Sunday, April 30, 2006

The Scourge of Skid Row

Think about the next fly that lands on your sandwich where did it just come from?

When we started to take a look at the "Service-Resistant" Homeless in our area of Venice all kinds of facts started to show up. This one is scary! This an article we found from the L.A. Weekly dated October 18, 2006 by Chirstine Pelisek.

Is this just the tip of the iceberg? You judge..... read the entire article just click on this link and run searches on the subject and educate yourself about this and how it affects us in the Venice area.

The unfortunate residents who are in close proximity to the homeless in the Venice area may not realize how nasty this stuff is. This can be spread to people who merely have contact with the homeless. The human feces, urine and other bodily fluids are left behind and the residents have to clean up we think that qualifies as "close proximity"!

Better wear gloves and a mask when you need to clean up human feces, urine misc. bodily fluids, or if you touch any bedding, any clothing or trash left behind. The pictures with this story are quite disgusting and quite alarming. Think about the next fly that lands on your sandwich where did it just come from?

The point of this piece is that the County Department of Health Services is not doing enough to stop the spread of "Skid Row Staph" and is the skid row homeless findi.

You can also find more information about "Staph" or Community-Associated Methicillin-Resistant Staphylococcus aureus (CAMRSA) Information at the web site.

The Scourge of Skid Row
A staph infection threatens the lives of cops, firefighters and homeless people. But don’t expect any help from county health officials Detective Tricia Hauck finished a burglary investigation at Pete’s CafĂ© and returned to the Central Division station near Skid Row. Her left foot started to feel uncomfortably warm. She wondered if it had anything to do with an ankle fracture she suffered on vacation in Mexico a few months earlier. Within a half hour, the warm feeling turned into pain so excruciating that her leg went numb. Unable to walk, the 39-year-old burglary-investigations supervisor was carried to a patrol car and rushed by her partner to an emergency room.

An MRI detected fluid around her bone. Later that day, a surgeon cut into her foot and removed an abscess. The diagnosis: Skid Row staph, or, more technically, a strain of methicillin-resistant Staphylococcus aureus that is sickening dozens of police officers, firefighters, health-care workers and homeless people. These cases pose a new challenge to county health officials, who so far have refused appeals by Skid Row care providers to step up help to the city’s most down-and-out population. Cops are so accustomed to seeing people with oozing boils that they call them Skid Row cooties.

Doctors inserted tiny tubes in Hauck’s foot to drain the curdled white pus. But the infection proved resistant to six antibiotics. Finally, on September 27, doctors prescribed the antibiotic of last resort — vancomycin, which she takes intravenously at home, where she spends most of the day in bed.

Twice a week, Hauck’s nurses come to her home to change her IV lines. Doctors fear the infection is eating at her bones, and that her ankle may become so overtaken with bacteria that they will be forced to fuse together the bones in her ankle, rendering her unable to walk without help. Right now, the least of her worries are the medical bills; drugs and supplies alone total around $2,000.

Hauck believes that she caught the highly contagious bug at her station on Skid Row, which has become a giant petri dish for Skid Row staph. Nearly 1,500 homeless people living and sleeping on the streets, with little or no access to proper hygiene, soap or warm water, make it an ideal breeding ground for the bacteria.

“We work in a filthy environment with people who don’t practice good hygiene and are in and out of jail,” Hauck says.

In 2005, staph infections hit at least 20 Los Angeles city firefighters, many of whom work on Skid Row. A staph infection landed a deputy city attorney, who works out of the Central Division police station, in the hospital for two weeks. An LAPD helicopter pilot, who helped a homeless man across the street, almost had to have his leg amputated. Two doctors working at a wound-care clinic got infected. A chaplain and a night manager working at the Union Rescue Mission got it. So did the director of public affairs and two other employees at Midnight Mission. Besides Hauck, a deputy chief and a rookie officer at LAPD’s Central Division have been diagnosed with Skid Row staph.

A giant petri dish full of Skid Row staph

“It is very seldom discussed down here, but it is a big fear for my officers every day,” says Captain Andrew Smith. “There are a lot of things that have been swept under the table, and we are really trying to shine a light on what is happening in Skid Row. I don’t think there is a lot of public awareness of this infection. We convened a meeting with the county one year ago and told them what our concerns are with the virus. I don’t think they were as concerned as we are.”

The Los Angeles County Department of Health Services is doing little to address Skid Row staph. Health officials rejected Midnight Mission’s request for a mobile health unit to monitor and treat homeless people. Instead, the health department gave homeless advocates fliers to pass out. “The response was nowhere near what we expected,” says Orlando Ward, Midnight Mission’s director of public affairs, who contracted Skid Row staph, along with his wife and a co-worker. “We are talking about the streets. People who are sleeping outside — wearing the same clothes with untreated wounds. We need people to be educated across the board.”

Around the county, a spot check of hospitals shows a half dozen or more cases being diagnosed in some emergency rooms every week. “It is now the single most common cause of skin infections, which is remarkable, because five years ago it was close to zero,” says Dr. Gregory Moran, clinical professor of medicine in the department of emergency medicine and the Division of Infectious Diseases at Olive View–UCLA Medical Center. “It has quickly emerged as a cause of these infections in regular people out in the community. We now have showed that it is not just limited to people in specific risk groups. Now potentially everyone in the community is at risk. Healthy young people are getting it.” Moran says he sees one or two fatal cases of Skid Row staph annually.

The bacterium that transmits staph can be passed through touch, shared surfaces and personal items like razors or towels. It can stay on clothes or bedding for five days. The infection often is dismissed as a large pimple, ingrown hair or a spider bite, but it comes on quickly and is extremely painful. In some cases, it looks more like a rash or cellulitis. Most cases are easily treatable with antibiotics; in rare instances, staph can cause blood, bone and lung infections.

Other health-care clinics in Skid Row have also seen a rise in cases. Union Rescue Mission reports at least three new cases a week. The Weingart Center treats six new cases.

“At a certain point, we won’t think of it as an epidemic but a new normal,” says Dr. Elizabeth Bancroft, a medical epidemiologist with the L.A. County Department of Health Services’ Acute Communicable Disease Control Program. “Doctors will just take it for granted and assume it will be [Skid Row staph].”

Dena Carreyn is a deputy city attorney assigned to downtown L.A., including Skid Row, as part of a neighborhood prosecution program. In November 2004, the 32-year-old Carreyn hugged a homeless woman who had just found permanent housing. The woman had open sores on her arms, and within four days Carreyn noticed what she thought was an ingrown hair or spider bite on the back of her neck. Her doctor told her it was a spider bite and put her on antibiotics. The infection didn’t go away. She went back to the doctor, who prescribed another medication. By February, abscesses had formed under her arm, groin and toe. Her neck wound grew to the size of a tennis ball. A culture sample revealed Skid Row staph. She was immediately admitted to the hospital, where she had vancomycin, the highly potent antibiotic, directly pumped into her chest. It took her five months to get workers’-compensation benefits, which were initially denied, because the city didn’t consider her infection a work-related injury.

“Nobody from the CDC or the health department told us in law enforcement that there was an outbreak,” she says. “It made me rethink my job and the dangers that I am in down here. You don’t think you would be exposed to infectious bacteria that could kill you. It never crossed my mind.”

In May 2005, Carreyn participated in a roundtable discussion on Skid Row staph, convened at Parker Center, with law enforcement, health-care advocates and the county health department.

“The county officers infuriated me about their attitude that you can get it anywhere,” says Carreyn. “They basically told me I was a liar. They were totally downplaying what happened to me, and that it is an easily treatable infection and just wash your hands and you will be fine. There were people who knew it was a nasty infection, and the health department was making it out not to be a big deal.”

Carreyn believes the health department should do more than expect homeless people, some of whom suffer from mental illness, to seek help at walk-in clinics. Even worse is forcing jail officials to deal with the cases that begin on Skid Row. “To rely on the jail as their only resource of medical attention is irresponsible,” she says.

LAPD’s Central Division has taken matters into its own hands. Officers will get training monthly on ways to avoid contracting it. The station plans to buy an industrial hand sanitizer, which will be placed next to the watch commander for all the officers to use when they enter the station. It sprays out a mist of pure alcohol. Wooden benches used by new arrestees will be replaced by stainless steel so they can be disinfected regularly.

It is a start, but Detective Hauck believes that the LAPD needs to step up its efforts to educate all officers about the risks associated with the bacteria.

“My whole career, I always worried about AIDS or hepatitis. I never thought about staph. There is no education on this whatsoever,” says Hauck. “We got tons of training about the African honeybee, and we have had no training on this.”

Director and Health Officer Jonathan E. Fielding, M.D., M.P.H. of the County of Los Angeles Public Health Department writes the following in response to the above article this too can be found at the L.A. Weekly Site "LETTERS"
"Contrary to Pelisek’s article, staph infections are not primarily spread by casual contact. There are significant risk factors that increase the chance of acquiring a staph infection, including crowded living conditions, lack of cleanliness, and exposure to contaminated surfaces and sharing personal items. These risk factors, unfortunately, are more common in correctional facilities or among the homeless, making it difficult if not impossible to entirely control the spread of staph infections"

Other Links to stories about skid row:
From the L.A. Times dated October 24th 2006 "Police allege 5 patients were dumped on skid row by hospital"

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