Mike Siegel / The Seattle Times

Handwashing signs are prominent at the Harborview Medical Center burn unit. Harborview has increased signage as part of its response to infection problems, including the MRSA epidemic.

Not so simple

Editor, The Times:

I am grateful to Michael J. Berens and Ken Armstrong for bringing attention to the challenging problem of MRSA ["How our hospitals unleashed a MRSA epidemic," Times, page one, Nov. 16]. However, it is no longer accurate to state that "six out of seven people infected with MRSA contract it at a health-care facility" nor to imply that universal screening of hospitalized patients will solve the problem.

The epidemiology of MRSA has changed markedly over the past decade. A recent study published in the journal Clinical Infectious Diseases showed that 90 percent of MRSA infections in San Francisco are now acquired outside the hospital setting. Universal screening has appeared to reduce rates of MRSA infections at some hospitals but not others. One approach to MRSA control will not fit all situations.

To truly control MRSA, we need less-expensive screening tests, simple decolonization regimens, better antibiotics and an effective anti-staphylococcal vaccine. This knowledge will come from biomedical research, yet since 2004 the National Institutes of Health budget has declined more than 13 percent after adjusting for inflation. It is time for a renewed national investment in biomedical research that will lead to an improved understanding of how MRSA causes disease and how it can be stopped.

-- Ferric C. Fang, Seattle

Antibiotic dependence

One major oversight in your otherwise excellent "How our hospitals unleashed a MRSA epidemic" was the origins of bacterial resistance -- overuse of antibiotics.

Antibiotics kill the weakest bacteria, often allowing the strongest to survive and multiply. It's no coincidence that Staphylococcus aureus has evolved into a more lethal form, MRSA. It was the target of the first antibiotic drug -- penicillin -- which came into widespread use in the 1940s. The overuse of antibiotics is the root of the MRSA crisis.

We know that lifestyle factors such as exercise, stress and diet influence our ability to resist infections, yet once antibiotics became available the health of the human immune system was ignored by the dominant medical system. Likewise, natural antibiotics, which had been used for thousands of years, fell out of favor.

Perhaps the crisis of MRSA will help swing the medical pendulum back toward a whole-systems approach to infections: First strengthen the host and utilize natural compounds, saving drug therapy for last.

-- Thomas Ballard, Seattle

Clean up your act

I was shocked to read your first story about the MRSA situation. I learned about ordinary staph in 1953, when my first child was born. I went to a U. S. naval hospital, where they had had an outbreak the previous year, and were taking measures to regain their accreditation.

Procedures were strict. The floors were mopped with antiseptic each morning. When my baby was brought to me for nursing, I was instructed to first wipe the nipples with alcohol. And to care for my stitches, I was to pour a pitcher filled with a solution of water and green soap over them. I was there for five days, so the lessons were firmly implanted.

The next two children were born in civilian hospitals, and I was rather taken aback at their comparatively lax standards. Now I realize that many hospitals have become even more careless, compared with that rigid naval-hospital routine. I believe that this stems from an attitude -- incorrect as we now know -- that antibiotics can take care of everything.

I hope your series induces hospitals to really tighten up their procedures. The MRSA screen before surgery is surely less costly than risking the loss of a life.

-- Edna Peak, Des Moines