An Ounce of Prevention -- At Last

County jail officials finally decide to get serious about a highly contagious disease

Some doctors call them “super bugs,” bacteria that have grown so resistant to antibiotics they can withstand all but the most powerful and expensive drugs. Untreated, they can cause serious illness such as pneumonia and bone disease, even death.

Three weeks ago I wrote about one of these super bugs known as methicillin-resistant Staphylococcus aureus, or MRSA (pronounced mer-suh), a nearly drug-impervious staph bacteria that infected at least two inmates at the county jail system’s Metro West Detention Center. I criticized the Miami-Dade Corrections and Rehabilitation Department’s handling of the episode, noting that one inmate was misdiagnosed twice during a two-month period, until his condition had deteriorated so badly his mother called the county health department to investigate (“Contagious Outbreak Untreated,” June 10). Only then did a doctor examine the inmate and correctly diagnose his MRSA infection. By that time the inmate, Jason Mancas, had an ulcerated lesion on his stomach the size of a baseball and could barely get out of bed.

Even after a health-department nurse identified the infection and issued a memo on prevention, corrections department supervisors did not alert staff at other county jails. “We felt the issue at Metro West was self-contained,” says Arthur Brown, the department’s director of patient services.

But others warned there was a threat of contamination beyond Metro West’s confines. Mancas had mixed with other inmates for months before he received treatment, not to mention the fact that he’d appeared in court at least once during that time. (There are six jails and a boot camp in Miami-Dade, housing an average of 6500 inmates.)

Across the nation MRSA is becoming common in jails and prisons, where close quarters and poor hygiene allow it to spread quickly among inmates. It is particularly debilitating to people with weakened immune systems. Physical contact is the method by which the infection spreads; cuts and other open wounds put individuals at great risk. Direct contact is not necessary; it can be contracted from surfaces such as bed linens.

So commonly is MRSA misdiagnosed as a spider bite that healthcare literature now warns that all reports of spider bites originating in correctional facilities should be tested for disease. Mancas says he was told at one point his sore was an insect bite.

In May the Broward County Sheriff’s Office was so alarmed when six cases of MRSA were discovered in one of its jails it immediately declared “zero tolerance for MRSA” and launched an aggressive campaign to halt its spread. The sheriff’s office isolated the inmates for treatment, ordered all facilities disinfected, turned up the temperature of the water, had health workers educate staff during roll call, and issued a press release to warn people who regularly come into contact with inmates.

By contrast Palm Beach County jail officials were slow to react to a MRSA outbreak there and are suffering the consequences. More than 300 cases have been reported so far, according to a story in the Palm Beach Post, requiring a thorough disinfection of all jail facilities and courthouses. Inmates are not the only people to have been infected. Assistant public defender Carol Bickerstaff had to undergo surgery on her right arm in January to treat a MRSA infection that had spread from her shoulder to her elbow in a matter of days. She says the jail’s reluctance to alert the public left her vulnerable to the infection. “I was told that I could have lost my arm,” Bickerstaff says. “If I had known there was a MRSA outbreak in the jail, I could’ve at least told my doctor.”

Now inmates diagnosed with MRSA in Palm Beach County stand behind a glass partition when appearing in court, and Bickerstaff wears gloves and washes her hands “like Lady Macbeth” when visiting the jail.

She offered this warning to Miami-Dade officials: “They ought to treat even one case very seriously, because they want to keep it to just one case. Here, I don’t think they will ever get it out of the jail now.”

Administrators are often reluctant to acknowledge a MRSA outbreak, she says, because it means they will have to incur the costs of taking a culture of all suspicious lesions and sending them to labs for testing. Miami-Dade County Manager George Burgess has asked the corrections department to work with the Public Health Trust to “identify cost-saving measures” at Ward D, the jail floor at Jackson Memorial Hospital.

For many Miami-Dade corrections officers and public defenders the only news of a jailhouse MRSA outbreak came from my column. Trust me, this is not gloating. It’s absurd that government employees should have to learn about a potential health risk from a weekly newspaper.

“After reading your article, I immediately contacted the [corrections department] regarding the potential risk to our employees and clients,” says LaEtrice McMurray, the public defenders’ liaison with the corrections department. “We also distributed a memo to our employees providing them information about the bacteria and standard precautions to prevent infection.”

Some corrections officers taped the article to the wall on the ninth floor of the pretrial detention center downtown — that is, until patient-services director Arthur Brown ordered them to take it down. “It came to our attention that the article was posted on the wall,” Brown says, adding that he didn’t want to alarm employees. (I was told that Brown described the article as “bullshit.”)

During the past two weeks corrections officers have reported suspicious sores on inmates. In addition to the two confirmed cases at Metro West, four more inmates suspected of having the infection were examined. According to Brown, no MRSA cases were confirmed. Another four inmates were examined at the training and treatment center, known as the stockade. One of them had a wound consistent with MRSA and officials are awaiting the results of a lab test.

Finally, “to deter anxiety,” Brown and department spokeswoman Janelle Hall announced last week an education campaign throughout the entire corrections department. It began with an e-mail blitz this past Thursday. Medical staff will begin visiting all the jails to instruct officers in identifying and preventing the spread of MRSA. “We’re doing it corrections-wide. This is a mass undertaking,” Brown says. “We’re being very proactive now.”

At last.

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