February 23rd, 2010
06:36 PM ET

Hospital-acquired infections lead to substantial loss in life, and waste billions

By Miriam Falco
CNN Medical News Managing Editor

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.

February 23rd, 2010
05:27 PM ET

Keep fighting despite the losses

By Dean Hanan
CNN Fit Nation Triathlon Challenge Participant

A few months ago, before I ventured onto CNN.com’s Fit Nation Web site and got myself into this amazing triathlon training experience, I woke up and ran into the kitchen, prepared some coffee and went outside on the balcony to smoke a cigarette. That had become my morning ritual after September 11, 2001.
[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2010/images/02/23/dean.jpg caption="CNN Fit Nation Challenge participant Dean Hanan."]
I stared at the Coney Island beach and remembered how I used to run the beach when I was a lifeguard. How easy it was to effortlessly run a mile in seven minutes. And how I used to swim, gliding through the water like a seal.

Being in shape seemed so easy back then. But then you experience life. You suffer setbacks, you lose a relationship, a friend, a job, or money becomes tight. Sometimes it’s a major loss. For me it was losing my aunt at age 8, moving to Florida during my senior year of high school to care for my sick grandparents, losing friends, and almost losing the love of my life on September 11, 2001 when, as a New Yorker, and an American, our hearts were broken.

We all suffer setbacks. Some of us eat a little more, drink a little more, smoke cigarettes or worse. Sometimes we let others down. The hard part is to break down the walls of feeling guilty. Guilt is not what we are supposed to learn from our flaws or mistakes. Life molds us. We can take the good from it and move forward or we can focus on the negative and keep it in us to paralyze us from moving forward. My mom and dad always said obstacles are the things that help us realize how strong we don’t know we really are. They were right. We all suffer setbacks. We all lose jobs, money, loved ones, and things we care about. We all go through the good times and the bad times.

But it’s not about how many times life kicks you down to the ground into the dirt. It’s about having enough guts to turn around, look life back in the face, and tell yourself you are worth it! I cannot give up! I will always fight! No matter how much it may hurt or scare you. No matter how many people think they know you and what you are made of! It’s about getting back up off the floor, dusting yourself off and looking into your own eyes in the mirror and making a decision that we are all capable of: To never give up! To take that small amount of spirit left in your body and to realize that after everything you have gone through…YOU ARE STILL HERE!

You are not alone! You ARE still here! Go get ’em!

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

February 23rd, 2010
02:11 PM ET

Before you send your child to the doctor

By Sabriya Rice
CNN Medical News Producer

Prosecutors announced Monday that a grand jury has indicted Delaware pediatrician, Dr. Earl Bradley on 471 felony counts in the alleged sexual abuse of his patients. Bradley has practiced in Lewes, Delaware, for more than 10 years, and is now facing charges which include, rape, sexual exploitation, endangering child welfare and assault.

How could this happen? Most physicians don't get involved in criminal activities, however sometimes a bad apple can fall through. According to the Federation of State Medical Boards, approximately two hundred of the 735,000 actively licensed doctors in the United States have been found guilty of criminal acts.

In many cases they continue to practice; in some states a license can't be revoked until a witness has testified and the physician is found guilty of the charges. Patients have no way of knowing unless they do their own research.

Parents, here are some things you can do:

1) Find out if your pediatrician has a criminal past:
To find out whether your doctor has been disciplined by a state medical board, here's a state-by-state directory of medical boards.

2) Check your pediatrician's national profile:
Some states explain why a doctor has been disciplined while others don’t, so just searching in your state might not reveal a doctor's history of problems elsewhere. You can also get a national profile on your doctor for just under $10 by searching on the Federation of State Medical Boards website.

3) Get a good recommendation
You can view the American Academy of Pediatrics’ list of recommended pediatricians on their website.

Editor's Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.

About this blog

Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.