The war against hospital-acquired infections is waged with high-powered antibiotics such as vancomycin, linezolid or daptomycin.

For six long months, Nellie Scott's body was the battlefield.

Scott is a 72-year-old Rapid City woman who survived a siege by several life-threatening, antibiotic-resistant infections, including a staph infection known as necrotizing fascitis and the intestinal infection vancomycin-resistant enterococci. At one point, she also tested positive for methicillin-resistant Staphylococcus aureus - commonly called MRSA, a Staph a infection that is resistant to commonly prescribed antibiotics.

Scott's medical nightmare began after back surgery at Rapid City Regional Hospital in October 2007. Surgical complications required her to have additional surgeries at a Minnesota hospital. By the time she was discharged six months later, she had been a patient in three hospitals and barely survived her bout with the Staph infection commonly referred to as "flesh-eating bacteria."

Scott doesn't know where the infections originated, but it was stopped by emergency surgery at Regional Hospital, an army of powerful and expensive antibiotics and state-of-the-art wound care. The original incision site became an open wound on her back measuring 14 inches long, 4 inches wide and 3 inches deep, which continues to heal from the inside out.

"It's probably quite a blessing that I don't remember a good share of it," Scott said last week in her Rapid Valley home.

Thankfully, Scott's MRSA infection responded to vancomycin, as the majority of those infections still do. If it hadn't, she might have been South Dakota's first reported case of VRSA, also known as vancomycin-resistant Staphylococcus aureus.

"Far worse than MRSA is VRSA," said Dr. Lon Kightlinger, state epidemiologist for the South Dakota Department of Health.

"Vancomycin is a high-power, next-line antibiotic used when other antibiotics don't work against Staph, so it is very alarming to find VRSA. Very few VRSA have been reported in the United States and none reported in South Dakota."

MRSA is only one of more than 60 communicable diseases that must, by law, be reported to the state health department by hospitals, clinics and longterm health care facilities.

The list includes well-known ailments such as tuberculosis, influenza and HIV/ AIDS, but also the more recent antibiotic-resistant strains of bacteria such as clostridium difficile and VRE, which are bacterial infections of the gut or genital tract.

But it can be difficult for patients to assess the risk of getting an infection in a hospital here.

Currently in South Dakota, medical facilities are not required by law to report their hospital-acquired infection rates to the public.

However, a subcommittee of the Governor's Health Care Commission is examining health care transparency issues overall, and infection rates will likely be included in that discussion, a state health department spokesman said.

Some states do require that hospital infection rates be available to the public. Discrepancies and inconsistencies in that reporting process can make for unfair or inaccurate comparisons, hospitals argue.

Rapid City Regional Hospital says only that it gets "national attention for our low rates of infections" as well as for its compliance with handwashing guidelines and employee influenza vaccination rates.

Kightlinger praised Regional Hospital's infection control program for its effectiveness, as he does the other large hospitals in South Dakota.

"We are in a colossal battle against the pathogenic micro-organisms, and our infection control practitioners are on the front lines of that battle," he said.

Tamara Rhames, R.N., director of infection control and patient safety at Regional Hospital, works to prevent the spread of MRSA and other hospital-acquired infections. She treats MRSA as the serious foe it is.

Standard precautions of handwashing and gloving during procedures involving blood or bodily fluids are standard procedures for all hospital patients, but her staff also employs "contact precautions" in the face of other communicable infections.

Hospital patients known to be infected or colonized with MRSA require extra barriers, which Rhames describes as a "glorified" form of standard precautions designed to create more physical barriers between the patient and staff or visitors who may spread the drug-resistant Staph germ to other patients in the hospital.

MRSA patients are placed in a private room, and anyone entering the room who will have bodily contact - even a hug or hand holding - is supposed to don gloves and gown. Any medical equipment used on a MRSA patient, such as blood pressure cuffs, stays in the patient's room for the duration.

MRSA patients and their visitors are often confused by what may seem like inconsistent application of those precautions but, Rhames said, the level of patient contact determines the barriers needed.

A physician who comes in for consultation with a patient may not be required to wear a gown or gloves, but a nurse who will deal with wound care or bodily fluids would take full contact precautions. MRSA is not transferred as an airborne infection. It spreads by direct contact.

"Our goal is to protect anybody else - other patients, visitors, staff, family members - through the use of barrier precautions," she said.

After six months and a hospital bill in the $700,000 range, Scott's ordeal with hospital-acquired infections was much worse than the average MRSA infection.

But even in more easily treated cases, dealing with MRSA is always an expensive proposition, typically adding between $10,000 and $20,000 to the cost of an otherwise normal hospital stay, Dr. James Keegan of Regional Health Systems said.

Contact Mary Garrigan at 394-8424 or mary.garrigan@rapidcityjournal.com