Posted by medconsumers on June 1, 2005
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