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February 23rd, 2010
06:36 PM ET
Hospital-acquired infections lead to substantial loss in life, and waste billionsBy Miriam Falco Researchers believe 48,000 deaths could have been prevented and $8.1 billion dollars could have been saved in the United States, if patients hadn't gotten infections after being admitted to a hospital. (Watch Video) Previous research has shown an association between deaths and hospital infections, but according to a new study, it's difficult to figure out whether the patient actually got the infection in the hospital. In the study, published this week in the Archives of Internal Medicine, the authors set out to find out how many patients died because they got infected in the hospital. "Just the way we know that there are 15,000 people who die every year in this country because of HIV, we should know how many people die because of infections they got in the hospital,” says Ramanan Laxminarayan, a senior fellow at the social sciences think tank Resources for the Future. He and his colleagues wanted to find out how many people became sickened by pneumonia or sepsis (a life-threatening infection that has spread throughout the body) while they were hospitalized. They looked at 69 million hospital discharge records from 40 states between 1998 and 2006. In an effort to rule out patients that already had infections or were so sick they would not have survived even without a hospital-acquired infection, researchers considered only patients who went in for elective surgery, not because of an emergency. "These were people that the surgeon would not have operated on if they showed any signs of infection and not being well," Laxminarayan explains. He says that judging by the number of patients who then got an infection as opposed to those who didn’t, there were an estimated 290,000 cases of hospital-acquired sepsis and 200,000 cases of hospital-acquired pneumonia in 2006. Further, he said, "48,000 sepsis and pneumonia deaths can be attributed to hospital-acquired infections every year." In addition to the loss of life, these infections add to health care costs. The researchers estimate that the extra hospital days lead to $8.1 billion in added costs. Laxminarayan says there are multiple reasons for patients getting an infection. "You could have a surgery and the wound is not dressed properly or the operating room is not scrubbed properly or someone didn't wash their hands." Laxminarayan says some hospitals are starting to standardize procedure to reduce the spread of unnecessary infections. Probably best-known in the medical community is Johns Hopkins physician Dr. Peter Pronovost, who developed a five-step checklist for doctors to follow when inserting a central line or catheter in a patient: wash your hands using soap or alcohol prior to placing the catheter in the patient; wear sterile gloves, mask, hat, gown and completely cover patient with sterile drapes; avoid placing the catheter in the groin if possible; clean insertion site of patient’s skin with chlorhexidine antiseptic solution; remove catheters when they are no longer needed Pronovost’s checklist caught the eye of the hospitals in Michigan who asked him to help them reduce medical errors in their intensive care units. More recently, surgeon and author Atul Gawande developed a checklist for surgeons. But the majority of hospitals still don't use checklists yet. Which means mistakes can still happen. Nancy Foster, the American Hospital Association's vice president for Quality and Patient Safety Policy, tells CNN that this new study confirms what they have known from previous studies but it doesn't show the progress hospitals have made since 2006, which is when the last data were collected for the study. "We at AHA are working with Peter [Pronovost] and others who are expert in infectious disease to help hospitals implement those strategies all over the country," says Foster. She points out that many hospitals now have prominently placed hand gel dispensers everywhere. They are also encouraging patients to ask hospital personnel if they washed their hands. But more needs to be done to make systemwide changes. To help make that happen, two years ago, Foster says, the AHA received funding from the Agency for Healthcare Research and Quality for programs to prevent infections in hospitals in Michigan and 10 other states. "Just last year, we received additional funding from the stimulus package to roll out the project nationwide," she says. Study author Laxminarayan believes hospitals need financial incentives to make changes. He points out that last year Medicare, the federally funded health insurance program for retirees, stopped paying hospitals in some cases, if preventable infections occurred. He thinks this should be done on a broader scale. Until that happens, Laxminarayan thinks there are at least three things hospitals could do now that don't cost them more money but could save lives: improve hand-washing; adopt checklists; and screen everybody who comes into the hospital for germs that could infect somebody else. He says they need to be tested if they are colonized with bacteria – not necessarily infected – because they could be inadvertently transmitting bugs that could infect others already in the hospital. |
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OK ... hospital acquired infections kill tens of thousands of Americans a year and cost insurers (Medicare, Medicaid, private insurers) BILLIONS (Yes that is with a B!) of dollars a year? Not a typo .. not a mistake.
Wow! Amazing and utterly unacceptable!
Here's something for hospitals and those who own/run them ... CLEAN UP YOUR ACTS!! Figuratively and literally! And with a decrease in the infections, insurers would pay out a LOT less money and the savings to insurers that would go a LOONG way in helping keep costs down and insurance for medical services in the affordable price range for people!! How's THAT for a novel concept?!
The science and technology needed to significantly reduce hospital acquired infections (HAI's) IS out there, I firmly believe that! And the money hospitals and their ownerships NOW spend on lawyers & lawsuits to defend against these wrongful injuries and deaths could be redirected to infection control and the outcomes of the people who are entrusting their very lives to these facilities could be DRAMATICALLY improved!
And isn't THAT what medicine is SUPPOSED to be all about???
As a healthcare worker, I agree that patients should ask their caregivers if they have performed hand hygiene. But this is a 2 way street–has the patient and his family and visitors washed their hands? If visitors who are out in the community come to the hospital they bring whatever bacteria they have come in contact with to the hospital. They touch elevator buttons, siderails, the patients.
What do you do when family members refuse to follow isolation precautions? These same people can be seen in the hospital cafeteria and lobbies
I totally agree that hospitals need to be more strict with visitors. When my husband went into ICU, I found 4 people in his room (visitors) before I got there. Visitors entering ICU need to be screened or something, made to put on protective garb, they shouldn't be allowed to just traipse into the patient's room, especially a whole bunch of them. My husband died from a hospital acquired infection. I found this out after obtaining the records, and after overhearing the nurses talking about a blood culture. Bunches of people should not be allowed into the patient's room in IMCU also. This particular group doesn't follow hospital rules anyhow. Security came and asked them to leave, finally because during 3PM-5PM the unit needs all visitors out. I acquired a staph infection from this hospital's ER 4 yrs ago via a tetanus shot.
What this article states is true. Hospital acquired infections do cost morbidity, mortality, and money.
However costs that nobody wants to look at are unnecessary costs spent at the end of a person's life, prolonging them simply because we can. Millions upon millions are spent sustaining people with terminal illnesses in hospitals and extended care facilities.
The proposed screening of every person who comes into a hospital is actually way more expensive and impractical. Screening for things like MRSA still takes nearly 16 hours. And in current guidelines is not recommended by the CDC, because of its impracticality. Also because tests come with the inherent risk of having a false negative it makes screening everyone just silly. Could you imagine coming to visit a loved one and being asked to return in a day or two because you had to be screened for various bacterial colonizations? Screening patients, however is cost-effective and informative. Allowing isolation and informed medical management to take place.
Reducing hospital acquired infections is a noble and well-founded cause, however I'm not sure that penalizing hospitals by not paying them for any of the cost of treating those illnesses is also not a great idea. As more and more guidelines come in place for things that are tracked as performance and hospitals are penalized monetarily, hospitals will eventually fail and be bankrupt simply because patients not just the hospitals are responsible for some of the conditions (outside of infection) proposed to have monetary penalties.
There are definitely many more ways in which to cut medical cost.
As a med/surg RN, we see numerous hospital aquired infections.Usually pnuemonia or UTI's from Foley catheters that have not been inserted with sterile technique, or sepsis. Unfortunately, the most common reason for the pnuemonia is simple:handwashing. Since the 1st day of nusring school, it's been beaten into nurses that we have to wash our hands. RN's for the most part do this. However, we are not the only people who see patients, and that's a problem.Doctors are notoriously noncompliant with handwashing, and I often watch them go into "Isolation" rooms" I.E. people who have MRSA, C-diff, VRE, and ESBL without proper gowns and gloves. Then they don't wash their hands when they leave.
Many of us also will come to work sick-because we get into trouble if we are out.
Its a matter of common sense and training. Everybody who sees a patient is responsible for their actions in their treatment. Unfortunately, hospitals can't afford hall monitors. We do the best we can. And any nurse who has confronted a doctor about washing their hands knows how that goes. (Not well). We protect our patients the best we can, and jump on an issue as soon as we suspect one. Generally, we are able to treat the infection quickly. It is a horrible loss of money for the hospitals, and traumatic for the patients.
I recently mined the National Surgical Quality Improvement Program database for the factors most likely to contribute to post-operative infection and find that this type of research is becoming more practical and validated. As surgeons, we are able to try and optimize patients who will be undergoing surgery and do our best to prevent infections.
I survived MRSA (acquired in a hospital in Phila) which led to sepsis, which resulted in me be placed in a medically drug induced coma for approximately 17 days. Thankfully I survived but I had to have my right leg amputated below the knee. Another patient in the same hospital ward as me also contracted MRSA which unfortunately resulted in his demise. There were rumors that other patients had also contracted MRSA and also died. I pursued legal action however, as I found out from my lawyer (a huge and well know law firm in Phila), a patient can't sue the hospital for damages because I had to prove in a court of law that a specific individual (ICU nurse, operating nurse etc) was neligent and had (by not washing hands etc. )directly infected me the MRSA. My lawyer stated that since MRSA was a ":common" infection in hospital settings that fact alone would not be accepted by a court of law as a basis for a civil law suit. Other individuals who may having experienced what I went through should be aware of this information. I am grateful that I survived, don't get me wrong. However, losing a leg because a health care professional failed to wash his/her hands is a stiff price to pay for ones incompentency.
I think the key to preventing hospital associated infections is to stay out of the hospital in the first place. Just stay at home and die instead. It'll save us billilons of dollars!!!!!
My basically healthy mother died of post-surgery hospital acquired sepsis in 2007. We reported the incident to our state's regulatory board, JCAHO and Medicare and received no responses.
My 13-day old son was a victim last year of MRSA (Hospital Staph Infection). It is definitely something out of control especially when individuals look for hospitals to be clean and safe environments.
Amazing that nurses are completely invisible in this story, even though it is they who are responsible for preventing infections. The doctors are diagnosticians and sugeons; this is not really their domain.
As a surgeon I cringe every time I have to touch an elevator button or open a door in the hospital because hospitals are the most dangerously germ infested places in the world. You never know which contaminated patient, provider or visitor placed their germs there with an unknowing touch. People are beginning to realize that out patient clinics and surgery centers are far safer and a lot less expensive.
Use your elbow or knuckle.
Thanks for the tip of using OP surgical centers whenever possible. So far I have been doing this. When pressing elevator butttons I try to use my knuckle instead of finger tip, don't know if thati is doing the trick or not, or wearing gloves. Always use the hand gel dispenser when entering and leaving room. Visitors need this crammed into their heads also. Visitors can be given a handout also, educating them on these things, I would hope? My beloved husband died from a hospital acquired infection. I only know this from going thru his records, unfortunately.
As an OR nurse, I can agree with some of the comments, however, MRSA screening preoperatively is not over-rated. Most recent literature states that most cases of MRSA are community acquired not hospital acquired, meaning the patient already was colonized with MRSA PRIOR to admission. Those who would test positive on culture for MRSA would not undergo surgical intervention unless treated appropriately preoperatively. Cultures from post op incision sites have shown that most of those infections are endogenous in origin, meaning the patient's own microbes infected the wound, especially sternal wounds due to the closr proximity of the nose and mouth to the chest incision. Family members are also responsible to protect their own-they need to wash their hands and STAY HOME AND NOT VISIT if they are sick.
I have worked in Hospitals for 25 years in the
Housekeeping/Environmental Services department. I have seen so many violations and was in fear that if something really bad came in it would spread like wild fire! I have seen Nurses jump from room to room without washing hands or following the proper policies and procedures, more so on Isolation Rooms. If these hospital acquired infections are to lowered All Departments that have direct contact with a patient need to be trained and monitored more often and
Housekeeping Departments must have more trained staff to stay on top of surfaces and areas that are touched hundreds of times daily.
Same ole Company Belt tightening applies to Hospitals too...Cut this...Cut that....Our Department had so many time limits on cleaning and turning over rooms quickly so they could place another patient in the room there was no way to properly clean and Sanitize/Disinfect the room properly..so....We were always short staffed and even the few times we had all open positions filed the VP's had cut so many that it was impossible to clean properly. It will continue to rise just like the CEO's salary,,,,Sad but true!
Hospital bourne infections and the poor quality of the nursing staffs here at my local hospitals are two of many reasons that I'm choosing to have my baby at my home rather than in a "professional" setting. As long as my pregnancy continues to be low-risk, I would much rather be calm and amongst my own germs at home with a midwife who will attend the entire birth, rather than agitated by having to monitor if every healthcare worker who walks into my hospital room has washed their hands so a doctor can charge an exhorbitant fee for catching the baby only.
Until hospitals put a washing station in every patient room, you will not see much improvement. The only way to prevent these infections is by a systematic approach. Checklists are a good start but the cleanup facilities in the patient room must be observable by the patient. Whenever a nurse or doctor enters the room, he must wash his/her hands everytime. Blaming a patient's visitor is just a smoke screen. Visitor's do not stick their hands near the surgical wounds; only doctors and nurses do. I have never heard of a visitor inserting a cather or giving intravenous fluids to a hospital patient.
Bacteria are everywhere; it is the tranmission of the bacteria to the patient that is causing the problem.
Skip find a better lawyer. Make the point that a hospital has an absolute responsibility to provide a safe enviroment for their patient. If you get an avoidable infection, then the hospital has failed their implied contract with you.
As a physician, I fully agree that good hygeine and appropriate checklists will reduce the number of hospital acquired infections. Any reasonable steps, especially something as simple as checklists and hand washing, should be universally implemented across the nation.
However, it simply isn't true that every hospital acquired infection can be prevented. We are all covered with bacteria, included staphylococcus. Any time there is a cut in the skin or a foreign body placed through the skin there will always be a risk that the wound will become infected. No amount of handwashing can change this.
While it is indeed critical to improve hospital hygeine, patients must also realize that there is a certain amount of risk present in any procedure. Everything should be done to mitigate the risk, but it can never be completely eliminated.
There are many basic steps to take i.e good hygine from everyone who works or visits the hospital. As healthcare worker one thing that still needs to be addressed (although many hospitals have adopted education and practice protocols) is the missues of antibiotics both hospital and community based. With MRSA and now Vancomycin resitant microbes being more and more common; practicioners and patients must evolve as well.
But interns and residents are not taught well enough!
I had urinary retention following major back surgery and an intern wrote orders that I was NOT to be catherized, fearing infection. I had to fight for many hours to get proper treatment and was in awful pain with an overfilled bladder. I don't know where she thought the urine was to go??? A ruptured bladder would have been much worse than a catheter for causing an infection.
Then a resident refused to change a saturated and hanging dressing for fear of infection! Perfect fertile ground for infection.. Took threats to report him to chief of staff before he'd even LOOK at the dressing. Then changed it-16 hours after requested.
There are other things that can be done.... Antimicrobial protection that can stop the Nosocomial loop is out there. CBCsurfacetech has some amazing products that are non toxic and last up to three years. It is expensive, but it can fix the spread of these problems in hospitals, schools, athletic facilities etc... We used it on our sports fields, so why aren't hospitals using it....Ridiculous!!!!!
Simple incentive to reduce infections, if the patient acquires an infection while in the hospital, then the hospital cannot charge for the treatment of the infection.
I experienced my first MRSA infection in 1985. My second MRSA infection was in 2004 after having a VP shunt replacement surgery. The infection began in my brain and because my shunt drains into my abdomen, the MRSA infection spread to other parts of my body. I battled this infection for 6 months and ended up with brain damage that ended my federal govt career of 32 years. This wasn't the worst part of my story. I requested a detailed copy of my hospital bill so that I could review it. When received, I noticed that I had been charged over $5000.00 for a heart valve. Remember, I had brain surgery. I made numerous calls and sent letters requesting explanation of this charge. After numerous follow ups and two years later, I finally received a letter from the hospital stating that they made an error and that the $5000.00 charge was for miscellanous items (not defined).
Of course, my insurance and private payments had already paid most of the hospital bill. Shouldn't they have to explain part by part or piece by piece by I was charged this amount?
my bro got c. dif in the hospital and died a few months later. the hand sanitizer does not kill c. dif which is prevalent in hospitals nationwide.
It is estimated that 200,000 hospitalized patients died from pneumonia in 2006.
http://www.merck.com/mmhe/sec04/ch042/ch042c.html
Hospital acquired pneumonia (HAP) happens because the natural defenses of the mucous membranes in the respiratory tract are exposed to cold dry air in the hospital environment. The mucus membranes no longer can support defensive mast cells and other immune cells when desiccated. This is especially true for patients who have had traumatic rib injuries, are elderly, are recovering from anesthetic, are forced to lie flat on their back, have been given drugs or sedatives that dry the mucous membranes, or breathe through their mouth instead of their nose while sleeping or sedated.
The precautionary cure is the provision of 30 degree C, 100% humidified air with a mask for all such compromised patients entering the hospital. These are readily available and hook up to the air supply provided to each hospital bed. They are called HH (heated humidified) masks. They are very inexpensive compared to the Billions of dollars in losses from HAP.
Since HAP is defined as a pneumonia acquired after 48 hours in the hospital, the first 48 hours are critical. Heated, humidified masks should be provide to all such compromised patients upon entry to the hospital.
Additionally, the HH masks act as a barrier to airborne pathogens.
The solution to Hospitals acquired infections,is so ridiculously simple and cheap(Inexpensive).It is amazing that nobody tought about it so far.I wrote an article to this effect.Now I have to find any Academia that will listen to me.(The article is in submission).
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