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A new report suggests germs that are resistant to antibiotics are spreading more widely than previously thought. The report from the U.S. Centers for Disease Control and Prevention says 32 out of every 100,000 Americans get these infections annually. Sometimes, they can be deadly. The report was published today in the Journal of the American Medical Association.

NPR's Richard Knox has more.

RICHARD KNOX: One of the latest victims is a 4-year-old New Hampshire girl. She died a few days ago in a Boston hospital of pneumonia caused by resistant staphylococcus. According to new estimates by the U.S. Centers for Disease Control and Prevention, that little girl is one of 19,000 Americans who die every year of resistant staph. Something like 94,000 Americans get life- threatening resistant staph infections every year. That's three times previous estimates.

Dr. Elizabeth Bancroft is with the Los Angeles County Health Department.

ELIZABETH BANCROFT: The reason the rate is so astounding is that this rate is larger than the combined rates of all four of the most traditionally followed bacterial diseases, the ones that were considered of the greatest public health significance.

KNOX: Bugs such as pneumococcus, invasive strep and bacterial meningitis. There's new information, too, on where invasive staph germs are coming from.

BANCROFT: What happens in a hospital doesn't stay in the hospital. People can be discharged from the hospital carrying organisms that only later they become ill with.

JOHN JERNIGAN: The overwhelming majority of these serious infections are associated with the delivery of health care.

KNOX: That's Dr. John Jernigan of the CDC. He says 85 percent of Americans with serious resistant staph infections got them in the hospital or other health care facility, but most of them didn't get sick until they were back in the community.

JERNIGAN: There are some evidence that people can carry this particular bacteria on their body for some period of time - months or years - without it causing any problem.

KNOX. Then seemingly out of the blue, they get deathly ill with a hard-to-treat infection. The new data show that it happens in both directions. Patients are bringing resistant staph into the hospital, too.

Elizabeth Bancroft says the clear message is that prevention has to begin in institutions that are supposed to make as well, not spread deadly diseases. She says hospitals can do quite a lot.

In Europe, some hospitals are screening each and every patient at admission for evidence of resistant staph. Those who are infected are put in private isolation rooms that can be entered only by people who are gloved, gowned, and masked. Apparently, no American hospital has gone that far, but Bancroft says some are implementing a raft of measures to stop resistant staph.

BANCROFT: For example, a patient on a ventilator, keeping the head of the bed up so that the patient doesn't inadvertently swallow or let anything get down into their lungs, get them off the ventilator as soon as possible, keep them on antacids, so there's nothing from their GI tract that might have bacteria that could potentially reflux up into their lungs.

KNOX: But the single most effective measure is plain old hand washing.

PAUL LEVY: So here we are in this - in a standard patient room. And as you come into the room, there is the dispenser right outside the door where you're supposed to...

(SOUNDBITE OF LIQUID SOAP DISPENSING)

LEVY: ...take a squirt of the liquid that you wash with your hands and that kills off the bugs.

KNOX: Paul Levy, the president of Beth Israel Deaconess Medical Center in Boston has tried to make it easy for his staff to disinfect their hands with alcohol-based gels. But he says it's been very frustrating.

After months of cajoling, hand-washing on most hospital units went up from 52 percent to only 57 percent. Some remain below 40 percent.

LEVY: The problem you run into a hospital is that people are very busy, doctors, in particular, are very busy. And they might say, well, I'm not going to touch the patient, so they bypass the dispenser.

KNOX: Beginning next year, the federal Medicare and Medicaid agencies says it will stop paying for care associated with hospital-acquired infections. That's got hospital's attention. But Levy is skeptical that even that will give doctors and nurses to wash their hands as much as they should.

Richard Knox, NPR News, Boston.

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