Infection epidemic carves deadly path in hundreds of hospitals

[NRSKarenRN, BSN, RN]

infection epidemic carves deadly path

poor hygiene, overwhelmed workers contribute to thousands of deaths

first of three parts.

by michael j. berens

tribune staff reporter

july 21, 2002

http://www.chicagotribune.com/templates/misc/printstory.jsp?slug=chi%2d0207210272jul21

a hidden epidemic of life-threatening infections is contaminating america's hospitals, needlessly killing tens of thousands of patients each year.

these infections often are characterized by the health-care industry as random and inevitable byproducts of lifesaving care. but a tribune investigation found that in 2000, nearly three-quarters of the deadly infections--or about 75,000--were preventable, the result of unsanitary facilities, germ-laden instruments, unwashed hands and other lapses.

the industry's stance also obscures a disturbing trend buried within government and private health-care records: infection rates are soaring nationally, exacerbated by hospital cutbacks and carelessness by doctors and nurses.

deaths linked to hospital germs represent the fourth leading cause of mortality among americans, behind heart disease, cancer and strokes, according to the federal centers for disease control and prevention. these infections kill more people each year than car accidents, fires and drowning combined.

hospital infections often are preventable by adopting simple, inexpensive measures. strict adherence to clean-hand policies alone could prevent the deaths of up to 20,000 patients each year, according to the cdc and the u.s. department of health and human services.

"the number of people needlessly killed by hospital infections is unbelievable, but the public doesn't know anything about it," said dr. barry farr, a leading infection-control expert and president of the society for healthcare epidemiology of america.

"for years, we've just been quietly bundling the bodies of patients off to the morgue while infection rates get higher and higher."

hospitals provide ideal reservoirs for germs, with temperature-controlled environments and a steady stream of germ-carrying strangers pouring through the doors each day.

germs that wouldn't be harmful to healthy people in their homes or at work can turn deadly for patients too young, too old or too weak to fight the infection.

in chicago in 1998, as fever-ridden health-care workers tended to patients and as others worked without always washing their hands, eight children died of an infection that spread from the misericordia home on the southwest side into a hospital. the flulike outbreak, which the city of chicago never revealed to the public, was halted weeks later after three dozen sick health-care workers were ordered to stay home.

in a detroit hospital, as doctors and nurses moved about the pediatric intensive care unit without washing hands, infections killed four babies in the same row of bassinets, according to court records and interviews. but it took three months for administrators to close the nursery for cleaning.

staphylococcus germs thriving inside a west palm beach, fla., hospital invaded more than 100 cardiac patients, killing 13, according to court records. the survivors underwent painful and debilitating surgery, as rotting bone was cut from their bodies.

the health-care industry's penchant for secrecy and a lack of meaningful government oversight cloak the problem. hospitals are not legally required to disclose infection rates, and most don't. likewise, doctors are not required to tell patients about risk or exposure to hospital germs.

even a term adopted by the cdc--nosocomial infection--obscures the true source of the germs. nosocomial, derived from latin, means hospital-acquired. cdc records show that the term was used to shield hospitals from the "embarrassment" of germ-related deaths and injuries.

to document the rising rate of infection-related deaths, the tribune analyzed records fragmented among 75 federal and state agencies, as well as internal hospital files, patient databases and court cases around the nation. the result is the first comprehensive analysis of preventable patient deaths linked to infections within 5,810 hospitals nationally.

the tribune's analysis, which adopted methods commonly used by epidemiologists, found an estimated 103,000 deaths linked to hospital infections in 2000. the cdc, which bases its numbers on extrapolations from 315 hospitals, estimated there were 90,000 that year.

the cdc links infections to patient mortality both directly and indirectly. direct cases typically involve patients who specifically died of complications caused by an infection. indirect cases involve infections that played a major role in a patient's death, but may not have been the primary cause.

though cdc officials now say they believe most hospital infections are preventable, the agency has not arrived at a precise number.

the tribune examined federal health inspection reports and other public documents from 2000--the latest year health-care records were available nationally--to estimate that 75,000 of the deadly hospital infections took place in conditions that were preventable. deaths were considered preventable if patients contracted infections that were spread as the result of deficiencies documented by state, federal or health-care investigators.

for every death linked to an infection, thousands of patients are successfully treated each year. and many hospitals battle infections with diligence and the latest technology.

but the tribune investigation found that breakdowns occur more frequently than patients suspect and that the consequences often are deadly.

government and hospital industry reports analyzed by the tribune reveal that:

- serious violations of infection-control standards have been found in the vast majority of hospitals nationally. since 1995, more than 75 percent of all hospitals have been cited for significant cleanliness and sanitation violations.

in thousands of cases observed by federal or state inspectors, surgeons performed operations without washing hands or wearing masks. investigators discovered fly-infested operating rooms where dust floated in the air during open-heart surgeries in connecticut. a surgical assistant used his teeth to tear adhesive surgical tape that was placed across an open chest wound during a non-emergency procedure in florida.

- hospital cleaning and janitorial staffs are overwhelmed and inadequately trained, resulting in unsanitary rooms or wards where germs have grown and multiplied for weeks, sometimes years, on bed rails, telephones, bathroom fixtures--most anywhere.

because of cost-cutting measures, u.s. hospitals have collectively pared cleaning staffs by 25 percent since 1995. during the same period, half of the nation's hospitals have been cited for failing to properly sanitize portions of their facilities, a shortcoming that can colonize new patients with lingering germs.

- hospitals are required to have professional staffs devoted to tracking and reducing infections, but rampant payroll cutbacks have gutted those efforts. these staffs have been reduced an average of 20 percent nationally in just the last three years. many hospitals disregard the cdc's recommendation of at least one infection-control employee for every 250 beds.

for three months in 2000, for example, illinois masonic medical center closed down its infection-control efforts because of lack of staffing, federal inspection records show. the 507-bed north side hospital now has new owners and has hired three infection specialists.

the tribune analysis of patient records shows that hospital-acquired infections contributed to or were the direct cause of death for at least four men and two women, ages 72 to 83, during the three-month period at illinois masonic. four patients had respiratory infections; two had an infection that led to blood poisoning and caused inflammation of internal organs. hospital officials said they could not verify the deaths based on the available information in state records, which omitted names.

federal inspectors determined at the time that illinois masonic had adopted a "complete disregard" for infection-control tracking. more recent inspection reports have found no problems with masonic's infection-control program.

since 1969, when u.s. surgeon general william stewart confidently told congress that the nation could "close the book on infectious diseases," hospital infection rates have quietly pushed higher each year, registering a 36 percent increase in the last 20 years, according to cdc records.

today, about 2.1 million patients each year, or 6 percent, will contract a hospital-acquired infection among 35 million admissions annually, cdc records show.

the american hospital association said the last decade of unprecedented cost-cutting and financial instability has impacted all areas of hospital care, including infection control.

roughly a third of all hospitals are operating at a loss and a similar percentage are teetering on the edge of bankruptcy, according to the aha.

"it's had an effect on infection control and it's had an effect on our ability to recruit and retain workers. it's had an effect on our ability to invest in new and updated equipment as much as we would like to," said rick wade, aha executive vice president for communications.

"it's also a question in front of society: how much do you want to invest in high-quality, safe medical care?"

nurses, in particular, say staffing cutbacks have made the most basic requirements of their jobs difficult to fulfill, and a major study by the harvard school of public health recently linked nurse staffing levels to hospital-acquired infections.

the national study of 799 hospitals found that patients were more likely to contract urinary tract infections and hospital-acquired pneumonia if nurse staffing was inadequate. the study projected that the widening nursing shortage could create even more problems, such as higher mortality rates.

"when you have less time to save lives, do you take the 30 seconds to wash your hands?" said registered nurse trande phillips, who works in san francisco.

"when you're speeding up you have to cut corners. we don't always wash our hands. i'm not saying it's right, but you've got to deal with reality."

infection in an operating room

a deadly outbreak that swept through a connecticut medical center in late 1996 reveals how washing hands or wearing clean clothes can be as critical to a patient's life as a surgeon's skill.

the outbreak, which received scant media attention, is detailed in thousands of pages of hospital records normally kept from public view but opened last year by the connecticut supreme court after the hospital was sued. the case, which involves four patients who contracted infections inside bridgeport hospital, also exposes how the bottom line influences decisions that allow germs to flourish in what are supposed to be the most sterile quarters in a hospital.

operating room 2, where up to one in five patients in 1997 contracted infections, epitomized the hospital's problems.

the air often was contaminated by dust because of faulty ventilation, hospital records show. flies buzzed overhead during open-heart surgery. doctors wore germ-laden clothes from home into the operating room. many never washed their hands.

gloria bonaffini, 71, was wheeled into operating room 2 in december 1996 for what doctors considered routine coronary artery bypass graft surgery.

doctors told bonaffini that she would be back home within the week, her husband recalled. instead, an infection burrowed into her sternum, and she remained hospitalized for more than a year.

"i asked a nurse what was wrong with gloria," said her husband, phil bonaffini, 73, who later sued the hospital. "the nurse looked at me and very quietly said, `she has the infection.'

"i asked, `what infection?' but the nurse ran away."

on her 448th day in the hospital, gloria bonaffini died.

her death certificate indicated that heart problems had killed her. but medical records showed the presence of a staphylococcus germ.

she contracted staphylococcus sometime during surgery, and symptoms of high fever and nausea began to flare within four days, hospital records show. the germ and resulting infections attacked most organs in her body and ultimately caused her heart to fail, records show.

staphylococcus is typically spread by touch and is commonly found on the skin and nasal passages of healthy people. most staph infections are minor, but for a heart patient, the bacteria can have grim consequences because they infect a person who already is weakened and often invade deep inside the chest during surgery.

to gain access to the heart, doctors slice the sternum bone, a process known as cracking the chest. germs carried by contaminated hands or instruments can become embedded in the bone before the sternum is fused back together. removing contaminated bone often stunts the spread of infectious germs. however, in many cases, the germ can never be fully eradicated, hiding in the body and potentially flaring up weeks or years later.

bridgeport hospital had wrestled with issues of infection control and deadly germs even before bonaffini was operated on.

"bridgeport had a long history of high infection rates, but corrective action was not taken until it was too late," said attorney peggy haering, who represented phil bonaffini. "what became clear is that these infections were preventable."

in 1995, hospital officials hired a respected nursing organization to survey the facility after a dozen patient infections were linked to unsanitary conditions. as a result, the association of perioperative registered nurses drafted a comprehensive report detailing a dozen deficiencies and specific improvements.

however, many recommendations were ignored, court and hospital records show.

the report's primary recommendation--and the most expensive to implement--called for replacing the air filtration system in operating room 2. yet, the $20,000 repair price was deemed too costly at the time, hospital records show.

between october 1996 and january 1997, four other patients died "with probable hospital acquired" staph germs, according to a hospital memo obtained by the tribune. the memo doesn't link the deaths directly to the germ, but in two of the cases, it contributed to the patient's "illness" or "demise," according to the memo.

the infections at bridgeport didn't always kill. dozens of patients survived but with a lifetime of pain, hospital and court records show.

in january 1997, during cardiac bypass surgery in operating room 14, eunice babcock, 59, became infected with staphylococcus. doctors later removed much of babcock's sternum, and the operation left deep, disfiguring scars on her chest. doctors had to take her abdominal muscles and fold them over her chest cavity for protection.

that procedure has impaired her ability to walk more than 20 yards without collapsing.

even as gloria bonaffini hovered between life and death in a coma, doctors at bridgeport hospital voted on april 21, 1997, against testing all patients for infection because it was not "cost effective," according to minutes of a meeting by the hospital's infection-control committee obtained by the tribune.

instead, the hospital decided to wait until patients showed symptoms before initiating tests and treatment, the records showed.

at one point, hospital officials discussed the possibility of moving each infectious patient to a private room. but the infection-control committee decided the cost of more private rooms was prohibitive, internal hospital records show.

doctors and nurses assigned by administrators to examine the problem were shocked by what they found, court and hospital records show.

a hidden camera was installed outside operating room2, and the tapes revealed that up to half of doctors, primarily surgical residents from yale university, did not wash their hands before entering the operating room, according to hospital records.

operating rooms should be secured and sterile during surgeries, but nurses and doctors routinely stepped inside room2, even while open-heart surgery was under way, to make personal calls on a phone mounted on the wall.

doctors also are supposed to change from street clothes into clean scrub outfits in a changing room at the hospital, but many doctors wore the scrubs home and back into the hospital the next day--and then directly into the operating room.

officials at bridgeport hospital, which settled the suits related to the outbreak for an undisclosed amount, acknowledge they could have been more aggressive in fixing known problems.

"nobody here intentionally spread germs, but we've learned that even the smallest breakdown in infection control can have devastating consequences," said hospital spokesman john capiello.

the non-profit, 665-bed hospital has undergone a $30 million remodeling in recent years.

improvements include updating air filtration systems in operating rooms; more patient isolation rooms; motion-sensitive sinks with timed release of water to encourage proper hand scrubbing; and waterless-soap dispensers for cleaning hands quickly.

doctors are never allowed to wear scrubs to work from home. the telephone in operating room 2 is off limits to anyone but the surgical staff.

as a result, infection rates that once soared to 22 percent of cardiac surgery patients have been brought down to nearly zero during most months, according to the hospital. the tribune verified the lowered infection rates with public health authorities and through independently obtained hospital records.

on its web site, bridgeport provides a clear warning about infections, a voluntary practice seldom adopted by hospitals and almost never with an acknowledgement that many cases are preventable.

"naturally, there are germs present in hospitals--treating germs is part of our mission! therefore, it is possible to get sick from a stay in the hospital. hospital-acquired illnesses are a major concern, especially since one-third to one-half of acquired infections may be preventable," reads the web information.

bridgeport's battle with deadly germs belies the contention that infections are inevitable, said dr. zane saul, director of infectious diseases at bridgeport.

"we aren't doing anything new today," saul said. "we're just doing what we should have been doing all along."

germ warfare

in the 1840s, a hungarian-born physician, ignaz philipp semmelweis, stood in a vienna auditorium before his medical peers and proffered a controversial theory: washing hands saved lives.

when treated by doctors with unwashed hands, pregnant women often developed fatal infections following hospital births, but mothers rarely contracted infections if doctors thoroughly scrubbed their hands with soap and water, his groundbreaking study found.

european doctors quickly embraced the soap-and-water regimen--the semmelweis technique. infection rates plummeted immediately.

u.s. doctors debated the procedure for an additional two decades.

by the end of the century, however, america developed a hospital system second to none, in part through an obsession with cleanliness. prevention became a life-or-death necessity because almost any infection could kill.

but by the 1950s, the widespread use of penicillin and other antibiotics allowed doctors to overcome once-lethal infections, and over the decades, prevention gradually became less of a priority. new generations of doctors have grown accustomed to responding to symptoms--wait until the patient is sick, prescribe a drug.

within the average u.s. hospital today, about half of doctors and nurses do not wash hands between patients, a dozen recent health-care studies show.

the direct observations of federal and state inspectors in recent years underscore the carelessness that threatens patient health. in baltimore, inspection records show, a doctor placed his stethoscope on the chest of a sweaty patient in the grip of pneumonia, then walked to another room and placed the unwashed, moist device on the chest of a patient. the patient developed pneumonia.

in loyola university medical center in maywood, a resident physician dropped a surgical glove on a dirty floor, picked it up, put it on his hand and changed the bloody dressing on the open wound of a burn patient. the hospital told inspectors that it has retrained the resident and others on its staff.

all hospitals are required to adopt general infection-control standards to qualify for the federal medicaid program, but each facility is allowed to draft its own rules on everything from potency of drugs to eradicating germs.

most hospitals, for instance, leave catheters connected to patients because cdc studies show that even daily removal exacerbates infection rates. but a few hospitals still work under the misguided belief that changing needles every 24 hours avoids infections, studies show.

a checkerboard of local, federal and private health-care regulations does little to force hospitals to step up infection control. most violations are quickly resolved by a hospital's promise to provide more training, federal records show.

"can you imagine the medical community outcry if even a single doctor died from germs because of a failure to wash hands?" said mark bruley, a forensic investigator who studies hospital conditions for ecri, a non-profit laboratory near philadelphia.

"health-care workers aren't the ones getting hurt. because they don't always see the outcome, they are blind to problems."

there is little incentive and, often, little time for doctors and nurses to comply with even basic standards.

nurses and other health-care workers complain that it's virtually impossible to wash hands between every patient contact, which could number 150 times or more a day in a busy hospital. a recent study showed nurses would spend 2 1/2 hours each day to wash hands thoroughly with disinfectant and water. additionally, frequent washing causes the skin to dry out and crack.

consequently, most hospitals have begun to use a waterless disinfectant that kills germs and instantly dries on hands. nurses can squeeze the solution on their hands from wall dispensers and continue to the next patient as their hands are cleaned. studies show the waterless system kills germs as effectively as soap and water. however, many nurses fail to adopt even this simple measure, hospital inspection reports show.

the sanitary condition of a hospital also depends on the diligence of its housekeeping staff, but in many facilities those staffs are poorly trained and overburdened.

since 1995, federal inspectors have cited 31 chicago hospitals for failure to properly sanitize rooms between patients, mirroring problems found in half of hospitals nationally.

"hospitals hire people and say just go in there and clean," said pia davis, president of a chicago health-care chapter for the service employees international union. "they don't show them what chemicals to use or not to use. we have report after report showing that rooms are not cleaned every day."

still, in some hospitals, there is a growing awareness that germs need to be fought with more than the latest drugs--that hospital sanitation, patient monitoring and infection tracking are key to saving lives in a never-ending battle.

"what is needed is not more antibiotics," said dr. gary noskin, chief of infection control for northwestern memorial hospital, which has some of the nation's lowest infection rates.

he attributes the hospital's success to rapid detection of germs and aggressive treatment of infections.

"these bugs are so smart," he said. "they have been here a million years before we were here and they'll be here a million years after we're gone."

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the series

sunday: thousands of hospital patients die from avoidable infections they picked up while under care.

monday: following simple procedures could have helped save the lives of thousands of sick children.

tuesday: dangerous antibiotic-resistant germs are spreading from hospitals to the community at large.

[NRSKarenRN, BSN, RN]

Lax procedures put infants at high risk

Simple actions by hospital workers, such as diligent hand-washing, could cut the number of fatal infections.

Second of three parts.

By Michael J. Berens

Tribune staff reporter

http://www.chicagotribune.com/templates/misc/printstory.jsp?slug=chi%2D0207220180jul22.story

Tamia Jones arrived two months early, weighing less than 3 pounds. For the first three days, her life was charted from precarious to uncertain to probable. By the fifth, she opened brown eyes and was weaned from feeding tube to mother's milk. On the seventh, she died.

One of the nation's most prolific and lethal germs, pseudomonas aeruginosa, was on the loose in a hospital nursery.

Tamia's parents say no one at Sinai-Grace Hospital in Detroit even mentioned the infection to them. If it was a secret, it became one that was impossible to keep.

In three months in spring 1997, on the same floor, within the same nursery unit, along the same row of bassinets, hospital germs contributed to the deaths of three other babies and slipped undetected into 15 more newborns at Sinai-Grace.

Pseudomonas is just one killer among dozens of lethal germs that have transformed pediatric intensive care units into the most dangerous area for infections in a hospital, a Tribune investigation found.

The Tribune linked the deaths of 2,610 infants in 2000 to preventable hospital-acquired infections. Examining patients of all ages, the Tribune identified 75,000 preventable deaths where hospital-acquired infections played a major role. This analysis, based on the most recent national data, is the most comprehensive of its kind and draws on thousands of hospital and government inspection reports.

Pediatric intensive care units experience up to three times the number of infections as other hospital areas, including operating rooms, according to the Tribune analysis and records at the federal Centers for Disease Control and Prevention.

And though overall infant mortality rates continue to decline inside U.S. hospitals, the rate of lethal pediatric infections acquired in hospitals is rising, state and federal health-care records show.

In the majority of cases in pediatric intensive care units, those lives might have been saved by simple acts of washing hands or isolating patients the moment infections were detected, according to inspection and investigative files at the U.S. Department of Health and Human Services.

The records reveal hundreds of examples of unsanitary conditions and unsafe practices:

His nose dripping from a common cold, a doctor in a Los Angeles hospital in 1999 worked the bedsides of newborn patients for half an hour without stopping to wash his hands. Within a week, 12 critically ill children contracted infections from pneumonia-causing staphylococcus germs. Two newborns died. A hospital investigator traced the germ back to the doctor.

Without protection from a mask, gloves or gown, a New York nurse took the blood pressure of a child suffering from staphylococcus, a germ that attacks the respiratory system. She then immediately embarked on bedside checks in another ward of at least six other premature infants, three of whom contracted pneumonia and died in 1998.

Hospital investigators determined the nurse was the only common link among the infected children.

Inadequately trained housekeepers at Illinois Masonic Medical Center in May 2000 failed to properly sterilize rooms, beds, walls or floors at the mother-baby unit. A germ-killing disinfectant must soak on surfaces for at least 10 minutes to be effective. Housekeepers sprayed the solution and immediately wiped it off.

Coinciding with the lack of adequate cleaning, at least 10 infants contracted minor infections in the unit, a Tribune analysis found. All the infants were successfully treated. The hospital has been taken over by a new owner, Advocate Health Care, which hired three infection-control employees. No housecleaning deficiencies have since been cited at the hospital, state records show.

In analyzing the infection problems inside pediatric units, the Tribune examined computerized patient admission and billing records as well as state and federal health-care enforcement records encompassing nearly 4 million U.S. births each year.

Infants are among the most vulnerable patients, but they routinely are treated in ways deemed inappropriate for adults within the nation's 5,810 registered hospitals. Hospital investigations and CDC and Health and Human Services records show:

- Infants riddled with infections often are treated side by side with healthier babies in large intensive care units, allowing germs to spread among patients. At least 1,200 hospitals use large pediatric wards as a cost-effective way to treat the most children. But pneumonia-causing germs, for instance, can become airborne from coughing and sneezing.

Conversely, adult patients are usually segregated into different recovery rooms based on malady, and they are usually cordoned off with curtains or other barriers not typically found in pediatric wards. Adults also are more likely to be isolated in private rooms, the CDC found.

- Harried nurses rapidly shuttling between the beds of infected patients and other areas of the hospital unwittingly transported germs that are believed to have led to deadly infections in at least 500 children in 2000. Carelessness by nurses and aides also causes life-threatening injuries to thousands more each year. Adult patients with infections are more commonly treated by teams of nurses prohibited from contact with other patients.

- An estimated 200 newborns die each year because most hospitals are unwilling to pay about $5 extra per catheter to use germ-resistant, silver alloy catheters, a federal study found. Most ill babies are connected to catheters, which are hollow, flexible tubes inserted into the body to allow passage of fluids. Although the CDC and leading health-care agencies have called for nationwide adoption of the germ-fighting catheters, many hospital officials argue that the expense is not justified compared with the number of infections prevented.

Premature and low-weight newborns are the most vulnerable patients to infection. Their underdeveloped or non-existent immune systems often coincide with serious cardiac and respiratory ailments.

"The germs can sneak up at you at times," said Mary Gould, infection-control supervisor for Children's Hospital in Birmingham, Ala. "You can't be looking at all directions at the same time.... Something could be going on behind you.

"It's really frightening when you really think about it. So many different things can happen."

Outbreaks across the country

Health-care investigators often require months to unravel complicated relationships between germs and their source. But the way germs are spread, particularly inside pediatric intensive care units, reveals a frightening commonality: simple carelessness.

A three-year outbreak in a neonatal intensive care unit at Dartmouth-Hitchcock Medical Center in New Hampshire was linked to health-care workers who failed to wash their hands after petting dogs at home.

At least 15 infants were infected from 1993 through 1995 with a rare fungal infection known as Malassezia pachydermatis, commonly associated with ear infections in dogs. All the infants survived.

CDC investigators found the germ on scrapings of the ears or skin of 12 of 39 dogs owned by doctors and nurses. An internal hospital study, conducted surreptitiously after the outbreak began, found only 30 percent of health-care providers washed their hands between patients as required.

In Oklahoma City, an outbreak that raged from January 1997 to March 1998 was linked to pseudomonas germs embedded underneath the long or artificial fingernails of three health-care workers. The germ killed 16 infants and infected an additional 30 newborns.

The outbreak was aggravated by overcrowding of patients in a small space and by overburdened health-care workers who had difficulty washing hands between every contact with patients, CDC investigators found.

The lack of hand-washing is responsible for most germs spread in pediatric intensive care units, said Dr. William Jarvis, chief of the CDC's hospital infections program.

Despite lessons from past outbreaks, hospital staffs often remain indifferent to hazards that can come from their own hands, said registered nurse Christine Kovner, a member of the New York State Hospital Review and Planning Council.

"I've looked at the hands and artificial nails on some nurses and just think, `Oh my God,'" Kovner said.

Federal and state hospital inspection reports show hand-washing is not the only personal hygiene problem. In hundreds of cases in pediatric operating rooms or intensive care wards, health-care workers have been cited for not wearing masks or gloves and for wearing costume jewelry, rings, necklaces and other adornments on the job. All are potential carriers of life-threatening germs, and most hospitals require their removal.

In November 2000 at Shriners Hospital for Children in Chicago, for example, state investigators filed a citation against a radiology technician who wore a large watch into the operating room.

In an adjacent operating room, investigators cited a surgical resident who entered the room with an untied mask, and another surgical resident who washed his hands, then fanned his arms back and forth in the air instead of using a sterile towel, potentially spreading contaminated water throughout the area.

Hospital officials have since banned all jewelry from the operating room and instituted a strict policy of wearing masks and hand-washing. No further violations have been reported.

Sanitation is particularly important in pediatric intensive care units, where hospital-acquired infection rates range as high as 20 percent, compared with less than 1 percent among infants born without medical complications, according to the American Association of Critical-Care Nurses.

Infection rates in pediatric ICUs rank higher than any hospital department because nearly all patients are attached to respirators, intravenous pumps or other invasive devices that can become an entry point for germs.

Deadly germs in the nursery

Sinai-Grace Hospital towers over Detroit's northwest side. Each year the 500-bed medical center handles 3,700 births, about 10 new lives every day.

The uncommon death of Tamia Jones on March 21, 1997, gave no pause to the pace.

On the sixth day of Tamia's life, a laboratory test showed she had been infected by a pseudomonas germ. But the infection caused by the germ worked faster than the antibiotic that was dripped into her body through an intravenous line, hospital records obtained by the Tribune show. She died the next day.

It took more deaths of premature babies and nearly two months before the hospital decided to close the nursery, segregate infected patients and scrub down every piece of equipment.

Pseudomonas is a water-based germ that can flourish in sinks, ice machines, damp towels, on the leaves of potted plants, even inside hand-lotion containers. The germ is typically spread by touch and can result in lethal infections, including in the respiratory and urinary systems. Unlike some germs that live on the skin, pseudomonas quickly looks for pathways into the body, such as respirator tubes.

Infectious-disease experts said even one case of pseudomonas in a pediatric intensive care unit should prompt immediate cleaning, isolation and enhanced testing of all current and future patients in the ward.

Dr. Wasif Hafeez, chief of Sinai-Grace's infectious diseases department, who was a lead investigator on the outbreak, defended the hospital's reaction, saying the bacteria moved so quickly the children were infected before the hospital could identify an outbreak.

"I don't think you could find anything that we could have done better," Hafeez said. The hospital reacted quickly once the outbreak was identified, he said.

"I get upset when someone says we should have been able to forecast that four children were going to die," Hafeez said. "I got my degree in medicine. Not astrology or palmistry."

He characterized the deaths as the "price of modern medicine." Fragile newborns lost 15 years ago are being kept alive with sophisticated machines and stronger medicines, which make patients more prone to "unbelievably virulent" germs like pseudomonas, he said.

After parents banded together to file a lawsuit, hospital officials pointed the finger of blame at Tamia's mother, Tracey Jones, who suffered several prenatal complications the officials said could have been caused by a pseudomonas germ. When Jones was brought to the hospital for an emergency Caesarean section, she might have carried the germ into the facility, a pediatric doctor at Sinai-Grace testified in a deposition.

There was one problem with that theory. Doctors had taken swab tests of Jones' nose and mouth in search of proof that pseudomonas lived on her body after Tamia's death; the tests were negative, according to hospital records obtained by the Tribune.

Hafeez confirmed the negative test results.

What the hospital never divulged to parents is that the germ was found on an employee, internal hospital records show.

Hafeez acknowledged for the first time to the Tribune that pseudomonas was found on the hands of a respiratory therapist who had worked in the intensive care unit. The therapist, he said, was ill and had undergone a colostomy; a small tube ran from the therapist's abdomen, emptying body waste into a bag.

The moist areas of tubing or even the bag could have been breeding spots for the germ, he said.

In addition to the strain of pseudomonas found on the therapist's hands, hospital tests identified two other strains in the intensive care unit, but the source of those germs was never determined, Hafeez said.

Rebecca Walsh, an attorney who represented the families of the dead children, said the parents were never warned of the outbreak or that hospital officials had identified the germ on any of their employees.

Parents would later testify in depositions that lapses in health care were all too evident: Many nurses and doctors did not wash hands or wear gloves while moving from crib to crib.

On March 30, nine days after Tamia died, another baby girl was brought into the neonatal unit. Alexis Crooms, weighing 1 pound 12.3 ounces, showed steady improvement. She stopped breathing 19 days later. An autopsy revealed the presence of pseudomonas.

Despite laboratory evidence that Tamia had died from pseudomonas, Alexis was never specifically tested for the germ while she was alive, according to court depositions by doctors.

While Alexis was in the nursery, a premature infant boy arrived and was placed in the same row of bassinets. Within 17 days, Prateep Bazel Jr. was dead. Tests done shortly before his death revealed pseudomonas, hospital records show.

Pseudomonas can cause dozens of different infections, making diagnosis difficult. Tamia developed inflammation of the spinal cord and brain; Alexis was gripped by lung-destroying pneumonia; Prateep was overwhelmed by inflammation of his internal organs.

The fourth baby died on June 26. Once again doctors identified pseudomonas, but they were too late to save Breanna Friday, whose intestines were attacked by an uncontrollable infection.

The lawsuit filed by the parents of the four infants was settled out of court in 1999 for an undisclosed sum.

Hafeez said the hospital has since adopted stricter hand-washing policies, eliminated large hand-lotion containers at the nurse stations and banned all potted plants from patient-care areas. It immediately isolates infants with infections. There have been no further pseudomonas outbreaks, he said.

Tracey Jones, who works as a receptionist, said she believes the hospital owes the families an apology, not just money from a settlement.

Tamia's twin brother, Timothy, 5, an avid T-ball player, occasionally breaks down in tears and asks where his sister is, his parents said.

"He knows he had a twin sister," Jones said. "They say twins have a bond. We just tell him that she is in heaven, waiting."

After the death of a newborn, hospital nurses at Sinai-Grace snap a photo to provide a lasting image for parents to take home.

For her picture, a lifeless Tamia was dressed in a white pullover gown, a pink bow tied to her hair and a stuffed teddy bear nestled under her right arm.

"I've never picked up my picture," Jones said. "I just can't bring myself to do it."

She has no photos of Tamia in her Detroit home.

"I prefer my memory."

[oramar]

I wondered when they were going to finally start to realize the real cause of failure to do proper handwashing. All the lectures in the world on hand washing won't accomplish anything if the person has toooooo much work to do.

[NRSKarenRN, BSN, RN]

Unsanitary conditions, heavy reliance on antibiotics create microorganisms that flourish in the community

Last of three parts.

By Michael J. Berens

Tribune staff reporter

July 23, 2002

http://www.chicagotribune.com/news/specials/chi-0207230231jul23.story

Lapses in infection control and overuse of antibiotics are spawning drug-resistant germs that are spreading from hospitals into the community at unprecedented rates.

These new super germs--stronger, more elusive and deadlier--have multiplied for decades inside thousands of hospitals and now are hitching rides into outside communities on the clothes and skin of patients, workers and visitors.

Until the last few years, most germs quickly died after exposure to the harsher environmental conditions outside hospitals. But, increasingly, microorganisms survive for days, even months. And they have developed the ability to breed most anywhere.

"It was only a matter of time before hospital germs became strong enough to live in the community," said Dr. Donald Graham, department chief of infectious diseases at the Springfield Clinic and professor at Southern Illinois University School of Medicine. "We're seeing them pop up everywhere."

In Illinois, the Tribune identified 4,712 cases during 2000 in which individuals contracted hospital-born germs without setting foot in a hospital or other medical center--a 1,000 percent increase in the last decade, an analysis of state patient records and public health reports show.

Last year, at least 200 people in Illinois died after contracting drug-resistant germs in their homes, at work or during leisure activities. Victims developed strains of pneumonia, blood poisoning and dozens of other infections rarely identified outside hospitals as recently as five years ago.

The progression of drug-resistant germs from hospital to community has taken decades to occur, spurred by a long-standing practice to rapidly treat patients with antibiotics but not invest in the more time-consuming efforts to locate the sources of germs, federal studies show.

As a result, many hospitals have become reservoirs of microorganisms that continue to adapt to germ-fighting drugs.

The flow of germs outside the hospital also is aided by cost-saving strategies to discharge patients quickly. In the 1970s, the average stay was about seven days for most patients. Today, stays at most hospitals average three days, according to the American Hospital Association.

Most infections are not detectable during the first three days after exposure, so doctors commonly flood patients with antibiotics, even when they're not sure an infection is present. Health-care researchers cite this practice as one of the chief culprits behind the rise in drug resistance.

During longer stays, hospitals had more time to identify infections and provide treatment. Patients were more likely to leave the hospital without a lingering infection. Briefer hospital stays mean that more patients are at home when infections first show symptoms.

Recent federal studies conclude that up to 16 percent of patients' family members carry germs spread by the patient. In most cases, the germs remain inactive but continue to spread to other people or places, creating a chain of migration that is largely untraceable. Tens of thousands of people now are infected each year as the germs find hosts outside the hospital.

Most victims who are infected are ill or suffer other health problems that weaken their ability to fend off the germs.

But Chicago attorney Brad Gershenson, 37, who had not been near a hospital for months when he was infected, illustrates how even individuals with no discernible medical problems fall prey to hospital germs.

Gershenson, owner of a medical supply company, believed he had a lingering cold-weather flu, his wife said. For five weeks, mild fever and nausea flared every few days, then disappeared. By November 2000, symptoms became so constant and severe that he went to the emergency room at Illinois Masonic Medical Center. He died less than 30 hours later.

Hospital medical records reviewed by the Tribune show Gershenson contracted bacterial pneumonia resistant to the most common and effective antibiotics: penicillin, methicillin and oxacillin.

Doctors traced Gershenson's movements and determined that he had not been inside or near a hospital before falling ill.

"He thought his symptoms would go away. By the time he came to the hospital, it was too late," said his wife, who asked not to be identified because of privacy concerns. "He was healthy and athletic and so young. It was so sudden and unbelievable."

Tracking the germs

In 1997, two pediatricians at the University of Chicago Hospitals stumbled onto a discovery that cast a national spotlight on hospital germs spreading into communities.

Their curiosity was aroused when they encountered a Chicago boy hospitalized at the U. of C. for a pneumonia that was resistant to methicillin, the most used and effective antibiotic against the infection. The germ is known as methicillin-resistant staphylococcus aureus.

Hospital-acquired MRSA infections have been common for a decade. But the Chicago doctors had never identified a case in which a healthy person contracted MRSA before entering the hospital.

Drs. Betsy Herold and Robert Daum dug deeper. The boy had not been sick, nor had he recently visited a hospital or any medical center. Likewise, none of the boy's family members had been sick or visited medical centers.

Admission records showed the boy was in the grip of pneumonia before arriving at the hospital, which ruled out the possibility that the germ came from inside the center. A month later, a second boy was admitted to the hospital with pneumonia caused by MRSA. Both boys survived.

Worried they were witnessing a new and dangerous trend, the doctors pored over patient medical files dating to 1993. They discovered 35 previously unknown cases where children appeared to contract MRSA outside the hospital.

Herold and Daum published their findings in the Journal of the American Medical Association in early 1998, the first documented proof in this country that MRSA had spread into communities.

The Chicago discovery was part of a national groundswell of recognition. In 1999, the CDC published a study detailing the cases of four children in two states who were killed by MRSA contracted outside a hospital.

In July 1997, a 7-year-old girl from Minnesota who complained of fever and a pain in her right groin died from MRSA.

In January 1998, a 16-month-old girl from North Dakota arrived at a local hospital in shock, with a temperature of 105 degrees. She died within two hours of admission. MRSA was found in her lungs.

In January 1999, a 13-year-old girl from Minnesota was taken to an emergency room after complaining of fever and spitting up blood. MRSA was found in her blood. She died seven days later.

In February 1999, a feverish 12-month-old boy from North Dakota was taken to the emergency room after repeatedly vomiting. MRSA, which was found in the lungs, resulted in pneumonia. The boy died a day later.

These and many other discoveries stoked renewed interest in infectious diseases as researchers delved into the molecular construction and behavior of germs.

Germs that once required moisture now survive on dry fabrics. Germs dependent on a living host can go dormant on inanimate objects for weeks before bursting to life upon contact with human skin. These germs are capable of reproducing in minutes, share their enhanced abilities with other germs upon contact and thrive on surfaces even after smothered with disinfectants.

However, doctors are still not sure what prompts MRSA germs to flare into infections.

Staphylococcus is typically a harmless bacterium found on up to one-third of healthy individuals. Resembling clusters of grapes under a microscope, it grows primarily in nasal passages and throats, on hair and skin. But staph germs can sometimes cause nausea, blood infections and pneumonia.

Staph's ability to develop resistance to antibiotics can be traced to practices not only inside hospitals, but also throughout the medical community, playing out over decades in doctor's offices and nursing homes.

Beginning in the 1940s, penicillin was the first line of defense against staph, killing nearly every germ. By 1982, penicillin was effective in less than 10 percent of cases.

Doctors have linked the growing resistance to overuse of penicillin, which has been doled out in massive doses for most every ailment, real or imagined. At one time, a brand of toothpaste contained penicillin to meet consumer demand.

As penicillin's effectiveness waned, doctors turned to methicillin, a more powerful antibiotic. In 1974, the replacement drug killed 98 percent of staph germs. By the mid-1990s, it could kill just half of them, and the percentage of staph germs resistant to methicillin is rising.

The problem facing the medical community is that germs, which multiply into millions of one-cell organisms every few minutes, can undergo spontaneous mutations that result in resistance. Every time an antibiotic is used, it presents another opportunity for the germs' genetic material, their DNA, to mutate and be passed on to the next generations of germs.

"We humans can take generations to adapt to stress," said the U. of C.'s Daum. "Bugs can take minutes."

Germs find a home

One measure of the hospital industry's decline in controlling germs and infections is found in hospital inspection reports compiled by state public health agencies and the U.S. Department of Health and Human Services.

Mirroring the national trend, nearly half of Illinois' 305 hospitals have been cited for potentially life-threatening breakdowns of infection-control standards since 1995. Violations range from failure to disinfect rooms, including intensive care units, to unsanitary habits of health-care workers, such as wearing contaminated gloves or clothes or failing to wash hands.

Though carelessness is a big part of the problem, so too is the harsh calculus of hospital administrators who don't want to pay the cost of searching for the reservoirs of germs, said Dr. Victor Yu, a professor of medicine at the University of Pittsburgh who specializes in hospital-acquired germ research.

Although infection control can be as simple as thorough cleaning and strict attention to hand-washing, some methods--such as updating air filtration systems or periodically flushing water pipes--are effective but costly.

"Too many administrators don't want to necessarily find germs inside their facility because repairs to equipment or extensive cleaning can mean shutting down a department or floor. Even a few hours is a significant loss of revenue," Yu said.

Yu and a growing body of infection-control experts are critical of the CDC-endorsed policy known as selective surveillance, in which hospitals don't screen all patients for infections, but target only the sickest or most vulnerable ones. Hospital officials argue that testing every patient is too costly.

Though selective testing identifies many hospital-acquired infections, it allows a significant number of germs and infections to go undetected, leaving colonies in the hospital that eventually can spread into communities, many of the nation's leading hospital epidemiologists say.

Hospitals, with their warm, constant temperature and immune-compromised patients, are ideal incubators for germs and prime hosts for outbreaks. Germs can find dozens of spots to multiply and wait for a person to infect.

Federal and state health-care studies document hundreds of cases where resistant germs have pooled for years inside hospitals.

Lawsuits filed this year on behalf of 110 patients against Palm Beach Gardens Medical Center near West Palm Beach, Fla., allege that drug-resistant germs thrived inside the medical center for more than five years.

Infections killed 13 cardiac patients and left most of the others with injuries that caused permanent crippling, said attorney Calvin Warriner, who represents the patients and their survivors.

Heart patient Michael Lebedecker, 61, became concerned after health-care workers examined his surgical chest incision without wearing gloves, said his wife, Janet. She said she witnessed a surgical resident use his teeth to tear surgical tape that was placed across a chest bandage.

"My husband was worried about infections, but doctors said not to worry because there were no problems," she said.

Lebedecker, who underwent bypass surgery in 1999, contracted an antibiotic-resistant germ in the hospital and died five weeks after the operation. Hospital records show that he was infected by MRSA.

Lorraine Lydon, 57, survived a similar infection following cardiac bypass surgery, but she now lives a life tethered to oxygen tanks and dozens of expensive medicines. She said she saw instances where health-care workers failed to wash hands between patients, but she did not think the lapses were potentially dangerous at the time.

MRSA was detected in her sternum within a week after the September 2000 surgery. Doctors told her they never determined the source of the germ.

Doctors have tried so many times to remove infection-ridden bones from Lydon that further surgeries could prove fatal to her weakened body.

"I've already had 18 surgeries, but the germ is still inside me. It will never go away," she said. "Besides, they've already removed virtually every bone in my chest. There's nothing else to take."

Investigative records from Florida's Agency for Health Care Administration show 23 complaints have been filed by patients or employees relating to infections or unsanitary conditions at Palm Beach Gardens from 1997 through 2001.

A Palm Beach Gardens spokeswoman declined to discuss specific patient cases or inspection reports. But she said patient safety is its top priority and the hospital has a long record of quality care.

The Tribune visited the facility twice--in April 2001 and a year later--and found many noticeable improvements in the one-year period, from freshly painted walls to redesigned waiting rooms.

However, infection-control breakdowns still existed, from nurses observed failing to wash hands between patients, construction dust floating in the air near the emergency and operating rooms, and employees who left the hospital in scrubs and returned to restricted operating room areas.

At lunchtime, for example, nearly a dozen nurses and other health-care employees streamed outside, carrying cafeteria trays of food to picnic tables on small grassy strips shaded by trees.

As the employees sat at picnic tables, ducks and other fowl darted about their legs in search of fallen crumbs. The birds frequently brushed feathers against the scrub uniforms of the nurses. Birds are considered major carriers of germs, particularly salmonella, which can cause lethal blood poisoning. Birds also can be carriers for staphylococcus germs.

Many employees wore protective slipcovers over their shoes as they trooped into the grass littered with bird feces. They did not remove the contaminated slipcovers before re-entering the hospital.

Into the community

Though most infections can be treated with drugs, the orificenal of available antibiotics for more stubborn infections is rapidly shrinking. In labs throughout the world, pharmaceutical companies are racing to develop more powerful infection-fighting drugs.

Staphylococcus germs are among the most common in a hospital. For more than a decade, as the germ grew resistant to methicillin, doctors have battled it with vancomycin. The antibiotic is commonly referred to as medicine's last line of defense against staph infection.

CDC studies show that up to half of patients who received vancomycin to prevent infections were treated unnecessarily, a practice that contributes to drug-resistant infections.

In 1999, the CDC issued a warning to the nation's health-care professionals that a Chicago-area woman who lived in a nursing home had developed an infection partially resistant to vancomycin. Other cases have been reported nationally.

Last year, the American Association for the Advancement of Science warned that some forms of staph infection, such as bacterial pneumonia, could become untreatable by vancomycin if germs grow stronger.

Those fears are proving true.

On July 5, the world's first fully vancomycin-resistant staphylococcus germ was discovered in Michigan. A 40-year-old patient, a diabetic with chronic kidney problems, contracted a staph infection in a gangrenous toe. Diabetics often suffer poor blood circulation, which can cause the eventual loss of toes, feet and legs.

This patient apparently didn't pick up the germ in a hospital, and CDC tests did not turn up the germ in an outpatient clinic where he received dialysis. Where he was infected has not been pinpointed.

The infection marks an important first. Vancomycin's failure to treat it is seen as a warning that there will be future cases of antibiotic-resistant staph.

In this case, doctors were able to control the infection by removing infected tissue and keeping symptoms such as fever in check with other drugs.

The CDC encourages hospitals to follow 12 steps to stem infections and prevent the spread of germs.

This strategy includes washing hands more often and thoroughly, even for health-care workers who wear gloves, which can become contaminated while they are being put on. Also recommended by the CDC: selecting antibiotics and doses with increased care and precision; using catheters, which can provide an entryway for germs, only when absolutely necessary; and immediately stopping treatment when the infection is cured or unlikely.

Borrowing a theme from anti-crime efforts, the CDC has adopted the phrase "Just say no to vanco" to remind doctors not to prescribe vancomycin unless absolutely necessary.

The CDC also is finishing an eight-year study on the impact of antibiotic use on germ resistance in 41 hospitals.

The study targets 12 common germs, such as staphylococcus aureus, and has found that resistant germs can thrive anywhere in hospitals.

In one case study, coordinated for the CDC by the Rollins School of Public Health of Emory University in Atlanta, 4,303 samples of staph germs taken from intensive care units were studied. Nearly 36 percent were resistant to the most common and effective antibiotics.

For Buffalo Grove resident Debra Shore, the race to find new antibiotics could become an issue of life or death.

Last year, a staph germ resistant to methicillin infected her right foot, which had suffered complications related to her diabetes. She already had lost three toes to amputation, and the infection caused swelling and intense pain in her foot.

Because she had not been in a hospital or doctor's office for weeks before the infection, Shore and her doctor are convinced that the germ was contracted somewhere in her home.

Shore received a new antibiotic that won FDA approval in 2000. The new drug, Zyvox, is marketed by Pharmacia Corp. as an alternative to vancomycin. Medical studies show Zyvox is as effective as vancomycin.

Drug company officials and doctors hope introduction of new drugs will stunt or delay germs' ability to develop resistance. Although there have been no reported cases of staph germs developing resistance to Zyvox, other germs have already developed resistance to the new drug.

In July, infected by staph again, Shore began a new round of antibiotics to try to save her right foot.

Doctors decided to alternate antibiotics to reduce the chances of staph germs developing a resistance, and this time they chose vancomycin. It seems to be working.

"I fear there will be a day when there are no more drugs to help me," Shore said. "My doctor said this germ only was found in hospitals years ago. Now it's everywhere.

"If this germ gets any stronger, I may not be able to survive the next round."

[-jt]

ANA Response to Chicago Tribune

Newly-elected ANA President Barbara Blakeney, MS, RN, CS, ANP, has written a letter to the editor of the Chicago Tribune in response to a series on hospital infections that was published July 21-23, 2002........

July 24, 2002

Chicago Tribune

Op-Ed Page

435 North Michigan Avenue

Chicago, IL 60611

Dear Editor:

The American Nurses Association (ANA) would like to respond to the recent three-part series on "unhealthy hospitals," written by Chicago Tribune reporter Michael J. Berens. ANA applauds his efforts to underscore the importance of appropriate infection control procedures an issue for which ANA and its members have been on the front lines for many years. However, like the question of medical errors, hospital-acquired infections are indicative of

the larger, systemic problems eroding the quality of patient care.

In the early 1990s, many providers of health care services reduced their RN staffs under the premise of saving money. The result is that RNs everywhere are trying to do more with less. Fewer nurses are forced to treat more patients. The problems caused by nurse staffing cutbacks are exacerbated by additional cutbacks specifically in the area of infection control. As Mr. Berens' series states, "Hospitals are required to have professional staffs

devoted to tracking and reducing infections, but rampant payroll cutbacks have gutted those efforts." These actions have a domino effect on the health outcomes of patients. Mr. Berens also refers to the recent study in the New England Journal of Medicine, which found a direct link between increased nursing care and lower rates of urinary tract infections and pneumonia, and fewer deaths from pneumonia and the blood infection sepsis.

An important first step in addressing some of the problems raised in Mr. Berens' series, is to lift the veil of secrecy that has surrounded these issues for too long.

ANA and its member nurses continue to be at the forefront of the movement to enact whistle-blower and patient safety legislation on both the state and federal levels. This type of legislation sheds much needed light on hospital staffing practices and patient outcomes; gives consumers access to important data they need to make informed choices; and protects nurses who speak out on behalf of patient care.

ANA also is pushing for federal legislation that would mandate quality "report cards," so that hospitals and other health care systems would be required to publicly report about RN staffing levels, risk-adjusted patient mortality rates, infection rates, and other safety and quality issues.

In his series, Mr. Berens states that "For every death linked to an infection, thousands of patients are successfully treated each year. And many hospitals battle infections with diligence and the latest technology." ANA and its member nurses couldn't agree more. And, working together, we believe even more can be done to ensure the highest possible level of patient care.

Sincerely,

Barbara Blakeney, MS, RN, CS, ANP

President

American Nurses Association>>>>>

###

http://www.ana.org

[fedupnurse]

There was a piece on this topic on GMA the other day. The person stated that nurses should be spending a total of 2.5 hours per shift washing their hands (didn't specify 8 or 12 hour shifts) and that this was no longer possible to wash hands for the appropriate length of time due to cutbacks in hospitals and unreasonable workloads for nurses.

Something any staff nurse could have told you for many years now!

[LasVegasRN]

Originally posted by NRSKarenRN

Staphylococcus is typically a harmless bacterium found on up to one-third of healthy individuals. Resembling clusters of grapes under a microscope, it grows primarily in nasal passages and throats, on hair and skin. But staph germs can sometimes cause nausea, blood infections and pneumonia.

I'm still worried over this strept infection my daughter has that has been resistant to antibiotics so far. I know - different organism, but I think the same concerns apply.

[NRSKarenRN, BSN, RN]

ANA President Barbara Blakeney, MS, RN, CS, ANP, has written a letter to the editor of the Chicago Tribune in response to a series on hospital infections that was published July 21-23, 2002.

http://www.ana.org/pressrel/2002/ltr0725.htm

July 24, 2002

Chicago Tribune

Op-Ed Page

435 North Michigan Avenue

Chicago, IL 60611

Dear Editor:

The American Nurses Association (ANA) would like to respond to the recent three-part series on "unhealthy hospitals," written by Chicago Tribune reporter Michael J. Berens. ANA applauds his efforts to underscore the importance of appropriate infection control procedures - an issue on which ANA and its members have been on the front lines for many years. However, like the question of medical errors, hospital-acquired infections are indicative of the larger, systemic problems eroding the quality of patient care.

In the early 1990s, many providers of health care services reduced their RN staffs under the premise of saving money. The result is that RNs everywhere are trying to do more with less. Fewer nurses are forced to treat more patients. The problems caused by nurse staffing cutbacks are exacerbated by additional cutbacks specifically in the area of infection control. As Mr. Berens' series states, "Hospitals are required to have professional staffs devoted to tracking and reducing infections, but rampant payroll cutbacks have gutted those efforts." These actions have a domino effect on the health outcomes of patients. Mr. Berens also refers to the recent study in the New England Journal of Medicine, which found a direct link between increased nursing care and lower rates of urinary tract infections and pneumonia, and fewer deaths from pneumonia and the blood infection sepsis.

An important first step in addressing some of the problems raised in Mr. Berens' series, is to lift the veil of secrecy that has surrounded these issues for too long. ANA and its member nurses continue to be on the forefront of the movement to enact whistle-blower and patient safety legislation on both the state and federal levels. This type of legislation sheds much needed light on hospital staffing practices and patient outcomes; gives consumers access to important data they need to make informed choices; and protects nurses who speak out on behalf of patient care. ANA also is pushing for federal legislation that would mandate quality "report cards," so that hospitals and other health care systems would be required to publicly report about RN staffing levels, risk-adjusted patient mortality rates, infection rates, and other safety and quality issues.

In his series, Mr. Berens states that "For every death linked to an infection, thousands of patients are successfully treated each year. And many hospitals battle infections with diligence and the latest technology." ANA and its member nurses couldn't agree more. And, working together, we believe even more can be done to ensure the highest possible level of patient care.

Sincerely,

Barbara Blakeney, MS, RN, CS, ANP

President

American Nurses Association

org/pressrel/2002/ltr0725.htm