A few weeks ago a historic report released by a state agency in Pennsylvania (PHC4) discovered that during 2005, over 19,000 patients contracted an infection while they were in the hospital which led to one in nine dying. Turns out, patients are almost six times more likely to die during a hospital stay if they acquire an infection than not. It is the first report in the nation identifying the rate of infections acquired by patients by individual hospitals. The Institute of Medicine, a few years back, found that at least 98,000 patients a year die nationwide from acquiring infections while they are hospitalized. Most experts believe this number is even higher.Imagine if we put these numbers in the context of airplane crashes. Let’s say that only one-third of the infections could have been prevented – that’s just over 32,600 people or three plane crashes EVERY WEEK carrying 200 passengers each. Imagine the public outcry. Think the airlines could go on with business as usual? Think we’d still be flying? Or picture how you’d react tomorrow morning if the local headlines read that nearly 100,000 people were going to die of SARS in the next twelve months. Got your attention?
The industry tells us that hospitals, of course, are places for very sick people, and very sick people have germs. Doctors, nurses and technicians make contact in the most intimate of ways: via blood, urine and bodily contact. It doesn’t take much for germs to travel from one person’s hands to dozens of people every day. The problem for patients, however, is that their immune systems are weakened creating a “Welcome Mat” for bacteria. They contend that the severity of a patient’s illness is what increases the risks of getting a hospital acquired infection (HAI).
BUT health policy expert David Nash, editor of American Journal of Medical Quality and chair of the Department of Health Policy at Thomas Jefferson University, argues that, "It's the process, not the patients" that spawns hospital-acquired infections. According to Nash, three recent independent studies found that “despite hospitals' claim that in the sickest patients it's inevitable that someone is going to get a hospital-acquired infection, that's just not the case." Nash recommends that hand washing among hospital workers, carefully keeping surgical gowns and clothing sterile during procedures, reduced numbers of hospital personnel going in and out of operating rooms and more selective use of antibiotics could significantly reduce the alarming infection rate (Washington Post, 11/21). Marc Volavka, Executive Director of PHC4, is even more adamant: "The simple fact is that every patient who enters a hospital in Pennsylvania and in this country is at risk for a hospital-acquired infection. This is about flawed processes and the chaos currently existing within our health care delivery system."
YOUR TURN
1. Should hospitals require that every doctor, nurse and technician wash their hands in front of patients before examining or treating them? Should they tell patients on admission to ask hospital personnel, "Did you wash your hands?" Would you ask?
2. Should Medicare start linking its payments to hospital infection rates? For example, if someone gets a urinary tract infection that is hospital acquired, Medicare wouldn’t pay the hospital the added costs to treat the patient’s infection.
3. Should every state issue annual consumer reports on hospital acquired infections by hospital? Would you use this data to select a hospital for your next surgery?
10 comments:
People should be VERY wary of using this data to select a hospital. The PHC4 study is best used to compare the progress of the same hospital over time, which can't be done with this first year study.
Each hospital collects this data differently. It is possible, even likely, that a high rate of reported infections signifies a hospital that is doing a MORE effective job of managing and reporting infections than a hospital with an apparently low rate.
As future editions of this report are issued, it will be possible to see if your local hospital is getting better or worse at preventing hospital acquired infections, but the study does not have much use now for selecting a hospital.
Under any circumstances, patients should ask their health care providers (in and out of the hospital) if they have dilligently practiced appropriate infection control procedures. As always, the patient's most dogged advocates must be the patient and their family.
1. Yes, it is a good idea for hospitals to require that every doctor, nurse and technician wash their hands in front of patients before examining or treating them. Health care providers should be washing their hands before treating every patient in any case, so having them do so in front of the patient provides a good safety check. Patients should also be encouraged to ask whether their health care providers have washed their hands. A culture change is needed in hospitals so that patients and families are not afraid to speak out, and are listened to, when basic patient safety measures are not followed. I would probably post a sign near my bed asking if providers washed their hands in case I forgot or was groggy from post-surgery medication.
2. Yes, Medicare should start linking its payments to hospital infection rates. There is growing evidence that hospitals can prevent infections, even among the sickest patients, by following common sense measures such as handwashing and ensuring nurses have all their supplies before entering the operating room so they do not increase the risk of infection by going in and out of the room. Hospitals already lose money for each case of a hospital acquired infection, and they will pay even more attention to implementing patient safety measures if they stand to lose even more for each infection that occurs.
3. Yes, states should issue annual consumer reports on hospital acquired infections by hospital. Doing so would require some investment in data collection and reporting, but the positive impact on patient safety would be worth it. If this information were available to me, I would definitely use it to help me select a hospital for my next surgery. More importantly, health insurance companies and employers should use this information to decide which hospitals to include in their networks and/or provide incentives to hospitals that perform well. This would give hospitals even more reason to review and improve their patient safety processes.
1. Absolutely yes! Patients should be told to expect that healthcare workers wash their hands and wear gloves as needed. I am not sure that washing hands in front of the Pt. is needed, you could wash them in the hallway etc just prior to entering the room. Pts. have the right to ask healthcare workers to wash their hands.
2. No, there are many factors that may cause a hospital aquired infection, not just poor asepsis. Linking payment to this would not be appropriate.
3. Consumer reports are available on almost everything these days so, why not healthcare. These reports must be valid and reliable and the study's limitations must be made very clear to the public. I agree with some of the issues noted in the comments of others regading this.
My family has experience with this problem. Both of my parents contracted infections in hospitals; my mother was stuck in the ER at a crowded hospital for three days before being moved to a room. She contracted a rash all over her legs and no one could tell her what it was.
Everyone must know about this problem because all of us either will be patients or know someone who is. Thank you for the infomeation about preventing infections.
Kate Megargee
This is a very interesting an important article. I don't think it should be the patient's responsiblity to ask the doctors/nurses to wash their hands. I think it should be mandatory for them to either wash their hands in front of each new patient they are examining or put on fresh rubber gloves.
If you are so ill and come into a hospital or emergency room, you could be really out of it, or perhaps are elderly and not very coherent, or might even be a baby. It really doesn't matter. Hospitalized people are very sick or they would not be in a hospital. It should be the responsiblity of the hospital staff to make sure and to monitor their own professionals do the right things, and not leave it up to an ill patient or family to have to be a 'watch-dog' for professionals to do what they should be doing in the first place. There should be mandatory laws regarding all of this. As such, if an infection happens, the responsiblity for this lies with the hospital and their professionals. So, perhaps there should be some real teeth put into state and hospital rules that ultimately cause the professionals to have to pay some serious fines for their lack of safety and care. A relative, aged late 80's with diabetes, wound up with a very bad infection in one arm because of improper use of needles, and uncaring staff and had to have surgery done to remove the vein in that arm. Luckily, the patient recovered very nicely, after weeks of being in the hospital and in a rehab hospital (think of the cost factor!!), and had almost died because of the lack of concern, good and safe practices. It was sad that the family had to get a bit nasty to get things done, including having the person moved to another floor. Many people don't want to get rather pointed with staff in hospitals, be it doctors or nurses. After all, most people want to trust them and believe that they have the patient's health in their best interest. One would not have to worry or be concerned if the responsiblity of good health care rested appropriately with good and caring hospital staff whose main interest was in taking care of the people and providing good health care instead of simply collecting a paycheck and thinking that they are the only people in the world who have heavy work loads. They should be there in good conscious for the good and well being of the people they are caring for and want to do the best things possible for their patients. If that was done, you would not see out of control infections for one thing.
The quickest way to get the hospitals to address the infection rate is for them to be responsible for ALL medical bills, including drugs, relating to the infection contacted in their hospital.
How long do you think it would take for each hospital to clean up their act and greatly reduce the infection rate! I don't understand why they are not held responsible now.
(1) I think most patients will have a difficult time asking their primary hospital-doctors "Did you wash your hands?" each time the doctor lays hands on them - and in the most critical times, just before, during and after surgery, the patient may not be able to ask. The physicians, nurses and other hospital caregivers who examine and treat patients need to accept and monitor the procedures necessary to interrupt infection - through training, observation and consequences for poor performance. PA hospitals now have a scorecard - they must use it to safeguard patient health AND to be competitive in an increasingly competitive hospital market. Routine reminders, additional hand-washing sinks and hand-driers and maybe some additional technology (what if the doc put his/her hands under a glo-light in the patient's room that painted bacteria and virus bright red?) would help. Plus rewards for those who follow all the guidelines - days off, incentive pay, gifts (get the pharmaceutical companies to contribute instead of dropping gifts off to doctors who use their drugs).
(2)Witholding payment might just cause hospitals to restrict (not blatantly) the types of patients admitted, or the kinds of procedures carried out. And there are patients who contribute to their own infections - one of my hospital mates ripped out his IV's three times and tossed feces around the room. Reward and publicize excellence -- low rates of nosocomial infection - or at least major progress toward reducing such infections in a hospital. Identify poor facilities and use the Hospital Association of PA, the State Health Department and the Nurses Association in concert to do site reviews and change practices. Publish the results.
(3)Every state should use a standard boiler-plate system, so comparisons can be made, with additional indices in those states who have more experience with the "counting". Given a choice - in a non-emergency setting, I'd ask my doctor which place had the best record for the surgical or medical action I was being admitted for. If he or she chose tthe 'low" scorer, I'd ask why.
Congratulations on creating a forum for consumers on the critical issue of infections acquired in hospitals.Hopefully, information concerning quality of care will also be exposed. I have heard recently from families who are hoping that both issues will be publicized.
In addition to daily ads from healthcare providers extolling their excellence we are inundated through the media and postal service about the need for healthcare coverage for many. The public needs to know this is not all that is needed. How about a serious investigative report on the quality of healthcare being provided.
This report would need to investigate poor staff decisions, state and federal regulations impacting patient care and documented medical errors. Consumers must find a way to hold healthcare providers accountable. Case in point: This patient was planning to go home within a couple of days. Due to poor staff decisions, state and federal regulations and documented medical errors he spent over 2 months in 4 hospitals and 12 different rooms. Death was the final result. His infection regime included UTI, pneumonia, c-dif, MRSA, and finally sepsis. Medicare licensing regulations required transfers from 3 hospitals and in most cases a change in physicians. Information about the patient's condition was available when the doctor has a question for the family. Most questions to doctors requesting a phone call were never returned.
A reader of your column suggested comparing the number of hospital deaths due to infections in the context of plane crashes. I would suggest we go beyond the unspeakable suffering of the patients and compare the cost of 1 week hospitalization against the cost of over 2 months hospitalization and you would have some idea of why the cost of healthcare is out of control.
Is it possible there would be more outrage if the public were consumers who paid the bills rather than the insurance companies and the government through Medicare and Medicaid?
The quickest way to get the hospitals to address the infection rate is for them to be responsible for ALL medical bills, including drugs, relating to the infection contacted in their hospital.
How long do you think it would take for each hospital to clean up their act and greatly reduce the infection rate! I don't understand why they are not held responsible now.
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