
@Mike - I have seen, but can't put my finger on, an article mentioning that there are researchers now who are growing concerned that as warm, moist climates become more widely spread, there will be fungi which were previously unable to colonize warm mammalian systems that will pick up the knack as their current habitats warm. Sink or swim for them could have a bad result for us mammals.
5
Found one of the articles - and it's about Candida auris and warming. The first link is from Science News (which I think everyone should subscribe to - bi-weekly science explainer).
"From 2012 to 2015, pathogenic versions of the fungus Candida auris arose independently in Africa, Asia and South America. The versions are from the same species, yet they are genetically distinct, so the spread across continents couldn’t have been caused by infected travelers, says Arturo Casadevall of the Johns Hopkins Bloomberg School of Public Health.
Instead, each continents’ C. auris may have become tolerant of the average normal body temperature of humans — about 37° Celsius — because the fungi acclimated to warming in the environment caused by climate change, Casadevall and colleagues argue. If this hypothesis turns out to be true, C. auris “may be the first example of a new fungal disease emerging from climate change” that poses a risk to humans, the researchers report online July 23 in mBio. "
https://www.sciencenews.org/article/climate-change-could-raise-risk-deadly-fungal-infections-humans
They always provide citations to the science they discuss.
A. Casadevall, D.P. Kontoyiannis and V. Robert. On the emergence of Candida auris: Climate change, azoles, swamps, and birds. mBio. Published online July 23, 2019. DOI:10.1128/mBio.01397-19.
4
My dad will be undergoing a stem cell transplant in the first quarter of 2020, and this has me quite worried, as he will be severely immocompromised during the treatment and 10 or so days of hospital recovery. Granted, it will be in a transplant center where extreme precautions are taken, but I will definitely be checking with the hospital first to make sure there were no cases of this fungus.
7
As a career hospital pharmacist who has seen many decades of broad-spectrum antibiotic overuse and added antifungal therapy ("just in case"), I too hope and pray that the government understands that we have a right to know whether a particular facility is more or less risky than another.
I dislike using Google or other reviews when every hospital keeps constant watch on infections, and has done so for many years. I might use Yelp for finding a restaurant but I have no way to get quality information about health facilities other than the meager Medicare data.
Let's open the hospitals closet doors and see what skeletons are hidden therein.
23
Rather than developing 10 drugs for eczema, pharmaceutical companies need to be concentrating more on infectious diseases. Congress should pass regulations which force them to put a percentage of R&D toward this serious problem.
11
@Jasmine Armstrong
No money to be made, its all about the money and of course shareholders
5
My otherwise robust 73-year-old sister died from C-diff after a "successful" surgery on a fractured ankle. She had been transferred from hospital to in-patient rehab facility where she passed away.
We believe it was not the hospital, but the rehab that was the source of the problem, though both had exceptionally good reputations.
In retrospect, the attendant dispensing medications could have used better protective practices, in all probability rolling bacteria from room to room on her cart. The rehab therapist wore a lab coat gray from age (or insufficient laundering)?
We didn't monitor all hand-washing.
There are no words to describe how shocked our family was. It is absolutely essential that we be our own advocates, and/or protecters of our families, whatever the facility or its stellar reputation. Keep on top of the practices of everyone who interacts with a patient, and, as we now do, keep a daily log to ID every person, drug and procedure.
In my sister's case, pre-op antibiotic dosage probably left her vulnerable, then there was no time/treatment to reverse her deadly spiral. Awful, heartbreaking.
42
So sorry for your loss. Something similar just occurred with my cousin in rehab.
10
@Jeanette My late mother was once in one of Manhattan's "top" rehab facilities and though she thankfully didn't die of an infection while there, I was at the rehab place practically every day calling them out on just about everything I was aware of.
Many of these "top" facilities are not required to report the number of "temp" from agency RNs they use with imperfect English language skills, the number of shifts that are short staffed because of people calling in sick, etc. Not to mention the times the whole floor's staff is in the "day room" snacking. This is what I found at 11 one hot summer night (in addition to mold in the fridge) when my mother, who rarely complained, called me to tell me she had been requesting help for 2 or 3 hours and gotten no response. So I took a taxi up there at 11 at night.
16
@ellienyc As a physician, it never stops amazing me how much time nurses spend eating and chatting at the nurses station.
This explains the enormous health crisis facing nurses today: over 50 percent of nurses are morbidly obese (that translates as severely overweight).
https://abcnews.go.com/Health/study-finds-55-percent-nurses-overweight-obese/story?id=15472375
5
“On the flip side, the C.D.C. reported substantial declines in cases of MRSA...” maybe for humans but MRSA has jumped the human chain and is infecting canines. (In dogs called MRSP). This is one of the rare few superbugs dogs and humans share.
Last April I took my dog in for what was a benign polyp on his paw. He never healed. After a couple months, the vet finally decided to test my pup for MRSA. He tested positive. It is now November, my dog has been through 12 antibiotics. He no longer has his paw bandaged but he does limp.
My pup will be at higher risk for the simplest procedures and more than likely considering how long he had it before being diagnosed; I am probably carrying it.
All those years ago when doctors handed out antibiotics for the simplest cold has probably gotten us to this point. It’s really scary to know these superbugs can jump species. My pup was the first dog at my Vet’s practice to contact MRSA.
4
So if C Auris is resistant why should we think the cleaning techniques in the video will be effective? Haven't facilities chosen to rip out walls and ceilings because this cannot be killed?
8
“Worse than we previously thought.” No surprise there. It seems most things are deteriorating-worsening-self-destructing worse than previously thought- climate, job markets, relationships, contaminated food, politics -
8
So basically all the hospitals have been infected. Great!
5
We set up a government to solve problems individuals cannot but Republicans are destroying that government. So are they going to solve the problems?
4
@H Munro
Big medicine has been fighting transparency for years. It is resisting all Trump efforts to allow the requirements of a free market.
More than half the instances are in California and California. What have the Democrat state governments done? Why didn't the CDC publicize this when Obama was president?
Democrats never encourage the deep state to reveal any sins or problems on the part of their big business owners.
5
@H Munro Don't blame Trump or the Republicans - Democrats are monopolizing the news for 3 years without any result that they hoped for. That's been pretty darn destructive!
Trump wants flavored vaping banned. Who in Congress supports him on this? Name one Democrat. Can't do it? Every Dem and Every GOP has to toe the party line. They are not allowed to do what their constituents want, only what power brokers like Nancy, Mitch, and Chuck want, otherwise, sorry no upward mobility for you, newbie.
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Wow so basically every major hospital in the state.
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The picture shows clearly how this infection spreads adn will continue to spread.
Sloppy donning of the gown, which is basically off and not covering the visitor, no gloves, and I bet (since this is what I see daily) no one is washing hands either.
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@reader Just FYI, studies have shown us women doctors wash our hands at a much higher rate than our male colleagues.
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I no longer go to the doctor expecting antibiotics when I'm sick. Even if he says "It's probably a virus, but I can write you a prescription just in case." I say, "No thanks."
Here's the quote from Fleming's 1945 speech;
"the microbes are educated to resist penicillin and a host of penicillin-fast organisms is bred out ... In such cases the thoughtless person playing with penicillin is morally responsible for the death of the man who finally succumbs to infection with the penicillin-resistant organism. I hope this evil can be averted." I guess we didn't listen.
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We are in an evolutionary arms race. It was never a matter of ‘If’ but ‘When’. Microbes evolve very fast. Bacteria are great at acquiring new DNA even from dead bacteria. Pharm companies have not kept up with developing new antibiotics.
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@Hippo I am not a fan of some decision making by big pharma, but this is not one place to put blame on the fast increasing antibiotic resistance.
What about the antibiotic use in commercial agriculture? Do an internet search on prophylactic use of antibiotics. It will blow your mind and maybe convince you to stop eating fast food burgers.
And, how many people do you know that insist on getting a pill (often antibiotic) in exchange for a doctor's visit when it is not even clear that their problem is a bacterial infection?
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Yet more proof that people (or their advocates), especially when older, need to do everything possible to stay out of hospital. I suspect much more fuss would have been made of this if the victims were younger -- when people are older it is very easy to just say "well she was old," just as they do in NYC when old women are run down by cars in crosswalks.
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Several years ago my 91 year old father, who lived in another state, was hospitalized after feeling ill and – before being discharged 3-weeks later – was diagnosed with C-Diff. After his antibiotic treatment was done and a check-up pronounced him well, I brought him to live with me and my family in NYC. He did well for a short time then spiraled downward quickly, being admitted to what was then St. Vincents Hospital emergency room in Staten Island. Although we repeatedly told them about the C-Diff, the ER took no precautions with regard to isolating him, which they should have done because of alimentary disturbances and other patients and family members in close proximity to us. A day after he was admitted he succumbed to C-Diff. The emergency room had been staffed by well meaning professionals, although far too few, but nevertheless my father endured hours of filth and chaos that did him no good and, who knows, may well have contributed to the infection of others.
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If the human race is to win, or even tie, the never-ending battle with disease-causing microbes, we are going to have to keep developing new drugs, to supplement existing antibiotics to which bacteria and fungi are becoming resistant.
Some of the necessary work is done by the government, and much is done at universities. But the fact is that most of the work of developing new antibiotics, testing them, and bringing them to market is performed by big and small pharmaceutical companies. Like it or not, these companies perform a truly essential service to us all. They are far from perfect, and prices are too often too high. But we need these companies.
Today, drug companies are facing a major threat to their existence: US trial lawyers. Tort lawyers have won multiple multi-billion dollar verdicts against drug companies, most notably Bayer and Johnson & Johnson. Most of these cases are based on what is likely junk science. These verdicts threaten to bankrupt these companies.
During the late 1970's and early 80's tort lawyers nearly shut down vaccine production in the US; only passage, at the 11th hour, of a no-fault law by Congress maintained the availability of vaccines in the US.
If the lawyers succeed in putting big pharma out of business, our problem won't be high drug prices. It will be the unavailability of drugs essential to our lives and health.
The US desperately needs tort reform.
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Killing babies with talcum powder is junk science?
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@Mikhail
Pretending that using talcum powder causes ovarian cancer is junk science.
Not even the trial lawyers are claiming babies die from talcum powder. If they read your comment, they will launch a new campaign to find dead babies who were exposed in life to talcum powder.
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@Alex You may be right about tort reform. But as a pharmacist I can tell you that almost all antibiotics are developed in China and India and cross-licensed for sale in the US with Glaxo an other major companies. This has proven cost-effective for them due to lower costs overseas.
https://www.nytimes.com › 2009/01/20 › health › policy
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This is just beginning. It will only get much, much worse as these new bugs gain traction outside of nursing homes and hospitals. What do we do?
How about we ban antibiotics from pig feed, cow feed, chicken feed so that germs don't gain resistance to them?. How about the federal government getting pro-active in this action so that we have some hope of getting ahead of this growing public health issue. How about pumping huge incentives into academia to develop new antibiotics? How about all of these, now!
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The fact that nursing homes and hospitals do not want you to know which ones are having problems comes as no surprise. They are in the business of making money and profits, and if you know, you would choose to go somewhere else. Just one more example of our money driven "health"care system....and it's the same whether for-profit or not-for-profit.
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The battle against microbes developing resistance to antibiotics is unending.
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where is the list?
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@blond rockrr It's in there as sort of an attachment. I had trouble finding it. It lists different facilities but doesn't tell how many cases each facility had.
Patients and their families: just ask each care provider to WASH HIS/HER HANDS before touching you! PLEASE!
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@BA
To patients and their families: PUT ON GLOVES before you touch your loved one and WASH YOUR HANDS before leaving the room! PLEASE!
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No.
The only reason the CEOs of these NY hospitals are agreeing to releasing this information is because every single one of them realizes that somewhere deep in the bowels of each of their IT departments is an underpaid systems integration specialist who manages the data feeds out of their various laboratory information systems -- and they are all itching to dump every such test result into a text file and send it off to whomever.
I am fairly certain the same holds true for every other so-called 'health system' in the USA and wherever else.
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I remember when my microbiology professor in college quipped 'when the fungus gets you it's game over' This was over 30 years ago so looks like what was true then is still true now.
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As a former nurse familiar with some of the NYC based hospitals, and one that also studied bacteriology, virology and fungi - these bugs have a commonality, they can’t tolerate certain blood ph changes. Checking patients’ blood ph may lead to the clue why these patients are susceptible to the infections and how to fight off some of these infectious issues. Doesn’t hurt to seek and find if this info can help our most vulnerable.
🙌🏾🙏🏽🙌🏾
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@Stephanie Muirhead Humans live within a very narrow range of pH.
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@Stephanie Muirhead Most humans cannot tolerate blood pH changes - they develop respiratory alkalosis when pH increases and metabolic acidosis when pH is low. These conditions are life threatening.
Life becomes fairly incompatible when blood pH is not in the normal range.
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@Stephanie Muirhead do you have any essential oil recommendations?
The sad fact is this a totally man made medical rising tide of a disaster. Thank goodness it is getting public airing.
I guess add it to the list of man-made disasters, extinction of human tribes (ie native Americans etc), extinction of animal species, destruction of ocean and corral reef environments, and, of course, global warming, come to mind.
Over use of antibiotics, a miracle drug, is just up there as proof that humans might be smart as individuals, but stupid as a species.
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NYT, the figure legend stating, "A culture of C. auris in a petri dish. The C.D.C. now estimates more than 35,000 Americans die each year from the infection" is incorrect. As of October, 29, 2019, the total count of clinical cases in the US is 836 persons (https://www.cdc.gov/fungal/candida-auris/index.html).
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@Rick Believe the article references total deaths from all drug resistant infections.
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I have read through the comments. I have worked with C Auris patients. It is not pretty and is dangerous. That said, where I worked did take it seriously after people like me went on quiet but stern hissy fits about the danger. Let's just say I was not popular but thanks to the NYTimes I have proof that I was doing the right thing.
It is potent, it colonizes everything, it is extremely difficult to clean any body or surface that it is on.
I alerted other staff some of whom thought it was a droplet precaution they could blow off as the usual. It wasn't. I chose to wear a gown, mask, gloves over a lab coat and stand outside the rooms of those affected. However, that being said, C. Auris was on the floors etc. Those little spores flying through the air like they do to populate mushrooms. C. Auris flakes off the skin. We all shed skin.
Another thing I want to point out is that family members did not and would not adhere to protocol. Even staffers had the idea of customer service over contagion control. That is dangerous.
I am lucky to know some contagious disease specialists and I could turn to them to voice my concerns and get guidance.
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Thank you for this information. Does it wash out of clothing? What about people who walk over it? Burn the shoes?!
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What should be required of visitors? Should all visitors take precautions whether diagnosed or not?
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35,000 Americans die from drug resistant infections last year, 0 Americans die from measles. The Times runs a dozen or so articles on drug resistant infections, over a hundred on measles. Hmmmm.
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Read "The Coming Plague"
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My wife is pregnant and we are planning to give birth at one of the hospitals listed - how do we get more information?
Do we need to change hospitals? I imagine if we call the hospital to ask, they will say "no", for fairly obvious reasons.
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I’m a fungal immunologist by training. If your wife is immune competent, you have nothing to fear.
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@Nick How about a home birth with a doula?
I live in MA and avoid Boston hospitals myself!
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The list is really heavily NYC area based - and some other metro areas. Does not include many upstate community hospital, maybe some good news. (And well done all Hebrew Home affiliates, unless something is unreported!) But clearly, extra caution is warranted everywhere. A little sunlight does seem a good thing, and the list of commonly spread resistant agents is sobering.
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@Nell Good luck getting sunlight in NYC!
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Are any NY hospitals NOT affected??
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@Me
I wondered the same thing.
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I understand that Hospital for Special Surgery is the cleanest in the country. But they don't take "sick" people; they mostly do vertebrae and wrists and so on.
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Secrecy is the parent of major trouble, in medicine as in politics.
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So, every hospital?
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Information on hospital's incidents of infection should ALWAYS be public!
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Good luck trying to eliminate C. Auris. Excellent probability it’s on the skin of the decontaminator. As an aside, as one of your correspondents noted, I reckon a fungicide would prove more effective than an antibiotic...
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In Basel (Switzerland) they just bought two machines that irradiate rooms that had housed an infected person. They haven't had a case at their university hospital yet, but they are being proactive. I wish NYC hospitals had been proactive as well...
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@Beyond Repair. Do we know how effective or deficient hygiene and decontamination protocols for C.auris are in New York hospitals? I find the absence of information on this from the article very annoying! And, if the author of the article doesn't know because they (the hospitals) won't say, then that information belongs in the article, too. Right now, it's mostly "Oh my God" and "run away". Well, many of us may have to go to a hospital eventually, and people not having life-saving procedures in time because they are now scared can also cost lives.
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For those that missed it, there is a link to the list of affected hospitals/nursing homes in the article. Many of the major hospitals, such as Mt. Sinai, NYU Langone and Lenox Hill, are on the list. Transparency will, we hope, prod all of them to more adequately fight this this public health crisis.
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@Emme B I don't think it helps that NYC is so unbelievably crowded these days. I've been a patient at one of these hospitals for 20+ years. It used to be that I would go to the doctor with an issue, get blood work done, get test results in two days at most. Nowadays, it takes that same hospital at least two weeks for any results. I don't think hospitals can keep up, even with something this serious. Something needs to be done.
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Also, what should the public do to protect themselves? If this is something that can live on clothing, would visiting someone at a hospital and sitting in a visitors chair contribute to the spread? Would a simple clothes washing remove the fungus?
How easily is this spread outside of the hospital?
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@Fed Up As far as I know visitors to patients that have confirmed infections should be masked, gloved and gowned and wear shoe protectors.
A person needs to be shown how to put these on, and particularly off, correctly. There should be a disposal container in the room.
The picture at the top of this article is horrifying. The man has a gown which he is not wearing correctly, no gloves, and he is touching the patient with his bare hand.
Hospital visiting should be kept to a minimum when there is an outbreak at the hospital.
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@Jean Thank you, I'm asking in general. If this is something that can be found anywhere- on the floor, on clothing, etc. what stops it from being on a chair anywhere in the hospital? What if I'm going to the doctor's office at the hospital and sitting in the waiting room or stepped in an area where the was shedding from someone's skin that maybe the hospital doesn't know about? Am I now colonized because the hospital hasn't cleaned anything properly or hasn't tested certain areas of the hospital? And what about just regular doctor's offices where maybe the doctor has traveled to the hospital and back?
I live with an immune compromised person, I would love to know hot to not bring this home after a simple doctor's visit. So many unanswered questions here. Hopefully the NYT will do a follow up with answers.
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Seems like all of the hospitals in NYC are affected. This isn't surprising. I was in an ER in one of the boroughs a few weekends ago and didn't see simple hygiene protocols followed. Granted, the ER was very busy, but that shouldn't be an excuse.
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Make sure never to consider that the profit motive may be warping finding and developing new antibiotics, as it's better and cheaper to just push new uses for old drugs. You know: marketing is cheaper than product development.
Don't consider the mass use of antibiotics in factory animal farming either.
That'd be just naive.
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@Doug Tarnopol First, antibiotics don't work against fungi. Antibiotics are only active against bacteria. Only antifungal drugs work against fungi. And the reason that antibiotics don't work against fungi is because fungi are, on a cellular level much closer to our own cells than are bacteria. And that makes the development of antifungal drugs incredibly difficult and expensive. And the studies take years to get enough study subjects.
I worked on the development program of an antifungal drug. These are not drugs that are blockbuster profit makers. Fungal infections, for all the hype, are just NOT that common. Not like bacterial infections. Your contention about profit motives doesn't apply to antifungals.
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This is an important, necessary development for Patient Safety. Patients, Families and Providers have the absolute right to know if a Facility they use OR are considering using has/had this problem. What steps have been taken, to prevent reoccurrence? Have all Staff been properly trained/ retrained? Are Patients screened before or shortly after admission ? Infection Control is an often neglected and underfunded, hidden part of the entire care process, with horrendous results when the unexpected occurs. And it will occur, sooner or later.
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@Phyliss Dalmatian
Phyllis, please please please read the article:
In releasing the hospital and nursing home data, New York State officials implored patients not to avoid going to medical facilities just because they have treated C. auris patients. In fact, the hospitals and nursing homes listed may well be doing a good job of containing the fungus, said Dr. Howard Zucker, the commissioner of the New York State Department of Health.
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@Jonny She does list perfectly valid questions. In an ideal world, institutions would release what they're doing to contain infections along with disclosures of cases. 'S the only way consumers and others can determine if "they're doing a good job."
(They won't of course - opens them to formal and informal regulatory oversight and potential liability.)
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@Phyliss Dalmatian With facilities/corporations skimping (to say the least) nurses & nursing-assistants (in order to increase profit margins *even further*), this problem is just going to get bigger and bigger.
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It's hard for me (a medical layperson but communications professional) to read nursing homes' and hospitals' arguments against disclosure and not hear unstated concerns about branding and bottom lines. They are no doubt working in earnest to stem these infections, but they should remember that sunlight is the best disinfectant (sorry).
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@Grant
Fungii don't do well in sunlight. Just ask a mushroom.
Sorry for the joking tone.
People get so worked up and confuse virus, bacteria, and fungus.
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The European countries that strictly limit agricultural use of antibiotics have much lower incidence of antibiotic-resistant infections. USDA and FDA refuse to regulate this serious threat to public health. Factory farms pack huge numbers of animals into a tiny space and then have to use antibiotics to prevent diseases from tearing through the herd or flock. The workers at these farms have much higher probability of harboring drug-resistant microbiota than workers at other types of agricultural enterprises.
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@Rodrick Wallace
Data? Seems like hearsay, particularly when reviewing CDC info (836 cases through Oct 2019 in USA) and EU data (620 cases through 12/2017, with 300 approx in both 2016/2017.
Www.ncbi.nlm.nih.gov/MPV/articles/PMC5883451
Www.cdc.gov/fungal/candida-autos/index.html
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No list ,so what is the point of this article? ,I think most of the patients that died in NYC medical or healthcare institutions were quite sick at the get go ,but it is still important for we family caregivers to learn what's what?
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Click on or touch the list, near the top of the article. It will magically appear.
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@Carlyle T - You can “learn what’s what”: see the heading “Where Candida Auris Patients Were Treated In New York State” for a downloadable list of the hospitals and care facilities.
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Carlyle T. there is a hyperlink embedded in the article
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Is there a list (that I missed) of NYC Metro Hospital affected by the fungus?
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@Leah it's in a spreadsheet in the middle of the article:
Where Candida Auris Patients Were Treated in New York State
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@Leah It's in the hyperlink that begins "release the names. . ." Just click on it and you'll see it: It includes every major NYC hospital.
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@Leah - See the heading “Where Candida Auris Patients Were Treated In New York State” for a downloadable list of the hospitals and care facilities.
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The family members discussing the infections are not bound by HIPAA, the institutions not confirming them are following regulations, and the doctors confirming the infections are breaking HIPAA rules.
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@Steve W
HIPAA is not what you and most people think it is. It is less restrictive.
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@Steve W
It is only breaking HIPAA if individual patients are identified in partcilular.
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