In the emergency room with my injured daughter, I watched as rules to protect patients from infection were disregarded: a nurse wearing bangle bracelets (carrying bacteria from patient to patient); doctors touching contaminated privacy curtains and then their patients; the uncleaned stethoscope pressed on one bare back after another, caregivers pulling on gloves without cleaning their hands first, which contaminates the outside of the gloves and offers patients no protection.
On October 19, the federal Centers for Disease Control and Prevention announced “impressive progress” in reducing hospital infections. That statement is as misleading as the gloves. Some hospitals are aggressively preventing infections, but the CDC’s shockingly timid goals give other hospitals a pass to do too little.
A decade ago, hospitals began seeing exponential increases in a previously uncommon infection called Clostridium difficile or C. diff, for short. It is now outstripping the infamous MRSA (methicillin-resistant Staphlococcus aureus) in Pennsylvania and New York, according to recent state reports. But the CDC cannot tell us how many C. diff cases there are nationwide. Clifford McDonald, an infectious disease professional at the CDC, estimates it kills 28,000 annually, but admits he is relying on data from 2008 or earlier.
C. diff causes watery diarrhea, allowing the germ to race through the hospital on contaminated nurses’ uniforms, wheelchairs, and other objects. Patients touch bedrails, the call button and other surfaces where C. diff lingers, then touch their lips or pick up food without washing their hands first, and swallow the germ along with the food.
Faced with soaring cases in 2000, Carlene Muto, M.D. at the University of Pittsburgh-Presbyterian responded by cleaning patient areas with bleach, ensuring caregivers washed their hands with soap and water (alcohol based cleaners do not kill C. diff), isolating infected patients rapidly, and curbing antibiotics. Over five years, Muto brought down C. diff cases 71 percent and severe cases down 89 percent.
Cleaning is the first line of defense. The Mayo Clinic reduced C. diff by an amazing 79 percent in five months by making one change: wiping frequently touched surfaces around the patient’s bed once a day with Clorox bleach wipes. Yet, the CDC has set a five year goal of reducing C. diff by a paltry 33 percent.
Another type of infection, the central line associated blood stream infection or CLAB, is so preventable that Medicare calls it a “never event ” and will not pay hospitals to treat it. Some seriously ill patients have a tube inserted into a major vein to deliver multiple medications. The risk is that bacteria will invade the tube.
Johns Hopkins in Baltimore, Allegheny Hospital in Pittsburgh, Beth Israel Medical Center in New York City and other hospitals proved CLABS can be eliminated when the medical team uses a checklist: Clean your hands, put on a gown, use a sterile drape over the insertion site, prepare the patient’s skin with chlorhexidine soap, insert the line above the waist, and remove it as soon as possible.
Despite evidence that CLABS can be eradicated, the CDC’s goal is to merely cut them in half by 2013.
Catheter-related urinary tract infections are also “never events.” A major cause is leaving the catheter in too long (3 days or more). Studies show a reminder on the bed can solve this problem. Yet the CDC’s goal is a mere 25 percent reduction by 2013.
We have the knowledge to prevent infections. What is lacking at the CDC is the will. In 2002, the CDC estimated that hospital infections from all types of bacteria kill 99,000 Americans yearly. As shocking as that toll is, even more alarming is that the CDC has not updated its 2002 figure.
In 2008, the General Accounting Office alerted Congress that the CDC’s estimates are questionable. Surveys by the Association for Professionals in Infection Control on the number of MRSA and C. diff infections indicate that the burden of hospital infections is several times as large as the CDC estimates. Understating a problem is one way to ignore it.
When the nation is struggling to control health costs, hospital infections are adding at least $35 billion to the nation’s annual tab. Worst of all, patients who contract them pay a terrible price.
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