UNNECESSARY ILLNESS: FOUR STEPS TO SAVE PATIENTS' LIVES
Each year, more people die from hospital-acquired infections than car accidents, fires, and drowning -- combined. Along with the better equipment and technology that's saving patients' lives, comes a higher risk for these infections. In the last 20 years, hospital infections have increased nearly 40 percent -- adding 5 billion dollars a year to America's health care bill. What every hospital could do to cut down the risk and the rate of infections.
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On the outside, Dan Viratos looks like just another guy with his dog.
But he has constant pain. He's had 14 surgeries on the same knee.
Dan Viratos
Had staph infection
"There are days I actually wake up in the morning, and I know I can't get out of bed."
Surprisingly, the pain is not from his surgeries. It started when he developed a staph infection in the hospital after the surgeries.
Each year, 2 million people will pick up some kind of infection in the hospital. About 100,000 will die.
Barry Farr, M.D.
Epidemiologist
University of Virginia
Charlottesville, VA
"Over the past decade, we have seen downsizing of hospitals. We have seen downsizing of the infection control programs."
But Doctor Barry Farr says there are simple ways hospitals can lower their infection risk. First, implement a hand-washing program. Studies show nearly 50 percent of doctors and nurses don't wash their hands between patients.
The CDC says this alone could prevent up to 20,000 deaths each year.
Next, screen all high-risk patients for MRSA -- a dangerous and common hospital-acquired infection. Isolate those who test positive.
Barry Farr, M.D.
"If you're not taking this approach, there's a cost to not doing it, which is having high rates of more expensive infections."
It's been used at the University of Virginia since 1980 with great success.
Another step: hire an intensivist like Peter Pronovost. They monitor patients in high-risk areas of the hospital and can reduce mortality by 30 percent.
Peter Pronovost, M.D., Ph.D.
Intensive Care Physician
Johns Hopkins University
Baltimore, MD
"In most hospitals in the country, that doesn't exist, indeed, probably somewhere between only 10 or 20 percent of hospitals have this."
Finally, Doctor Sanjay Saint recommends antiseptic-coated catheters. By taking this step, the University of Michigan decreased infections by 36 percent and saved money.
Sanjay Saint, M.D.
Internist
Ann Arbor VA Medical Center/University of Michigan Health System
Ann Arbor, MI
"The savings that come from a decreased length of stay, as well as reduced antibiotic use will lead to a net savings of money."
Barry Farr, M.D.
"We're taking the ounce-of-prevention approach. Many other hospitals are taking the pound-of-cure approach."
For Dan, that pound of cure has cost him more than pain. He's lost his job and his peace of mind.
Dan Viratos
"The future? What's the future hold? I think psychologically, I think, I'm on pins and needles."
Now, he faces an uncertain future brought on by an unnecessary infection.
One of Doctor Farr's studies shows hospitals that do not take a preventive approach are spending between about one million and three million extra dollars each year because of higher rates of infections that are resistant to antibiotics.
BACKGROUND: Each year, 35 million people check into a hospital to be healed. About two million will develop a hospital-acquired infection during their stay. Hospital-acquired infections - referred to as nosocomial infections - kill about 100,000 people every year. Each year, more people die from hospital-acquired infections than car accidents, fires, and drowning combined. Along with the better equipment and technology that is saving patients' lives, comes a higher risk for these types of infections. In the last 20 years, nosocomial infections have increased nearly 40 percent -- adding $5 billion a year to America's healthcare bill.
WHAT HOSPITALS CAN DO: While these killer germs can be found in virtually any hospital, experts say there are steps hospitals can take to keep patients' safer. First, leading infection-control expert Barry Farr, M.D., from the University of Virginia, says implement a hand-washing program. Studies show nearly 50 percent of doctors and nurses do not wash their hands between patients. According to the Centers for Disease Control and Prevention, this alone could prevent up to 20 percent of hospital-acquired infections. Alcohol-based gels are popping up in more hospitals across the country, which make it easier for doctors and nurses to comply. These cleaners don't require water and doctors say they kill germs better than many soaps. Sanjay Saint, M.D., from the University of Michigan, says, "What these hand rubs have been shown to do is not only are they very effective in killing bacteria on the hands, but they also allow someone to wash their hands only for a fraction of the amount of time that's necessary to have adequate killing of bacteria." Another step hospitals can take is to screen all high-risk patients for MRSA, a dangerous and common hospital-acquired staph infection that's resistant to the antibiotics used to treat it. Then, isolate those who test positive. This is called active surveillance. The University of Virginia has done this since 1980.
Dr. Farr says: "In 1980, we recognized that [MRSA] had been spreading in our hospital for almost three years and had come to account for almost half of all the Staphylococcus Aureus infections in the hospital. Until that time, what had been done was to put patients in isolation that we happened to know about through the results of a routine clinical microbiology laboratory culture. A new approach was selected, which was doing active surveillance cultures to see who else might have this that might also need to be in isolation to prevent the ongoing spread. That approach worked extremely well and reduced the infection rates due to the resistant pathogen to almost half of all Staphylococcus Aureus infections to none within a year and a half." A third action step hospitals could take includes hiring an intensivist. Intensivists monitor patients in high-risk areas of the hospital and can reduce mortality by 30 percent. Peter Pronovost, M.D., an intensivist at Johns Hopkins University in Baltimore, says, "In most hospitals in the country, that doesn't exist, indeed, probably somewhere between only 10 or 20 percent of hospitals have this."
Finally, hospitals could use antiseptic-coated catheters to reduce infection risk. Dr. Saint says, "The catheters really act as a door or a gateway between a patient's skin and their bloodstream and so unfortunately, the skin is colonized normally with bacteria and the catheter allows those bacteria to walk along the outside of the catheter into the bloodstream." By taking this step, the University of Michigan decreased central venous catheter-related infections by 36 percent. Dr. Saint says: "Approximately 3 million central venous catheters are used every year and about 5 percent of patients will develop bloodstream infections because of the central venous catheter. Between 10 to 30 percent of those patients who develop the infection will end up dying because of the infection."
National Patient Safety Foundation
8405 Greensboro Dr.
Suite 800
McLean, VA 22102
(703) 506-3280
www.npsf.org
Centers for Disease Control and Prevention
Division of Healthcare Quality Promotion
www.cdc.gov/ncidod/hip/default.htm
JCAHO
www.jcaho.org
Copyright © 2004 Ivanhoe Broadcast News, Inc.
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