posted May 19, 2008
It has become fairly common these days to experience first hand the devastating news that you or a loved one has been transferred to the intensive care unit because, shortly after a successful surgery, they have acquired an infection within the hospital setting. Patients, while being treated for another issue, are contracting often fatal infections in the hospital, in fact, one in seven patients acquire a healthcare associated infection each day. Approximately tens of thousands of deaths each year due to ‘nosocomial’ infections are preventable.
Sadly, the Department of Health and Human Services is not providing necessary leadership in coordinating data from hospitals regarding their burden of infections. Equally sad is that simple and inexpensive prevention strategies, such as basic hand hygiene and a drop of bleach, could prevent these infections.
Approximately $5 billion per year at a cost to society as a whole are attributed to HAI’s. For every patient who acquires an infection within the hospital, an average of $18,000 or more is added to their hospital bill. These sums of money could be used in our society more diligently toward education for example, or for proper and expedient mental health treatment for our soldiers returning from Iraq.
More efficient coordination of data bases by hospitals and federal agencies is crucial to address these serious issues. Infection prevention must be an indispensable element in hospital planning from the bottom up.
My own mother almost died from an HAI caused by methicillin resistant staphylococcus aureas, known as MRSA or ‘mersa’ last winter following a rather uncomplicated heart surgery and it was heart-breaking for our entire family. It took her nearly three months to recover. We are not alone as many of you have experienced similar crisis.
If hospital staff does not adhere to professional standards and protocol, then a culture of complacency is perpetuated. Excuses are made because of backlogs in the workplace for example.
The government accountability office on healthcare issues, the Office of Health and Human Services, admits that there are problems with combining data and lack of databases which would help hospitals coordinate HAI data and infection control activities. The bottom line is that we fail to deliver healthcare as a science. Patients pay dearly for health insurance, with very high premiums, yet often do not get a clean hospital room. It is crucial to develop a culture of safety in hospital patient care. Patient safety is about dignity and respect for people.
As a recent surgical technology student, I was taught that the first priority is to the patient and the ‘sterile field’ with a responsibility towards surgical conscience. This means no excuses for putting the life of a patient or reputation of the hospital at risk.
All too often, one hears: “what happens in Vegas, stays in Vegas” for blatant errors made in the operating room. Standard procedure for such errors has been to “deny and defend” against malpractice suits; as few as 30% of medical errors are disclosed to patients. It is unfair that patients should have to pay the economic consequences of negligent treatment or medical mistakes.
Hospitals need to train all employees that disinfection on all levels needs to be a priority within every area of the hospital at all times and staff must work together to monitor one another to be sure high standards are met. Identification of the surgical site and preventing retention of foreign bodies after surgery are common practice, yet errors occur. Hospital acquired infections kill almost twice as many patients as breast cancer and HIV-AIDS together. Federal agencies must view this problem as a priority.
Health and Human Services has said they will take the following measures: 1) recognizing more leadership is necessary for patient safety, 2) posting of centers for disease control published guidelines for MRSA and other resistant microbes 3) improving and sustaining infection safety 4) providing information campaigns to the public, 5) “Value Based Purchasing”, ie, paying for hospital services based on quality of care, not just services rendered, and 6) identifying measures that are outcome oriented.
HAI’s are most commonly contracted through the bloodstream, at the surgical site, or through the gastrointestinal tract. If intensive care units used patient care checklists, 28,000 patients a year and $2-$3 billion for catheter related infections could be avoided.
Studies have found that three-fourths of surfaces in hospitals are infected with MRSA, which included half the surfaces in the O.R. and patient rooms. These areas can be overlooked by hospital cleaning personnel, including equipment and computers. Other infection sites can be contaminated blood pressure cuffs, EKG leads, unclean lab coats.
All hospitals need to access their own risks because federal agencies are collectively not achieving traction in implementing strategic and proven ways to save lives in avoiding HAI’s. Americans should expect more leadership in this area. There should be a course in medical safety for all medical students. There is often more mandatory testing for disinfection and cleanliness in restaurants and food processing plants in this country than in our hospitals.
Equally crucial in preventing HAI’s is the general public- you and I. Universal screening of visitors to patient rooms should be implemented. Whenever a visitor comes in contact with a recovering patient or newborn baby, they need to wash their hands. They should keep a certain distance from the patient, and if they have a cold or respiratory ailment, they should wear a face mask which could be provided in the room.
There was a time, before 1970, when visitor screening was mandatory; HAI’s were uncommon in those days. Know that we are just as responsible as hospital employees in helping to prevent patient infections.
Let’s all remember that a clean hospital room is a basic right. Clean them or close them. The consequence of poor standards of cleanliness or of surgical errors within our hospitals is a matter of life or death.
Please voice your concerns about hospital acquired infections to Rep. Henry Waxman, Chairman of the Oversight and Government Reform Committee in Washington, D.C.
Melinda Whiteman
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