Fighting health care acquired infections

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Going to the hospital can be a serious health hazard.

Each year, an estimated 1.7 million U.S. patients, two-thirds of them on Medicare, catch a bug while being treated for something else. According to federal agencies, nearly 100,000 patients die annually from what are formally called “healthcare-associated infections,” or HAIs.

A deadly meningitis outbreak linked to contaminated steroid injections is only the most recent, major example of infections that a 2011 report from GE Healthcare found kill more Americans than breast cancer and prostate cancer combined, and cost our health care system $35 billion annually, or $1,100 per admission.

The problem is getting some attention through a program established under health care reform. Partnership for Patients put $500 million in grant money into the fight to help hospitals and other health care providers reduce HAIs by 40 percent and cut hospital readmission rates by 20 percent by the end of 2013. If successful, the program expects to save Medicare $50 billion over the next decade.

Officials report progress

Already, officials have announced a 40 percent improvement in what are known as central line-associated bloodstream infections caused by germs that get into the body when tubes are inserted into large veins. The federal Agency for Healthcare Research and Quality and its partners, including the American Hospital Association, said in September that the reduction in these infections has saved more than 500 lives and $34 million in health care costs.

“No patient should ever become sicker as a result of the care he or she receives,” the agency’s director, Dr. Carolyn M. Clancy, told a news conference. “Until recently, these infections were thought to be an unfortunate consequence of care. Our work … demonstrates definitively that they are not.”

Protect your health from HAIs

Here are steps any hospital patient should take to avoid contracting a “healthcare-associated infection.”

  • Demand clean hands: Ask your nurses, doctors and visitors to wash their hands before touching or treating you.
  • Question injections: Nurses and doctors should never use the same needle or syringe on more than one patient.
  • Caution on catheters: Ask your doctor to remove your catheter as soon as possible. Infection risk increases the longer a catheter remains in place.
  • Prep for surgery: Ask your doctor how you can help prevent surgical-site infections before a surgical procedure.
  • Report symptoms: Tell your doctor if you experience redness; discharge or pain where you’ve had an IV, catheter or surgery; or unexpected fever or diarrhea, as these may be symptoms of infection.
Source: Federal Centers for Disease Control and Prevention.

Outbreaks brought attention to the problem

Infections related to treatment had long been health care’s dirty little secret until a string of headline-grabbing outbreaks — avian influenza (“bird flu”) in 1997, West Nile virus in 1999 and severe acute respiratory syndrome, or SARS, in 2003 — focused public attention on a growing, microscopic and increasingly lethal problem.

While those exotic bugs were far from the common infection strains that blindside 1 in 20 U.S. hospital patients, the public uproar over what seemed like a series of sci-fi movies come to life prompted consumer advocacy groups to demand action from legislators and hospitals.

Lisa McGiffert, a project director for Consumers Union, which publishes Consumer Reports, started the Safe Patient Project nine years ago to fight HAIs by convincing states to require hospitals to report their infection rates. To date, legislation has been introduced in almost every state and has become law in 27 states and the District of Columbia.

“We initially thought that hospitals were hiding this information and we should see it, but we quickly found out that they weren’t hiding it; they didn’t know it. They weren’t tracking it,” McGiffert recalls. “Even today, I would say there are very few hospitals in this country that know their overall infection rate.”

Dr. Marty Makary, a surgeon at Johns Hopkins Hospital and author of “Unaccountable: What Hospitals Won’t Tell You and How Transparency Can Revolutionize Health Care,” says hospital openness can change an ingrained medical culture that has become complacent about infections, over-treatment and surgical mistakes.

“When New York state required hospitals to publish their mortality rates for heart bypass surgery, death rates declined by 83 percent in six years,” he says. “But so far, no other states have persuaded their hospitals to follow suit.”

A fight similar to Whac-a-Mole

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, says while hospitals are striving toward and collaborating on best practices, the fight against HAIs resembles a microscopic version of Whac-A-Mole.

“You might get your hands around one kind of infection and be able to successfully reduce that,” she says, “But the emergence of a new strain or a new bug or the increasing virulence of a particular bug might overwhelm the success of reducing the kind of infection you’ve been working on.”

Foster says it takes a village to bring germs under control.

“Organisms are on surfaces everywhere — the hands of health care professionals if they don’t wash them as well as everyone who comes to visit in the hospital to give love and support to the patients,” she says. “If you pass along the flu to somebody in the hospital, it could kill them.”

McGiffert says the HAI challenge goes far deeper than hand washing. In her view, what are most needed are a mandatory standardized reporting form and a commitment to transparency from all hospitals and other health care providers.

“It is the responsibility of the boardroom to make sure that safety and preventing infections and other errors is a priority that should come before any other amenities that the hospital offers,” McGiffert says. “That is what people care about. They don’t want to go in the hospital and come out with something they didn’t have going in, and too many patients have that experience.”

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