Re: Dirty Hospital--KC

[Guest guest]

A friend of mine's husband developed a staph infection inside his hip after a

hip replacement. I suspect that means the sterile or was nasty nasty. He has

been in the hospital for 60 days in the infectious disease section. That's so

painful and awful. He is just 55.

tigerpaw2c <tigerpaw2c@...> wrote: Dirty Hospitals

Two million patients are infected in hospitals each year and 90,000

of those Americans die.

By Katharine Greider

http://www.netscape.com/viewstory/2007/01/03/dirty-hospitals/?

url=http%3A%2F%2Fwww.aarp.org%2Fbulletin%2Fyourhealth%

2Fdirty_hospitals.html & frame=true

January 2007

Email This Page To A Friend Print This Page

Of every 20 people who go into a U.S. hospital, one of them picks up

something extra: an infection. It's a lousy card to draw. Infection

stalls recovery, sometimes requiring weeks of intravenous

antibiotics or a grueling round of surgeries to remove infected

tissue. And for 90,000 Americans a year, the infections are a death

sentence.

A growing number of hospitals are working harder to stop infections,

but as more bugs become resistant to antibiotics, it's an uphill

struggle. Some 2 million patients get a hospital-acquired infection

every year. In Pennsylvania alone, more than 19,000 infection cases

occurred in 2005—up from 11,600 in 2004—out of 1.6 million

admissions to 168 hospitals, according to a report issued in

November by the state's Health Care Cost Containment Council.

Pennsylvania, the first state to provide infection data collected

directly from its hospitals, reported that nearly 13 percent of

patients who got infections died, compared with slightly more than 2

percent of patients who didn't have infections.

Nationwide, hospital infections are the eighth-leading cause of

death. One person who didn't recover was Dorothy Etheridge, a no-

nonsense New Hampshire resident who raised five children and worked

for 30 years as a mental health counselor. Etheridge had lung

surgery in 2004 to remove an early-stage cancer, and doctors

predicted a full recovery.

But within days, the normally robust Etheridge took a sharp turn for

the worse. She had contracted a nasty antibiotic-resistant germ

known as methicillin-resistant Staphylococcus aureus—MRSA—and she

spiraled into respiratory failure. Through eight months of

rehabilitation, bedsores and recurring infections, Etheridge fought

back. " She was, to put it mildly, stoical and compliant and did

everything and anything that she could to get herself home again, "

her daughter Lori Nerbonne says.

And get home she did. But after a week her temperature spiked. She

was admitted to another hospital, where she died, at age 73, of a

brain hemorrhage.

Left with painful memories of their mother's last months, Nerbonne

and one of her sisters set to writing letters and testifying before

the state legislature, joining a burgeoning nationwide movement that

aims to stop infections in hospitals.

A leading light of that movement is Betsy McCaughey, a health policy

expert and former lieutenant governor of New York. She founded the

nonprofit Committee to Reduce Infection Deaths—RID—two years ago

after hearing the story of Brad of Washingtonville, N.Y.

In 2002 was mugged. He survived brain trauma—but got an

infection in the hospital and died at age 28. McCaughey recalls

sitting with his mother, Pat, in her kitchen. " We looked through her

family albums: Brad as a little boy. And then Brad's funeral. It was

impossible not to be very, very saddened, " she says. " I thought,

enough is enough. "

Now McCaughey pushes and cajoles hospitals to prevent the spread of

infection. The necessary measures, she says, are simple and well

documented in medical literature. Yet they're not consistently

practiced or explained to patients. " A very good example, " she says,

is to tell patients to " shower with chlorhexidine soap if you're

going in for surgery ... it's so easy. And you get it in the

drugstore. "

In fact, job number one for advocates like McCaughey is to debunk

the notion that infection in the hospital is like bad weather—

unfortunate but inevitable. Administrators, they insist, have set

the bar way too low, content to keep their hospitals' infection

rates to national averages—for example, a wound infection for one of

every 24 surgical patients and a urinary tract infection for up to a

quarter of those requiring a catheter for a week or longer.

" There's this culture that says that when people are old or

immunocompromised, they're just going to get infections, " says

McGiffert, who heads the Stop Hospital Infections campaign at

Consumers Union, the nonprofit publisher of Consumer Reports. " Well,

they aren't 'just going to get infections.' If you're careful, they

won't. "

Generally speaking, there's little debate about what it takes to

check the spread of infection in hospitals, from giving patients

antibiotics before surgery to avoiding overuse of catheters and

intravenous lines. But hospitals are busy places, and the foe is

invisible. Research suggests that more than half the time, health

care workers even fail to wash their hands as recommended—a critical

bulwark against infection identified 160 years ago.

" These bacteria are largely spread through touch, " says McCaughey of

the RID committee. " In the old days, " she says, " nurses and doctors

were trained not to touch doorknobs, cabinets, curtains and blood

pressure cuffs once they scrubbed and/or gloved. But all of that

training really went by the wayside in the early '70s, when the

liberal use of antibiotics replaced that attention to rigorous

hygiene. "

Not coincidentally, those same years brought a galloping increase in

germs you can't knock out with standard antibiotics. In 1974 only 2

percent of staph germs in the United States were drug-resistant. By

2004, fully 63 percent—including the lethal one that attacked

Dorothy Etheridge—proved impervious.

One outcome of the crisis is that more hospitals are working harder

to stop deadly infections. In early 2005, for example, the nonprofit

Institute for Healthcare Improvement in Cambridge, Mass., enlisted

3,000 hospitals to practice interventions proven to save lives. One

approach targeted ventilator-associated pneumonia (VAP), a deadly

infection that strikes about 15 percent of patients who have a

breathing tube inserted. Hospital workers washed their hands

frequently, closely monitored incision sites and raised patient beds

to at least 30 degrees to prevent stomach fluids from backing up

into the lungs—measures that enabled more than 30 hospitals to

report no VAPs for at least a year.

Pittsburgh's Allegheny General Hospital is also waging war on

infections. In the past few years, says , M.D., who

until recently was chairman of Allegheny's Department of Medicine,

the staff has reduced the rate of bloodstream infections caused by

large-vein catheters by 90 percent and ventilator pneumonias by 85

percent. demonstrated that devoting resources to controlling

infection saved the hospital $1.2 million over two years. He and his

team reported in a supplement to the November-December American

Journal of Medical Quality that eliminating a single bloodstream

infection case pays for nearly a year's worth of measures to stop

the infections.

The savings to patients and insurers are more obvious. The November

report on Pennsylvania's hospitals noted that the average charge for

infection cases was $185,260, compared with $31,389 for noninfection

cases. Reducing infections is a win-win situation, says

. " You not only make human beings better, you actually

eliminate a huge amount of waste " in money and time.

How did his hospital do it? By studying quality-control techniques

of the industrial production line. One example: Signs everywhere

remind workers to wash their hands. " You have to make it so it's

second nature, you don't have to stop and think about it, "

says.

When an infection does happen, the treatment team meets to figure

out what went wrong. In one case they identified a mistakenly

reinserted, kinked IV line as a probable cause and explained their

conclusions to the patient's family.

In most hospitals, patients won't get such a thorough review and

disclosure about the source of an infection. Moreover, in most parts

of the country, it's virtually impossible to find out how well

hospitals are doing at infection control overall.

But that's changing, too, with Pennsylvania and California among the

states leading the way. In the past three years, 14 states have

passed laws requiring hospitals to report information about

infections to the public.

Public reporting not only informs consumers, it motivates doctors

and nurses to work for better results, says Joyce Dubow, associate

director at the AARP Public Policy Institute. In 1989, when New York

state started publishing hospitals' death rates after bypass

surgery, the hospitals conducted internal reviews, hired new

personnel and pushed out surgeons with the highest death figures.

Statewide mortality dropped like a stone, by 41 percent in four

years.

" Nobody wants their deficiencies published, " says Dubow. " And places

that do well take pride in their good work. "

Katharine Greider is based in New York and writes about health

policy and medical issues.

__________________________________________________