103k Deaths --> Hospital Infections: 4th Leading Cause of Death in USA !

Ragin Cajun · Jul 21, 2002

I do not doubt these statistics one bit after what I've seen. A nurse caring for my husbands mother, in the hosp., went to the linen closet wearing her gloves, that she had already contaminated with feces, it was 'just outside the door', and then looked at me like I was crazy when I said something to her about it. Hand washing almost NEVER takes place, and the SAME gloves are used from pt-to-pt in some facilities. I've seen it. Really Sad !! I can't tell you the inservices I've done on these very topics; time and time again. Gloves are expensive don't ya know ? Everything is the BOTTOM LINE anymore, even if patient safety is involved. A lot of it is ignorance,hence the inservices, but even then, things don't change much because employees have developed bad habits that are hard to break; and it is all so simply preventable. Soap and water are cheap!!

Rustyhammer · Jul 21, 2002

I've seen soap and paper towel dispensers stay empty when housekeeping has been short staffed and staff has to go to another room to wash hands. For awhile we were using that alcohol stuff that supposedly was a good replacement for handwashing (I have a hard time buying it though) and now even THAT is too expensive to have all the time.

I worry sometimes that I may bring something home with me.

When you work around so many bugs day after day it's easy sometimes to take the basics for granted and sometimes we get sloppy. We all need to remember to protect ourselves and our patients.

Thanks for the article.

-Russell

NancyRN · Jul 21, 2002

IMHO, hospitals should be required to provide scrubs for employees. I don't like wearing my bugs home and having to wash my scrubs in my own machine.

fedupnurse · Jul 21, 2002

I have seen numerous docs go from patient to patient without washing their hands and I have 2 respiratory theapists who routinely work my unit that not only don't wash their hands between patients but don't change their gloves. I have said something to them personally and gone to management and nothing has changed. SO now when I am working with these 2 people I tell them they must wash their hands before and after they touch any of my patients.

If we had safe nurse to patient ratios I bet you dollars to dougnuts that the infection rate would significantly decrease!!

Cascadians · Jul 25, 2002

[ Fair Use: For Educational / Research / Discussion Purposes Only ]

http://seattletimes.nwsource.com/html/nationworld/134499777_infect25.html

Thursday, July 25, 2002 - 12:00 a.m. Pacific, by By Michael J. Berens, Chicago Tribune

Hospitals' hidden killers: More germs are taking patients' lives

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 an investigation found that in 2000, nearly three-quarters of the deadly infections Ñ or about 75,000 Ñ 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.

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 Centers for Disease Control and Prevention and the U.S. Department of Health and Human Services.

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

The most vulnerable

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 a care home into a hospital. The flulike outbreak 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.

The Tribune analyzed records 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 analysis 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 role in a patient's death.

The Tribune examined federal health-inspection reports and other public documents from 2000 Ñ the latest year health-care records were available nationally Ñ 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 investigation found that breakdowns occur more frequently than patients suspect and consequences often are deadly.

Government and hospital industry reports reveal that:

¥ 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 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.

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. ¥ 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.

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 rise in the past 20 years, CDC records show.

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.

Nurses hardest-hit

Nurses, in particular, say staffing cutbacks have made the most basic requirements of their jobs difficult to fulfill, and a survey 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.

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.

Bridgeport Hospital's Operating Room 2, where up to one in five patients in 1997 contracted infections, epitomized the facility'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. 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. 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 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. 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. But in many cases, the germ can never be fully eradicated.

In 1995, Bridgeport 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 Ñ and the most expensive to implement Ñ called for replacing the air-filtration system in Operating Room 2. Yet, the $20,000 repair price was deemed too costly, hospital records show.

Between October 1996 and January 1997, four other patients died "with probable hospital-acquired" staph germs, according to a hospital 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.

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

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.

The nonprofit, 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.

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.

By the 1950s, the widespread use of penicillin and other antibiotics allowed doctors to overcome once-lethal infections, and over the decades, prevention gradually has become less of a priority.

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.

On their own

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. 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.

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. 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.

"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."

ceecel.dee, MSN, RN · Jul 25, 2002

I have a hard time believing that any hospital is encouraging nurses or anyone in patient contact not to change their gloves to save money.

I, too, think the hospital should supply scrubs for one and all.

I think housekeepping must play a big role in infection control, and their work is often substandard (at least in our place). Our physical therapists go from patient to patient without handwashing, our docs do sometimes, RT, OT....many people come in contact with multiple patients, all touching light switches, bed handrails, hallway handrails, door knobs....the list goes on and on. Housekeepping is important!

-jt · Jul 25, 2002

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. 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.........

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..........

Nurses hardest-hit

Nurses, in particular, say staffing cutbacks have made the most basic requirements of their jobs difficult to fulfill, and a survey by the Harvard School of Public Health recently linked nurse staffing levels to hospital-acquired infections.......>>

funny - our hospital administrators always deny that cost-cutting impacts on patient care or the quality of care. And when they laid off 650 employees - including housekeeping & ancillary staff at one of our hospitals recently, they publicly refuted the RNs concerns about pt care by convincing the newsreporters & community that layoffs of that category of personnel "will not negatively affect pt care". Wishful thinking would have those newsreporters & the community go right back to the hospital waving this article & demand that it explain itself.

-jt · Jul 25, 2002

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

rebelwaclause, ASN, RN · Jul 25, 2002

I watched "20/20" not long ago that aired a segment on this subject. They stated the number one culprits of spreading disease is....

a) Housekeeping

b) Nurses

c) MD's

d) all the above.

Correct answer...."c", MD's.

Go figure.....

live4today, RN · Jul 25, 2002

Damn!!! Can't seem to get away from those hospital-staff nosocomial infections even when I aint workin'!!! :rolleyes: :rotfl:

Fgr8Out · Jul 25, 2002

I too, saw the report on television last night.... Scary stuff, what those in the Health CARE Profession DON'T do to minimize nosocomial infections.... Stranger still, that we don't think enough about our own health to follow basic sanitary practices.

We have the alcohol foam at the doorway to each room... the dispenser is attached to the wall. According to the literature, no only are the alcohol foams effective when used (Remember, they are ONLY useful for mildly unclean hands... not hands that may be visibly soiled), but they are milder on the hands than the antibacterial soaps and hot water we use when washing. Of course, anything used regularly can cause irritation but, I do like the ease of squirting a lil foam on my hands if all I've done in a room is reset a pump, or take vital signs and haven't done anything that would truly dirty my hands.

Peace:)