Hospitals - Hazardous to Your Health?

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Hospitals - Hazardous to Your Health?

By Johannsen, RN, BSN, MSHA, CLNC

Friday, April 17, 2009

San Diego Daily Transcript (subscription) - San Diego,CA,USA

http://www.sddt.com/News/article.cfm?SourceCode=20090417cwa

A jury awarded over $2.5 million to Klotz in a medical malpractice

lawsuit against a heart surgeon, his group practice and St. 's Medical

Center in St. Louis, Mo.

Mr. Klotz had been rushed to the hospital with a heart attack and a pacemaker

was surgically implanted. He then developed a drug-resistant staph infection

that resulted in 15 additional operations, 84 days in the hospital and the loss

of his right leg, part of his left foot, a kidney and most of his hearing.

Bill Lawton, a retired policeman, went into a New York hospital for orthopedic

surgery. He contracted several bacterial infections that landed him in a

wheelchair for life.

Maureen Daly took her 64-year-old mother to the hospital for a minor shoulder

repair. Her mother became ravaged with multiple infections, left the hospital as

a quadriplegic on a feeding tube and died shortly thereafter.

These are dramatic examples of what can go wrong when a person is hospitalized.

But, the sad truth is patients are potentially compromised in hospitals every

day. Hospitals are now so widely perceived as dangerous places by the public

that a whole movement for family advocates to protect hospitalized patients has

sprung up across the country. Ensuring the safety of their loved ones by

overseeing the proper administration of medications, awareness of allergies, and

avoidance of infection are just a few of the justifiable concerns.

Hospital-acquired (nosocomial) infections (HAIs) result in at least 20,000

deaths in the United States every year according to the World Health

Organization (WHO). Other estimates indicate the number of deaths may be as high

as 100,000 a year, up to 90% of them preventable. Ten percent of all American

hospital patients, or 2 million people per year, acquire a clinically

significant nosocomial infection. The Center for Disease Control and Prevention

(CDC) has only recently acknowledged that hospital-acquired infections, defined

as infections identified at least 48-72 hours following admission, are a major

public health issue.

Hospitals, by their very nature, harbor a threatening number of viral, bacterial

and fungal pathogens. They also house vulnerable patients who act as compromised

hosts with broken skin and impaired immune systems. In addition to the high risk

of patient-to-patient transmission of infection in this environment, there is

danger in many of the invasive measures used to support patients. Common

invasive patient care measures such as intubation, the placement of

intravascular lines and insertion of urinary catheters pose significant risks.

The most common sites for nosocomial infections, in declining order of

incidence, are the urinary tract, surgical wounds, the respiratory tract, the

skin, the vascular system, the gastrointestinal tract and the central nervous

system. Even a relatively minor nosocomial infection can prolong a patient's

hospital stay by 3 to 24 days.

The most common means of spreading nosocomial infections in hospitals is through

direct person-to-person transmission or through exposure to contaminated

equipment (blood pressure cuffs, stethoscopes, EKG wires, etc.), supplies and

environmental conditions. The chain of transmission tends to be subtle, the

result of accidental or deliberate disregard for established protocols of

infection control. Preventing infections comes down to the basics: hand washing,

wearing gowns and gloves when appropriate, proper sterilization of equipment,

and thorough environmental cleaning.

Although hand washing has been proven to be the single most effective method to

reduce nosocomial infections, studies reveal compliance with recommended hand

hygiene practices is unacceptably low in hospitals. The importance of this

simple protocol is routinely underestimated by busy healthcare workers. Sloppy

sterile technique, rushing through procedures due to a lack of resources to

adequately clean rooms between patients, failure to change and properly maintain

invasive tubing, and inadequate oversight of environmental sanitation standards

are but a few of the daily transgressions in hospitals. Lab coats and scrub

clothes carry germs that can live up to 56 days, but many hospitals now require

the staff to do the laundering of this essential apparel in their own homes. The

job of infection control in hospitals has become increasingly difficult in

recent years because the microorganisms develop resistance to antibiotics,

becoming " superbugs " that are bolder and tougher to fight. The fastest growing

bugs in the system include MRSA (methicillin-resistant Staphylococcus aureus),

VRE (vancomycin-resistant Enterococcus), C. diff (Clostridium difficile) and

newly discovered " Steno " (Stenotrophomonas maltophilia).

For years, hospital infections were considered inevitable and an unavoidable

risk. According to Marci Drees, M.D., from the Center for Outcomes Research at

Christiana Care Health System in Newark, Delaware, " I think for too long we've

had the attitude that these infections `just happen' and are bad luck, but we

now know that many are preventable. " And that realization places physicians and

hospitals in an entirely new legal position.

The belief that infections are unavoidable shielded hospitals and doctors from

liability for decades. Betsey McCaughey, former lieutenant governor of New York

and chairman of the Committee to Reduce Infection Deaths (RID), a non-profit

patient safety organization she founded in 2004, suggests that the overwhelming

evidence that these hospital infections are preventable will cause the next wave

of class-action lawsuits:

Most victims who sue will not be able to prove precisely how the bacteria

entered their body while they were hospitalized. Soon, it may not matter. Jurors

will be told that the defendant physicians and hospital failed to implement

guidelines provided by the federal Centers for Disease Control and Prevention

(CDC) or such groups as the Society for Healthcare Epidemiology of America

(SHEA), the Infectious Diseases Society of America (IDSA), and the Institute for

Healthcare Improvement (IHI). Consequently, the argument will go, these

defendants should be deemed negligent and held liable for patients' infections.

Community standards of care and best practice defenses won't overrule plaintiff

attorneys' insistence that a patient's infection alone is evidence enough that

caregivers breached their duty. In 2004, Tenet Healthcare Corporation agreed to

pay $31 million to settle 106 lawsuits by patients who contracted infections

after heart surgery at Palm Beach Gardens Medical Center in Florida. Since then,

numerous lawsuits have been filed against hospitals in Florida, Massachusetts,

Utah and Kentucky by infected patients. Hospitals being sued are saying their

infection rates are within national norms as tracked by The National Nosocomial

Infections Surveillance (NNIS) system developed by CDC, although as of December

2008, 16 states and Washington D.C. had no laws on public reporting of hospital

infections.

Medicare has determined the acceptable rate of hospital-acquired infections is

zero. Effective October 1, 2008, the federal program has stopped reimbursing

hospitals for treatment of several types of preventable infections. These

infections are so obviously preventable that Medicare authorities call them

" Never Events " , meaning they should never happen. HAIs are costly, adding an

estimated $30.5 billion to the nation's hospital expenditures each year.

Patients, insurers and taxpayers have been assuming much of the cost. Hospitals

are now barred from billing patients for what Medicare doesn't pay, thereby

having to absorb even more of the expense. Preventing infections is fast

becoming a matter of " life or death " for a hospital's financial future as it

faces potential loss of reimbursement and an onslaught of lawsuits.

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Johannsen, RN, BSN, MSHA, CLNC, has over 20 years of experience in the

health care industry. Her expertise includes the areas of hospital

administration, managed care at HMO's and insurance companies, drug and device

clinical trials, and FDA drug and device recalls. Infection Control has been an

area of interest since working as a manager in the Operating Room and in

hospital Supply Processing and Distribution. For more information and/or

comprehensive expert service with your next medical-related case, contact:

Johannsen Legal Nurse Consultants, 619-876-2371, snjohannsen@....>