February 23rd, 2010
06:36 PM ET
By 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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