“We’re looking at a little known and largely ignored health crisis secondary to a pandemic or large-scale terrorist bombing like a nuke or something,” said a source involved in federal emergency medical preparedness planning.

HAI infections can cause serious illnesses and, in severe cases, death. Indeed, infectious diseases are a major cause of illness, disability and death, statistics and authorities point out.

This week, the Journal of the American Medical Association (JAMA) reported that a strain of methicillin-resistant Staphylococcus aureus (MRSA) spreading around the country is causing more life-threatening infections than public health authorities had thought, and killing more people in the US each year than AIDS.

The JAMA report ominously coincided with the disclosure that Bedford County, Virginia officials closed its 21 schools Wednesday to try to sanitize them in order to prevent the spread of the MRSA infection that killed a 17-year-old high school student.

Elsewhere, Robert S. Daum, a pediatric infectious disease specialist at the University of Chicago, told Reuters that in the last five weeks he has treated five children “who were sick enough to be hospitalized and require intensive care."

"This is a significant public health problem. We should be very worried," said Scott K. Fridkin, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC), which says the staph bacterium is responsible for more than 94,000 serious infections and nearly 19,000 deaths each year.

“It is a major public health problem primarily related to health care but no longer confined to intensive care units, acute care hospitals, or any health care institution,” the new JAMA study stated.

In contrast to what both JAMA and CDC officials said, however, Robert Parker, spokesman for the Virginia Department of Health, said “VDH considers [staph bacterium] to be sort of ubiquitous but not a public health threat any more today than it was yesterday or the day before.”

But CDC’s Fridkin said “life-threatening MRSA infections are much more common than we had thought … These are some of the most dreaded invasive bacterial diseases out there. This is clearly a very big deal."

The JAMA report noted that “as the epidemiology of MRSA disease changes, including both community- and health care–associated disease, accurate information on the scope and magnitude of the burden of MRSA disease in the US population is needed to set priorities for prevention and control.”

The CDC estimates nearly two million hospitalized patients acquire preventable HAIs each year, and that nearly 100,000 die from them, which is as many as AIDS, breast cancer and auto accidents combined, and up from 13,300 patient deaths in 1992. These deaths contribute at least $4.5 billion in additional medical costs and lost productivity.

"It's really just the tip of the iceberg," said Elizabeth A. Bancroft, a medical epidemiologist at the Los Angeles County Department of Public Health who wrote an editorial in JAMA accompanying the new studies. "It is astounding."

“We're increasingly facing antibiotic-resistant forms of these very common organisms," Bancroft said.

(Stop Hospital Infections, a project of Consumers Union, provides hospital infection reports on its website, as well as considerable other data on HAIs)

The JAMA study came on the heels of Britain’s Healthcare Commission reporting that at least 90 patients died from the HAI Clostridium difficile in three neighboring hospitals in southern Britain in two years as a result of what is said is “significant failings in infection control.”

According to the report, the infected patients died from the contamination, which the Commission said is a secondary infection caused by poor hospital care.

"It's a scandal. It's awful," British Health Secretary Alan Johnson told BBC Radio 4's Today program.

James Lee, the chairman of the National Hospital Trust-managed Maidstone and Tunbridge Wells NHS trust where the 90 patients died from Clostridium difficile, resigned, but not before accusing the British government of singling Maidstone and Tunbridge Wells out for vilification when ministers knew scores of other hospital trusts had even worse infection rates.

In an editorial in The Lancet , Johnson said rather than pandering to populistic concerns about hospital cleanliness, politicians should pay careful attention to the evidence on how to prevent HAIs.

Meanwhile, British authorities said all patients admitted to hospitals in Scotland should be screened for MRSA.

Back across the pond in the US, in September Cepheid was awarded two Veterans Affairs Federal Supply Service Schedule (VA/FSS) contracts for its GeneXpert System and the Xpert MRSA test for the rapid detection of Methicillin-resistant Staphylococcus aureus. The two contracts, VA/FSS 65 VII and GSA 66, respectively cover the purchase of Xpert MRSA tests and GeneXpert Systems, and are expected to streamline the acquisition process and ensure VA hospitals and other federal agencies can purchase GeneXpert Systems and Xpert MRSA test kits without individual negotiations as they await funding for the next fiscal year.

If too many hospitals are unable to address HAI control and prevention during a non-medical crisis, how will they possibly be able to deal with it during the real thing, health care crisis planners ask.

“So what do you think it’s going to be like during a catastrophic medical crisis where we’re having to put the sick anywhere we can?” and supplies and resources are stressed to their limits, asked an emergency health planner. Indeed, see the July 2007 HSToday report, “Seeking to Surge,” which examines the problem hospitals will have in dealing with the unimaginable numbers of flu-stricken persons needing hospitalization. Also see the HSToday reports, "Emergency Response: Intensive Care Needed," and,  "Responding to Avian Flu: It’s Not Too Late ."

Authorities told HSToday.us statistics show the number of people injured in a catastrophic terrorist attack who could die from HAIs will be disproportionately higher than the normal 1 in 20 that will die during a routine hospital stay.

“That’s just the way it’s going to be in the environment of a post-catastrophic attack,” one of the authorities explained, adding that if “antibiotic resistant infections begin to run rampant in such a crisis, we could find ourselves with another medical crisis on our hands.”

Indeed. This and other sources envision a scenario in which an avian flu pandemic leads to widespread unsterile conditions due to the sheer numbers of people needing medical attention, and that antibiotic resistant infections could nearly become a pandemic unto themselves, quickly depleting available antibiotics that might work in some patients.

“Shoddy infection control is poor preparation for an avian flu epidemic and poor homeland security,” says health policy expert, Dr. Betsy McCaughey, chairwoman of the Committee to Reduce Infection Deaths and former New York Lieutenant Governor.

“How can hospitals that lack the discipline and staff training to stop ordinary bacterial infections from spreading from patient to patient by touch possibly contain avian flu, which can be spread not only by touch but also by droplets when patients sneeze or cough? How can these hospitals contain a bioterrorism pathogen such as smallpox, which can spread invisibly in the air?”

Last year, McCaughey’s group issued the comprehensive report on HAIs, “Unnecessary Deaths.”

In Jan. 2000, the National Intelligence Council, the US Intelligence Community’s (IC) center for midterm and long-term strategic thinking which leads the effort to produce National Intelligence Estimates (NIEs), released an unclassified version of the NIE, “The Global Infectious Disease Threat and Its Implications for the United States,” which expresses alarm over the national security implications of HAIs. The NIE “represents an important initiative on the part of the IC to consider the national security dimension of a nontraditional threat.”

Indeed, the NIE “responds to a growing concern by senior US leaders about the Implications - in terms of health, economics, and national security - of the growing global infectious disease threat. The dramatic increase in drug-resistant microbes, combined with the lag in development of new antibiotics, the rise of megacities with severe health care deficiencies, environmental degradation, and the growing ease and frequency of cross-border movements of people and produce have greatly facilitated the spread of infectious diseases.”

A crisis will compound the problem. “Alone or in combination, war and natural disasters, economic collapse, and human complacency are causing a breakdown in health care delivery and facilitating the emergence or reemergence of infectious diseases,” the NIE emphasizes.

In this NIE, the IC clearly states that “hospital-acquired infections … will pose a threat” to national security, noting: “Inadequate infection control practices in hospitals will remain a major source of disease transmission in developing and developed countries alike.”

“Highly virulent and increasingly antimicrobial resistant pathogens, such as Staphylococcus aureus, are major sources of hospital-acquired infections that kill some 14,000 patients annually,” the NIE states, adding, “invasive medical procedures will result in a variety of hospital-acquired infections such as Staphylococcus aureus.”

According to the Committee to Reduce Infection Deaths, “the danger from these infections is worsening because, increasingly, they cannot be cured with commonly used antibiotics. In 1974, only two percent of Staphylococcus aureus infections were methicillin-resistant. By 2003, that figure had soared to 57 percent, and now is over 60 percent.”

“The threat from highly virulent, antimicrobial-resistant pathogens such as Staphylococcus aureus, Streptococcus pneumoniae, and enterrococci … is likely to grow, particularly if the remaining small arsenal of effective drugs, such as vancomycin, becomes ineffective,” the NIE concluded.

The NIE points out that “the growth and intensity of antimicrobial resistance among infectious pathogens increases, due both to pathogen mutation and to inappropriate and indiscriminate use of therapeutic drugs in both developed and developing countries. Two thirds of all oral antibiotics worldwide are obtained without a prescription and are inappropriately used against diseases such as TB, malaria, pneumonia, and more routine childhood infections. These practices contribute to antimicrobial resistance and the severe, nearly impossible to treat hospital-acquired infections.”

Both the IC and the Institute of Medicine have identified antibiotic resistance and the paucity of antibiotic R&D as increasing threats to US public health. In addition, there are growing concerns about the efficacy of pandemic influenza anti-virals like Tamiflu. Some studies have shown that certain influenza strains have developed an immunity to the drug, and the fear is that during a pandemic, this immunity will increase exponentially.