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Posts Tagged ‘infection’

Hospital-Acquired Infection Report

Posted by medconsumers on July 1, 2009

New York State Releases 2008 Hospital-Acquired Infection Report

June 30, 2009. The long awaited New York State 2008 report on hospital-acquired infections was released today at a press conference held at Roosevelt Hospital. The law requiring the report took effect in mid-2006, but the first report issued in 2007 did not by design provide the names of hospitals. The 2007 report did provide aggregate rates for the state by region and type and size of hospital, thus establishing a baseline for trending purposes. Arthur A. Levin, MPH, Director of the Center for Medical Consumers, was instrumental in writing the law and steering it through the legislative process.

Some important findings from the new report are as follows:

- No one hospital was found to have a high hospital-acquired infection rate across the board.

- Colon surgical-site infection rates decreased significantly in 2008 and were lower than 2006-2007 national rates.

- Coronary Artery Bypass Graft chest infection rates declined from 2007 and were significantly lower than 2006- 2007 national rates.

-Hip replacement surgical-site infections in 2008 were unchanged from the previous year.

-Central line-associated bloodstream infection rates in intensive care units for 2008 were the same or higher than the 2006-2007 national rates. The report breaks down intensive care units into categories, such as surgical, medical, pediatric and newborn.

As a result of including the auditing requirement in the law, New York State likely has the most reliable information of any state hospital infection reporting system. A Department of Health team of infectious disease specialists visited each of the reporting hospitals at least once during the year to review the accuracy of their identification and reporting. The Department of Health teams conducted sample chart reviews as part of their routine audit process. While in 2007, eight hospitals were identified as out of compliance with reporting requirements and eventually cited by the department; by 2008 all hospitals in New York State were in compliance with the law.

Consumers should understand that infection rates alone might not be a sufficient reason to go to or stay away from any one hospital. If the report had found that one or more hospitals with higher rates across all the measures, a prudent consumer would have had reason to avoid that facility. However, that was not the case in 2008.  Furthermore, the results are mixed for each hospital.

The department has said it will work with hospitals with higher than average infection rates on one or more measures to find ways to improve patient safety.

Here are some tips on how to best understand the report. The graphical presentation of results starts on page 55 with the results for colon surgical-site infection rates and the other measures follow. On page 26 of the report you will find an explanation of the tables. A summary of all the results for each hospital begins on page 123 (Table XXIII). The absence of any result in any cell (box) of the table means that the hospital does not provide that service (for example only 40 hospitals perform CABG surgery). Where “NA” appears in the cell, the hospital did less than 20 procedures in 2008, a number too small for statistical significance.

Contact Arthur A. Levin at medconsumer@earthlink.net

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Home Remedy and Antibiotics for Eczema

Posted by medconsumers on May 11, 2009

A small, preliminary study published in the journal Pediatrics showed a combination treatment can alleviate symptoms of the painful itchy skin disease called atopic dermatitis, which is the most common of the many forms of eczema. It combines a home remedy—soaking in bath water diluted with laundry bleach—and antibiotics.

Jennifer T. Huang, MD, and colleagues at the Northwestern University, Feinberg School of Medicine, Chicago, acknowledged that, along with other pediatricians, they had been advising the diluted bleach baths for some time because they appear to alleviate symptoms and cut down on infections. Their study is the first to include this home remedy.

In an effort to reduce the most troubling complication of atopic dermatitis, all 31 children with eczema who participated were given oral antibiotics for 14 days prior the start of the study. This was to combat the bacterial infection, most often staphylococcus, which can occur when children scratch themselves hard enough to draw blood.

The participants, ages 6 months to 17 years, were then randomly assigned to sit submerged in a bathtub full of water mixed with 1/2 cup of bleach for 5 to 10 minutes twice a week over three months, or a bathtub full of plain water. Only the children in the bleach-bath group were given an antibiotic ointment (mupirocin), which was applied intranasally.

At three months, the children in the bleach-bath group showed greater decrease in the severity in their symptoms and in symptoms of bacterial infections. Huang and colleagues wrote that the next research step should be more studies that assess the efficacy and long-term safety of diluted bleach baths without the addition of antibiotics.

Maryann Napoli, Center for Medical Consumers© May 2009

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Bladder Cancer: No adequate research to guide treatment decisions

Posted by medconsumers on May 1, 2009

“Bladder cancer is among the most prevalent and expensive cancers to treat in the U.S.” This is the opening line of a new study that looked at how early-stage bladder cancer is treated. It showed that treatment is all over the lot—from mild and minimally invasive to extreme and mutilating—because no head-to-head comparison study has ever been conducted to identify which is best.

The new study, based on information from Medicare claims, shows that the people treated least aggressively survived just as long as those treated aggressively. Moreover, the initial high-intensity treatments failed to prevent the need for more interventions in later years. These findings were published recently in the JNCI (Journal of the National Cancer Institute) by Brent K. Hollenbeck, MD, and colleagues at the University of Michigan.

Details about the first two years of care given to over 20,000 people, diagnosed with early-stage bladder cancer from 1992 through 2002, were taken from the Surveillance, Epidemiology, and End Results-Medicare database. Early-stage bladder cancer is defined as a cancer that has not spread to the muscle of the bladder wall.

“What our study highlights is that physicians who practice aggressively in terms of surveillance [followup procedures like cystoscopy] also practice aggressively in terms of the major interventions [e.g., chemotherapy, removal of all or part of the bladder etc.]. That’s their practice pattern,” said the lead author, Dr. Hollenbeck in a telephone interview. The “more is better” paradigm is pervasive among patients as well as physicians, he added, and it is encouraged by our medical care system that pays physicians for doing more.

“What makes bladder cancer so expensive to treat is that about 80% of patients have the chronic form and our study indicates that intensive management of early-stage bladder cancer is common but potentially unnecessary,” said Dr. Hollenbeck who is the Director of the Division of Oncology, Department of Urology at the University of Michigan.

For example, the main diagnostic and surveillance technique is cystoscopy, which involves the insertion of a thin tube into the bladder. It is used to remove cancerous cells from the bladder, check for recurrence, and as a means of infusing chemotherapy directly into the bladder. Cystoscopy carries a small risk of urinary tract infection and can find abnormalities that require further intensive investigations that ultimately prove to be benign, explained Dr. Hollenbeck, citing two reasons why doctors would not want to overuse this procedure.

When asked how a newly diagnosed patient can identify overly aggressive surveillance and treatment, Dr. Hollenbeck offered this advice. “The real issue of this disease is figuring out whether the cancer is a pussy cat or a tiger. For the majority, you will know very early on—in about three months—whether it’s a pussy cat,” said Dr. Hollenbeck, referring to the chronic, slow-growing form of bladder cancer (80% of all).

The physician will know this after surgically removing the tumor and in some cases, going back and removing cells in the section of the bladder where the tumor had been, Dr. Hollenbeck explained. The idea is to make sure that the cancer did not invade the muscle of the bladder wall. “Then, the three-month evaluation with cystoscopy, will more than likely let you will know whether you’re dealing with a pussy cat, and if so, the physician doesn’t have to be nearly as aggressive from then on. Surveillance should gradually be spaced out thereafter. The optimal intervals are unclear. We are trying to get a better handle on this as part of our ongoing effort.”

Maryann Napoli, Center for Medical Consumers© May 2009

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Hospitals Compared

Posted by medconsumers on June 1, 2008

Consumer Reports Provides Comparisons of Aggressive vs. Conservative Hospital Care

The “more is better” approach to American health care has been challenged consistently over the last 15 years by research compiled by two Dartmouth Medical School physicians. As reported in previous issues of HealthFacts, these researchers have studied the care given to Medicare patients in the last two years of life and shown that more tests, more procedures, more specialist care, more days in the hospital do not lead to a longer life or a better quality of life.

Now Consumer Reports has put the Dartmouth findings in a consumer-friendly format that will help Americans determine whether a hospital in their part of the country is likely to deliver aggressive or conservative care. Nearly 3,000 hospitals across the U.S. are included and will be available in the July 2008 issue of Consumer Reports and is freely accessible on the magazine’s Web site. It relies on data from the Medicare claims records of over 4.7 million elderly people treated from 2001 through 2005 for severe illnesses like cancer, congestive heart failure, lung diseases, dementia and coronary heart disease.

The brains behind this research are John E Wennberg, MD, and Elliott S. Fisher, MD, at the Dartmouth Medical School, who have regularly published findings in medical journals as part of a 30-year study of U.S. health care. Entitled the Dartmouth Atlas of Health Care 2008, this research project has also made its findings freely available at its own Web site (www.dartmouthatlas.org).

Contrary to what many Americans believe, aggressive care and consulting many specialists do not improve outcomes or lead to more patient satisfaction. In fact, altogether they slightly increase mortality. The Dartmouth researchers demonstrated years ago that more care often results in more procedures that are painful and unnecessary; more days in the hospital raises the chances of suffering a medication error or getting a fatal hospital-borne infection; and more specialist care leads to uncoordinated care. (Get a good primary care doctor is one of the take-home messages of the Dartmouth researchers.)

At a time when hospitals typically advertise their new high-tech equipment and friendly staff members, Consumer Reports provides an easy way for the public to see just how aggressive their care will be compared to other hospitals in their cities. (Next, we need to know the infection rate of all U.S. hospitals.) It raises a larger question for everyone to consider: Since overly aggressive care is not limited to the elderly, how can people of any age protect themselves when they become hospital patients?

Things aren’t likely to change until consumers make their wishes known and raise questions. Consumer Reports provides many excellent suggestions: Is this treatment likely to extend my life, and if so, for how long? How do its side effects and risks compare with the symptoms and risks of my disease itself? What will happen if I do not have the treatment? Will this test change the way you treat the disease? If not, what is the benefit of doing it? Is this test likely to lead to follow-up tests, biopsies, or other diagnostic procedures? How will this benefit my health?

The Consumer Reports Web site illustrates why New York University Langone Medical Center in Manhattan is #1 in the country in terms of delivering the most aggressive (and expensive) care. The Medicare cost per person in the last two years of life at this hospital was $105,067. This is compared with $44,090 at the country’s #1 hospital in terms of the most conservative care —Scott & White Memorial Hospital in Temple, Texas. (Both are chosen from a subcategory of 93 U.S. hospitals called “integrated medical centers”—that is, hospitals affiliated with medical schools.)

The average patient treated at NYU hospital in the last two years of life spent 54 days in the hospital, 12 days in the ICU, had 34 primary-care visits and 97 specialist visits. The average patient at the Hospital in Temple, Texas spent 16 days in the hospital, four days in the ICU, had 23 primary-care visits and 18 specialist visits. Yet, as Consumer Reports notes, “The Centers for Medicare and Medicaid Services rates care at Scott & White to be at least as good as that at NYU.”

The New York Times reported that the list of New York City hospitals at the Consumer Reports Web site shows a clear division in terms of aggressive care between the private and the public hospitals. As a group, the private hospitals were in the 94th percentile of aggressive care compared with the public hospitals in the 69th percentile. Although the latter is still above the national average, the difference cries out for explanation. The most obvious would be that poor people get inferior (i.e., less) care.

Dr. Eric Manheimer, who is the medical director at Bellevue (a public hospital) and on the faculty at NYU medical school, offered a unique perspective to The New York Times of someone who works for both the public and private systems. “The care at public hospitals was less aggressive because most of their doctors—he estimated 75-85%–were salaried physicians with little financial incentive to order tests or other interventions. At private hospitals, he said, supply can creates its own demand. There is often an abundance of beds and an endless list of specialists who can be called.”

Maryann Napoli, Center for Medical Consumers ©
June 2008

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Hospital-Acquired Infection…and What To Do About It

Posted by medconsumers on February 1, 2008

What kills more than five times as many Americans as AIDS? Betsy McCaughey, PhD, chairman and founder of the Committee to Reduce Infection Deaths (RID) wants you to know that it is hospital infections, specifically a bacterium called methicillin-resistant Staphylococcus aureus. MRSA infections are far more difficult to treat than ordinary Staph infections because they are resistant to most types of antibiotics.

Dr. McCaughey, former lieutenant governor of New York State, has made it her mission to get hospitals and especially the Centers for Disease Control and Prevention (CDC) to make prevention a high priority. In a recent Wall Street Journal op-ed article, she notes, “These infections are caused largely by unclean hands, inadequately cleaned equipment, and contaminated clothing that allow bacteria to spread from patient to patient. At one time, hospitals routinely tested surfaces for bacteria, but in 1970, the CDC and the American Hospital Association advised them to stop, saying testing was unnecessary. Astoundingly, the CDC still adheres to that position despite a 32-fold increase in MRSA infections.”

Dr. McCaughey is interviewed by Maryann Napoli, Center for Medical Consumers.

MN: The statistic that you use—100,000 deaths due to hospital infections annually in the U.S.—comes from the CDC, doesn’t it?

BM: The CDC is only one source. Their more recent statistic is: One out of every 10 to 20 people contracts an infection [while in the hospital]. The CDC puts the number of deaths at 99,000, but other sources say that is a severe undercount. So I usually say, “At least 100,000 deaths.” In fact it’s probably quite a bit more.

MN: What is your basis for saying that?

BM: Last October the Journal of the American Medical Association published a study about the extent of the MSRA infections in U.S. hospitals that nearly doubled what the CDC had been estimating. The reason is the methodology used. Instead of relying on what hospitals report or tell patients’ families, these new data are based on laboratory results which cannot be diminished or modified.

MN: Explain that.

BM: When the hospitals send all their tests to the labs, the laboratories simply count, “How many MSRA infections do we have here?” This was the first nationwide study using this methodology on the extent of MSRA—85% of which occurred in hospitals. The CDC realized that the extent of MSRA infections is far larger than what hospitals had been reporting. And if that’s true for MSRA infections, then it’s likely true for other types of bacteria. So the previous CDC guesstimates need to be reevaluated, based on this October 17 study in JAMA. It revealed the truth gap in the previous methodology.

MN: Denmark, Finland and the Netherlands reduced their soaring rates of MRSA infections to near eradication with multiple preventive measures (see “15 steps” at Dr. McCaughey’s Web Site). You are very critical of the CDC for not encouraging similar actions.

BM: For 25 years, the CDC has tracked the rapid rise in drug-resistant infections. They have consistently understated the extent and cost of the problem. And they have done too little to prevent it.

MN: How do you explain the CDC inaction?

BM: I can only imagine, but having been in government, I know that often agencies that are created to oversee an industry become co-opted by the industry. They spend so much time with hospital administrators rather than with grieving families and ill patients that they begin to share the hospitals’ concerns about the difficulties of changing procedures, the difficulties of more effective cleaning.

MN: You’ve been known to take cleaning matters into your own hands when friends or relatives are hospitalized.

BM: I’ve often gone into the hospital to visit a patient with a bag of cleaning supplies, including gloves, and cleaned the bed rails, the over-the-bed table, the TV monitor. I do it myself, knowing that otherwise it would not be clean.

MN: What do you use?

BM: Something like Windex [ammonia] because it has to stay on the surface for three minutes to kill the germs. It’s not a quick spray and wipe; it’s a drench and wait. Spray it on, wait three minutes to kill the germs and then wipe it off. The only one that Windex won’t kill is Clostridium difficile [bacterium that attacks the colon]—there you need something with bleach in it generally.

MN: We’ve been told that, when hospitalized, we should tell the hospital staff to wash their hands before touching us, but that’s difficult when you’re the one in the bed.

BM: Generally it’s the families [that should do it] because patients are usually too sick, too scared, too old, or in too much pain to act on their own behalf. Families should not be worried about being too aggressive when their loved one’s life is at stake.

For more information:

See 15 steps you can take to reduce your risk of a hospital-acquired infection at the Web site of Dr. McCaughey’s Committee to Reduce Hospital Infection Deaths (www.hospitalinfection.org).

Consumers Union (www.consumersunion.org/campaigns/stophospitalinfections/learn.html) for ways to take action and articles on the topic.

The Leapfrog Group (www.leapfroggroup.org) is aimed at reducing medical mistakes, including hospital infections. See whether the hospitals in your area have instituted 30 safe practices of which five are related to healthcare associated infections. The hospitals collect and submit their own data. The Leapfrog Group does not independently verify the data.

Maryann Napoli, Center for Medical Consumers ©
February 2008

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Probiotics: Research is Promising, But Few Products Can Be Trusted

Posted by medconsumers on January 1, 2006

Many people eat yogurt to protect themselves from antibiotics-induced diarrhea. Others swallow probiotic supplements for the same reason. Either way, the idea is to consume “good” bacteria in order to overcome the tendency of antibiotics to kill good, as well as harmful, bacteria in the gut, throat, and vagina. The public has caught on to the importance of eating microbe-containing foods, especially yogurt, as a way to prevent illness, such as traveler’s diarrhea, and as a way to maintain health. Now many yogurt containers proclaim the presence of “live active cultures,” and it is common to see probiotic capsules side by side with vitamins on the shelves of pharmacies and health food stores. Unfortunately, consumers may be wasting money because most of these products are untested and unproven to contain the necessary amounts of live microorganisms.

Consumer Reports

The problem was highlighted last year in the aftermath of a July 2005 Consumer Reports article featuring probiotics. It described several exciting areas of preliminary research that indicate probiotics could be beneficial to people with digestive disorders like irritable bowel syndrome and food allergies like atopic eczema. Other studies have suggested that probiotics may prevent respiratory infections, urinary tract infections, and precancerous changes that commonly occur in the large intestine. Such studies, however, prove only that one particular microorganism or a specific combination of microorganisms can provide this benefit. Unfortunately, some companies post these research findings on their Web sites implying that their untested products confer the same benefits.

As with all subjects taken on by Consumer Reports, the article ended with a list of products that passed the test-in this case, a list of yogurts, yogurt drinks, and supplements purportedly proven to contain the appropriate amounts of probiotics. But doubts were raised by Mary Ellen Sanders, PhD, president of the International Scientific Association for Probiotics and Prebiotics, in a letter to Consumer Reports (posted on www.isapp.net).

She objected to the article’s conclusion that 18 supplements and nine yogurt products actually contain one billion probiotic units, or colony forming units, the minimum needed for any meaningful health benefit, according to most researchers in this field. Furthermore, just having the right viable count doesn’t mean the product has been shown in a well-designed study to provide a health benefit.

While Consumer Reports was congratulated by Dr. Sanders for highlighting the potential value of consuming the right types of live bacteria and the importance of the dose delivered per serving, its testing methods were questioned. Dr. Sanders’s letter stated that many yogurts and probiotic supplements contain more than one type of bacterium and reporting the total may be misleading to consumers.

Consumer Reports had instructed readers “to pick a product with at least one billion probiotics units,” but that is actually the minimum for each strain of live bacterium in a product. Moreover, the magazine provided only sketchy information about the microbiological methods used to reach their conclusions about the recommended products. Unfortunately, this letter to the editor was not printed by Consumer Reports.

In a telephone interview, Dr. Sanders explained her frustrations with the products on the market that bill themselves as probiotics and/or carry the Live & Active Cultures seal of the National Yogurt Association (NYA). “The problem, in short, is this: with current labeling practices, consumers have no way of knowing if products contain the right number of efficacious probiotic strains. Even if the types are listed on the label, the names used may be inaccurate and the numbers may not sufficient or be what is claimed.”

In an effort to rectify the matter, Dr. Sanders met with officials at the U.S. Pharmacopeia (USP) in May, 2005 to see whether this public standards-setting authority would set the standards for probiotics. “As I understood it, the way the USP functions, it can only respond to a request from industry,” explained Dr. Sanders, “The USP needs a company to come to them and request verification.”

At this point, there is no incentive for a company to make such a request because they claim that consumers are not questioning what is written on the product label. “Things are not going to change until there is a demand from the marketplace,” she said. “What is needed is one or two companies to come forward and have their claims verified independently,” Dr. Sanders continued, suggesting that properly tested products might have a market advantage that would force all competitors to have their products tested.

Similar sentiments were expressed by researcher Gregor Reid, PhD, at the Canadian Research and Development Centre for Probiotics, University of Western Ontario . In a telephone interview he said, “The problem is the majority of the so-called probiotics products out there are unproven, though not harmful.” Even if companies meet the viable count standards that would allow them to be called yogurt, explained Dr. Reid, this would not be enough to call them probiotics. Rather, the specific live bacteria identified on the label must have been proven in a clinical trial to prevent or treat an illness or confer a defined health benefit, he explained. The live bacteria must also be at the same amounts used in the clinical trial.

Dr. Reid, a Professor of Microbiology and Immunology, and Surgery, is also concerned about the lack of incentive for companies to put out a high-quality product. Two companies in Canada pulled their products off the shelf, despite the fact that they had a proven benefit in clinical trials, Dr. Reid said, explaining that one company found it was cheaper to sell an inferior version of its own product. Can consumers trust any probiotic products that have been proven in studies to confer a health benefit? Dr. Reid answered in the affirmative, but the list* is short and none made it into the Consumer Reports article:

  • Culturelle with Lactobacillus GG , a supplement made by ConAgra, prevents and treats diarrhea;
  • VSL#3, made by VSL Pharmaceuticals, Inc. Fort Lauderdale , FL, keeps ulcerative colitis in remission;
  • Activia with Bifidus Regularis TM yogurt, made by Dannon, maintains regularity;
  • Florastor capsules and powder, made by Biocodex , France , maintains intestinal health and normal bowel function in infants, children, and adults;
  • Lactobacillus reuteri (capsules), made by Nature’s Way, treats diarrhea;
  • and Align containing Bifantis TM , made by Procter & Gamble, Cincinnati, Ohio, relieves abdominal pain/discomfort, bloating/distention, and bowel problems.

Dr. Reid has published numerous studies and commentaries about probiotics and owns patents on Lactobacillus strains GR-1 and RC-14. (Both strains are marketed in Europe to maintain the “balance of vaginal flora” under the brand name, Ombe, but this product is not yet available in the U.S. ) He has been working to improve quality and standards for products that claim to be probiotics. For example, the live bacteria in the products should be present for the length of shelf life. And the products should specify the exact strain of live bacteria, for example Lactobacillus acidophilus NCFM TM , as opposed to simply listing Lactobacillus acidophilus on the label.

It should be noted, however, that uncertainties about quality apply to all dietary supplements, including vitamins and herbal products, because this is an unregulated industry. One cannot be sure that any of these products contain what it says on the label because products classified as dietary supplements are not required by the FDA to undergo testing for safety or effectiveness.

When Dr. Sanders was asked what products currently on the market could be expected to be truly probiotics, she prefaced her answer by saying, “I’m not in any better position to answer that question than consumers because there is no third party verification.” Dr. Sanders did, however, single out three products-Culturelle supplements , DanActive TM yogurt drink, and Stonyfield Farm organic yogurt. (The last two products got the highest ratings by Consumer Reports.)

By way of disclosure, Dr. Sanders said that she serves on the scientific advisory board for Dannon, the company that makes DanActive TM , which claims to “naturally strengthen your body’s defense system.” Dr. Sanders points out that DanActive TM appropriately identifies the presence of 10 billion Lactobacillus casei cultures per serving on its label. [Editorial note: two other strains are listed on the label of DanActive TM without mention of the amount of cultures.] Dr. Sanders is not only a consultant for the probiotics industry but also an adjunct research professor at California Polytechnic State University .

While Stonyfield yogurt is one of Dr. Sanders’s three picks for products that appear to be probiotics, she expressed dissatisfaction about companies that do not inform consumers about the amount of live bacteria. “Stonyfield lists the six live active cultures on the label, but the company will not reveal the level of each strain or whether they are still active at the end of shelf life,” she said. “The company says it is proprietary information.”

Probiotics Research at a Turning Point

While there are plenty of reasons to be skeptical about the majority of probiotics on the market, there are also reasons to be optimistic. Dr. Reid spoke of a mindset in the mainstream research establishment that is dismissive of probiotics research and of his frustration about where the lion’s share of the research funding goes. “It’s drugs, drugs, drugs.” But he also reports a sea change in the last few years, much of it related to concerns about antibiotics. “Until a few years ago, we [probiotics researchers] were laughed at by our peers-both scientists and physicians. Now with the problem of resistant antibiotics, there is patient demand, and physicians are starting to pay attention.

” There are a number of reasons why probiotic research has become a hot topic. Despite over 50 years of antibiotics, infectious diseases remain a major cause of death, with gastroenteritis killing a child every 15 seconds. Antibiotics kill normal bacteria as well as good bacteria; hospital-borne infections are not declining; multiple-drug-resistant bacteria continue to emerge as the antibiotic pipeline dries up; pathogenic microbes are being linked with the induction or worsening of many chronic diseases.

“Add to this the pending threat of a deadly flu pandemic. All this has led to consideration of probiotics as one of the possible anti-disease countermeasures. Worried consumers, governments, scientists and industries are looking for new approaches to health restoration and retention. Probiotics have already been shown to alleviate some disease processes, so we need to explore their true potential, as well as understand their limitations.”

* All products can be purchased in the U.S. without a prescription. VSL #3 is available only at www.vslpharma.com or by calling 1(866-GET-VSL3).

Maryann Napoli, Center for Medical Consumers ©
January 2006

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Hospital-Acquired Infections

Posted by medconsumers on June 1, 2005

Protect Yourself

Citing evidence that safety problems in hospitals continue to be a significant threat to patients, two leading health-care quality “gurus” Lucian Leape, MD, Harvard School of Public Health, and Donald Berwick, MD, Institute for Health Care Improvement and Harvard Medical School, recently described the pace of safety improvements by physicians, hospitals and government as frustratingly slow. They argue that the lack of urgency to save lives will continue unless there is a sea change in the “beliefs, intentions, cultures and choices” of those who work in the health care system (JAMA, 5/23/05).

Leape and Berwick cite a 2004 Commonwealth Fund-Institute of Medicine meeting commemorating the fifth anniversary of the Institute’s report on medical errors, “To Err is Human.” They consider a list of concrete, technically achievable five-year goals for hospitals developed by the meeting participants as a good “starter set” of national patient safety goals. Those of us who attended that meeting felt strongly that 90% of all hospital-acquired infections could be eliminated by 2010—a move that could save as many as 90,000 lives annually.

An estimated 2,000,000 patients in U.S. hospitals suffer a hospital-acquired infection each year and more than 100,000 die as a result. Yet, hospitals are not currently held accountable for their infection track record. With a few exceptions, patients facing elective surgery cannot find out their odds of acquiring a serious infection in any given hospital; odds that may be considerably greater than being harmed by the surgery itself.

The Center for Disease Control and Prevention operates a national hospital-acquired infection reporting system. Despite the fact that it is paid for with taxpayer money, it cannot be accessed by the public. What’s more, it’s purely voluntary and less than 10% of all U.S. hospitals report to it. While more than 20 states require some sort of reporting, usually an infection-caused death, this information was kept from public view until recently.

But the veil of secrecy is slowly lifting. In the last year or so, Florida, Illinois, Missouri, Nebraska, Pennsylvania and Virginia have mandated public reporting. In New York, one of 13 states with pending legislation, I have been working with advocates, state legislators, and New York’s hospital trade associations, to pass a law requiring public reporting of hospital-acquired infection rates.

In the meantime, what can be done to prevent infection? Here are a few critically important steps that patients should insist be followed. First, make sure that doctors and hospital staff members wash their hands prior to close contact with you and your immediate surroundings. Unfortunately, research continues to find this simple, highly effective step is omitted more often than not. Recent studies have shown that alcohol-based hand rubs are a more effective preventative than washing with antimicrobial soaps. Sterile gloves not discarded after contact with a previous patient or hospital equipment can spread infection, so make sure staff members put on new gloves after hand washing and before touching you.

Second, if you’re having an operation, most likely a preventative dose of antibiotics will be given prior to surgery. Studies show that getting the antibiotic within one hour of the surgery maximizes protection against a postoperative infection. Unfortunately, nurses can forget to give the antibiotic within the one hour window and you may need to remind them, or have them explain why you don’t need it. The days of having the skin shaved in preparation for surgery should be over. Shaving causes minute nicks in the skin which can allow bacteria to enter the body. Hair clippers are now the preferred way of preparing a surgical site.

Patients and visitors can bring dangerous infections into the hospital. Consequently, some hospitals with aggressive infection control policies screen patients for infection prior to admission, and some limit contact with visitors.

To find out the status of hospital infection public reporting legislation in your state and how to help pass a reporting law, Consumers Union maintains an informative web site: www.consumersunion.org/campaigns Click on “Stop Hospital Infections.”

Arthur A. Levin, MPH, © Center for Medical Consumers, June 2005

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