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Coming
Clean
June 6, 2005
New
York Times
By BETSY MCCAUGHEY
INFECTIONS that have been nearly eradicated in some other countries are raging
through hospitals here in the United States. The major reason? Poor hygiene. In
fact, hygiene is so inadequate in most American hospitals that one out of every
20 patients contracts an infection during a hospital stay. Hospital infections
kill an estimated 103,000 people in the United States a year, as many as AIDS,
breast cancer and auto accidents combined.
And
the danger is worsening as many hospital infections can no longer be cured with
common antibiotics. One of the deadliest germs is a staph bacteria called
M.R.S.A., short for methicillin-resistant Staphylococcus aureus, which lives
harmlessly on the skin but causes havoc when it enters the body. Patients who do
survive M.R.S.A. often spend months in the hospital and endure several
operations to cut out infected tissue. In 1974, 2 percent of staph infections
were from M.R.S.A. By 1995, that number had soared to 22 percent. Today, experts
estimate that more than 60 percent of staph infections are M.R.S.A.
Hospitals
in Denmark, Finland and the Netherlands once faced similar rates, but brought
them down to below 1 percent. How? Through the rigorous enforcement of rules on
hand washing, the meticulous cleaning of equipment and hospital rooms, the use
of gowns and disposable aprons to prevent doctors and nurses from spreading
germs on clothing and the testing of incoming patients to identify and isolate
those carrying the germ.
Too
few hospitals in the United States are using these precautions, though where
they are used they are highly effective. In a pilot program, the veterans
hospital in Pittsburgh reduced M.R.S.A. 85 percent, and the University of
Virginia Medical Center eradicated it. Unfortunately most hospitals have not
shown the will to defeat infections.
More
than half the time, doctors and other caregivers break the most fundamental rule
of hygiene by failing to clean their hands before treating a patient. Gloves are
not the answer because pulling them on with dirty hands contaminates the gloves.
Nearly
three-quarters of patients' rooms are contaminated with M.R.S.A., which,
according to experts, can be found on everything from cabinets to bedside
tables. Once patients and caregivers touch these surfaces, their hands become
vectors for disease. Ordinary cleaning solutions can kill these bugs, but
surfaces need to be drenched in disinfectant for several minutes, not just
sprayed and wiped quickly.
Frequently,
stethoscopes, blood-pressure monitors and other equipment are contaminated with
live bacteria. Yet doctors and nurses almost never clean the stethoscope before
listening to a patient's chest.
Astoundingly,
most hospitals in the United States don't routinely test patients for staph
bacteria. Studies show that 70 percent to 90 percent of patients carrying
M.R.S.A. are never identified.
Clothing
is frequently a conveyor belt for infections. When doctors and nurses lean over
a patient with M.R.S.A., their coats and uniforms pick up bacteria 65 percent of
the time, and carry it to other patients.
Contaminated
clothing is believed to be the culprit at New York City's Mount Sinai Hospital,
which has recently struggled to control another type of infection called
Clostridium difficile. This common and seldom life-threatening infection is
often caused by fecal material from one patient entering another patient's
mouth. Doctors at the hospital suspect that this infection spread because
clinical nursing assistants wear the same clothes while doing two jobs: emptying
bed pans and delivering food trays.
Hospital
infections can be stopped, but most hospital administrators have not made
prevention a top priority. The Centers for Disease Control and Prevention are
also to blame. While the C.D.C. has made some efforts to curb hospital
infections, they have failed to ask hospitals to follow the rigorous precautions
that are working in other countries and in those American hospitals where they
have been tried.
In
2003, a task force for the Society of Healthcare Epidemiologists of America
chastised the C.D.C. for this failure, but the C.D.C. has still not acted. Every
year of delay is costing thousands of lives.
Many
hospital administrators say they can't afford to take the necessary precautions,
but they can't afford not to. Infections erode hospital profits because rarely
are hospitals fully paid for the added weeks or months that patients must spend
in the hospital when they get an infection. Studies show that when hospitals
invest in these proven precautions, they are rewarded with as much as tenfold
financial return. These infections add about $30 billion annually to the
nation's health costs. This tab will increase rapidly as more infections become
drug-resistant.
In
February, the Centers for Disease Control and Prevention declared that it will
not support the growing demand to make hospital infection rates public. That's a
shame because if you need to be hospitalized, you should be able to find out
which hospitals in your area have the worst infection problems. This secrecy may
allow some hospitals to save face, but it won't save lives or money.
Betsy
McCaughey, a former lieutenant governor of New York, is the founder of the
Committee to Reduce Infection Deaths.
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