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Monday, July 22, 2002To document the rising rate of infection-related deaths, the Tribune analyzed records fragmented among 75 federal and state agencies, as well as internal hospital files, patient databases and court cases around the nation. The result is the first comprehensive analysis of preventable patient deaths linked to infections within 5,810 hospitals nationally. The Tribune's analysis, which adopted methods commonly used by epidemiologists, found an estimated 103,000 deaths linked to hospital infections in 2000. The CDC, which bases its numbers on extrapolations from 315 hospitals, estimated there were 90,000 that year. They’re a newspaper, however, not a peer-reviewed journal, so they don’t have to disclose how they gathered the data or what the data actually were or how they extrapolated their results. We are just supposed to trust them. They do, however, bring out a specialist in infectious diseases to confirm their worst fears: "The number of people needlessly killed by hospital infections is unbelievable, but the public doesn't know anything about it," said Dr. Barry Farr, a leading infection-control expert and president of the Society for Healthcare Epidemiology of America. "For years, we've just been quietly bundling the bodies of patients off to the morgue while infection rates get higher and higher." Dr. Farr certainly has worthy credentials, but he also has a penchant for the dramatic. There may be an increase in hospital infection rates, but we aren’t yet at the point where we’re hauling dead bodies to the morgue in carts. The Tribune also accuses hospitals and doctors of colluding in a secret pact to prevent the general public from finding out about the rampant infection rates in American hospitals: The health-care industry's penchant for secrecy and a lack of meaningful government oversight cloak the problem. Hospitals are not legally required to disclose infection rates, and most don't. Likewise, doctors are not required to tell patients about risk or exposure to hospital germs. Even a term adopted by the CDC--nosocomial infection--obscures the true source of the germs. Nosocomial, derived from Latin, means hospital-acquired. CDC records show that the term was used to shield hospitals from the "embarrassment" of germ-related deaths and injuries. The implication is that the CDC came up with the term "noscomial" to hide the fact that infections happen in hospitals. According to Webster’s dictionary, the term dates to around 1843, just about the time doctors were realizing that germs cause disease and that they could be spread from unwashed hands. It was also a time when medicine relied on Greek and Latin to name new diseases and trends. Thus, it isn’t surprising that the Latin term for hospital, nosocomium would be changed to the adjective nosocomial to describe hospital aquired diseases. I’d like to see those CDC records that demonstrate the term was chosen to “shield hospitals”. As to the Tribune’s claim that doctors and hospitals rarely advise patients of the risk of infection, that, too is nonsense. The standard consent form for surgeries and procedures clearly states that one of the risks of having it done is infection. It may be true that we don’t sit down before hospitalizing a patient and tell them that they could pick up an infection by being in the hospital, but is it really appropriate to tell a man having a heart attack, “You need to be admitted to save your life, but I must warn you, you may develop an infection or other complication if we do so?" It’s too bad the story starts off with such hyperbole, for surely there is a worthy story here. If the rates of hospital aquired infection are going up, and if those rising rates are due to hospital understaffing, then those are problems that must be addressed. The Tribune claims that: - Serious violations of infection-control standards have been found in the vast majority of hospitals nationally. Since 1995, more than 75 percent of all hospitals have been cited for significant cleanliness and sanitation violations. In thousands of cases observed by federal or state inspectors, surgeons performed operations without washing hands or wearing masks. Investigators discovered fly-infested operating rooms where dust floated in the air during open-heart surgeries in Connecticut. A surgical assistant used his teeth to tear adhesive surgical tape that was placed across an open chest wound during a non-emergency procedure in Florida. - Hospital cleaning and janitorial staffs are overwhelmed and inadequately trained, resulting in unsanitary rooms or wards where germs have grown and multiplied for weeks, sometimes years, on bed rails, telephones, bathroom fixtures--most anywhere. Because of cost-cutting measures, U.S. hospitals have collectively pared cleaning staffs by 25 percent since 1995. During the same period, half of the nation's hospitals have been cited for failing to properly sanitize portions of their facilities, a shortcoming that can colonize new patients with lingering germs. - Hospitals are required to have professional staffs devoted to tracking and reducing infections, but rampant payroll cutbacks have gutted those efforts. These staffs have been reduced an average of 20 percent nationally in just the last three years. Many hospitals disregard the CDC's recommendation of at least one infection-control employee for every 250 beds. ....Nurses, in particular, say staffing cutbacks have made the most basic requirements of their jobs difficult to fulfill, and a major study by the Harvard School of Public Health recently linked nurse staffing levels to hospital-acquired infections. How much of this can we believe, and how much of it is hyperbole? There’s no doubt that staffing cuts have resulted in fewer custodial workers and fewer qualified nurses, but only the nursing shortage has been conclusively linked to increased infections. The other examples cited are isolated anecdotes, not global trends . The assistant who tore the tape with his teeth (really stupid), and the surgeons who perform surgery without washing their hands (good God!) are isolated incidents and hardly the standard of care. The days of performing surgery like this, are long gone. Still, the description of the Connecticut operating room is a distubing one: A hidden camera was installed outside Operating Room2, and the tapes revealed that up to half of doctors, primarily surgical residents from Yale University, did not wash their hands before entering the operating room, according to hospital records. Operating rooms should be secured and sterile during surgeries, but nurses and doctors routinely stepped inside Room2, even while open-heart surgery was under way, to make personal calls on a phone mounted on the wall. Doctors also are supposed to change from street clothes into clean scrub outfits in a changing room at the hospital, but many doctors wore the scrubs home and back into the hospital the next day--and then directly into the operating room. It doesn’t say much for Yale Medical School that their surgical residents don’t understand the necessity of basic hygiene, but it’s still hard to believe that this is the norm nationwide. We’ve long been aware that hospitals are fraught with dangers for the sick. Anytime you put sick people together in one building there will be an increase in the exposure to bacteria. Anytime foreign material is placed in the body, or the skin’s defenses are breached, the risk of complications and infections rise. To some degree, we can’t help the patient without taking those risks. We should, however, do our best to maintain personal hygiene and hospital cleanliness to minimize them. If the Tribune's series helps us to remember that, then it's all for the good. I just wish they had done a more measured and less hysterical job of it. posted by Sydney on 7/22/2002 05:39:00 AM 0 comments 0 Comments: |
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