Bacteria that are resistant to antibiotics prey on hospital and nursing home patients across the country, but at least one of these nasty bugs has been eliminated from a surgical unit in Pittsburgh.

Andy Starnes, Post-Gazette Alan Bernstein, nurse manager for the 4 West unit at the VA Pittsburgh Healthcare System, University Drive Division in Oakland, holds a visual aid for the housekeeping staff showing every item that needs to be cleaned in a hospital room. Staff nurse Ellesha McCray, left, puts on a disposable gown before tending to a patient. 4 West has eliminated methicillin-resistant staph, a bacterial infection, with a rigorous program of cleaning, gowning, hand washing and reminding workers of infectious "hot zones." Click photo for larger image. Previous articles Antibiotic-resistant bacteria cited in 2 VA deaths is widespread (5/25/04) Butler man dies after contracting staph in hospital (5/21/04)

No patient has contracted methicillin-resistant Staphylococcus aureus infection since October in the 36-bed unit on 4 West at the VA Pittsburgh Healthcare System. That's a significant improvement over 2002, when the same unit saw 12 patients infected with MRSA during the year, according to the U.S. Centers for Disease Control and Prevention.

The efforts at the VA in Oakland are being held up as a model in infection control by both the CDC and the Pittsburgh Regional Healthcare Initiative, a Downtown nonprofit group that promotes quality improvement efforts.

Even so, the VA Butler Medical Center garnered headlines last month when two families reported their loved ones had died at the facility with complications due to MRSA. A veterans' advocate in Butler County has called for a federal investigation.

The persistence of MRSA problems in Butler and throughout the region shows that the infection-fighting ways adopted on 4 West in Oakland haven't caught on like the bugs they seek to contain.

"Our challenge is really to help ensure that the results achieved in infection control in one area are quickly disseminated and acted upon across the region," said Geoff Webster of the local health care group. Last year, the health care initiative challenged medical centers throughout the region to eliminate all hospital-acquired infections.

"Pittsburgh has a chance, and an imperative, to move ahead quickly to eradicate MRSA and eventually all hospital-acquired infections," Webster said.

Staphylococcus aureus is often referred to simply as "staph." The bacteria are commonly carried on the skin or in the noses of healthy people, and commonly cause minor skin infections. But the infections can be serious when the bacteria get into a wound.

Staph infections have been treated for more than 50 years with a type of antibiotic related to penicillin. But those treatments have resulted in staph bacteria that are resistant to the medicine -- methicillin-resistant staph, in other words.

Staph bacteria and MRSA can spread among those who have close contact with infected people. The type of contact is almost always direct physical contact, not through the air, but MRSA can spread indirectly by touching objects that have been contaminated by a person with the bug. These objects can include towels, sheets, wound dressings and clothes.

The surgical unit on the fourth floor at the VA Pittsburgh's Oakland hospital didn't have a uniquely bad MRSA problem when it initiated its pilot project in 2002. But the effort was supported by CDC because it sought to employ principles espoused by the Pittsburgh Regional Healthcare Initiative, which promotes a systems approach used by companies from Toyota to Alcoa.

Preventing the spread of MRSA involves hospital staff paying keen attention to hand-washing before and after caring for patients. Infected patients are to be isolated and workers are to wear gloves, gowns and masks when tending to them.

One reason workers weren't doing this is that glove dispensers often were empty. Some rooms had gowns, but others didn't. So, workers on the unit created a new system for stocking supplies.

It sound simple, but when supplies aren't immediately available, workers have to make snap decisions about whether to immediately attend to an infected patient's needs, or to search for supplies, said Ellesha McCray, a nurse coordinating the effort. Sometimes, there's no time to wait.

"When the system is broken, people have to make difficult trade-offs," she said.

Doctors and nurses might say they always wash hands between patients, but studies that observe the behavior of both groups have consistently shown that's not the case, said Peter Perreiah, who coordinates the project for PRHI. One solution was to place dispensers of alcohol-based sanitizer gels in patient rooms, which provide for a quicker cleaning of the hands.

But the underlying problem was a lack of time. So, nurses in the project devised ways to administer medicines more efficiently, so they would have more time to do the right thing on hygiene. Nurses were spending a lot of time hunting for wheelchairs for patients, so the hospital created a new system for wheelchairs designed to give back this time to nurses.

Patients can be either infected with MRSA or they can be colonized, meaning the bug is present in their system but not causing a problem. Staff on 4 West at the VA was to regularly test all patients coming into the floor to see if they were either infected or colonized; both groups were isolated, because a colonized patient can pass the bug to someone else.

All patients were tested when they left the floor, too, so that workers could know quickly whether a patient they cared for had become infected. That information allowed for front-line workers to get involved quickly in finding areas for improvement.

Lines on the floor of isolation rooms clearly mark the infectious "hot zones," beyond which workers must be gowned. Stethoscopes can carry bugs, so doctors must use a scope that stays in the zone rather than one they carry into the room, Perreiah said. Wheelchairs can carry bugs, so the VA project has addressed the system for keeping chairs clean.

Even patients are part of the solution. Rooms in the 4 West unit include signs that read: "You have a right to clean hands. Please remind everyone to sanitize or wash their hands when entering and exiting your room."

Perreiah said improvements on the unit are suggested and tested by front-line workers themselves, before they're put into place. That has helped not only the infection rate, but also the satisfaction of workers.

"We definitely have input on the care, and that's not true everywhere," said Dora Gentile, 56, of Shaler, a nurse who started working on the unit more than a year ago. Gentile has more than 20 years experience working at the old St. Francis Medical Center and other hospitals in the city, but she hadn't before seen a unit so engaged in infection control, she said.

The challenge now is to get more units to follow the local VA's example, said Dr. John Jernigan, chief of the interventions and evaluation section in the division of health care quality promotion at CDC. The approach to the problem in Pittsburgh draws on principles used in other industries, and other hospitals might opt for a different approach, Jernigan said.

But it's clear that hospitals can dramatically cut their infection rates, and that they need to do so: MRSA is responsible for 100,000 hospitalizations each year, and has been a growing problem for more than 20 years.

"We're very encouraged by the results that they've had, and we're very interested in working with the Pittsburgh Regional Healthcare Initiative to examine how broadly applicable these technique are," said Jernigan. "We're hoping that other hospitals can demonstrate similar success."