Swabs in Hand, Hospital Cuts Deadly Infections
By Kevin Sack, The New York Times, Published: July 27, 2007
At a veterans’ hospital here, nurses swab the nasal passages of every arriving patient to test them for drug-resistant bacteria. Those found positive are housed in isolation rooms behind red painted lines that warn workers not to approach without wearing gowns and gloves.
Every room and corridor is equipped with dispensers of foamy hand sanitizer. Blood pressure cuffs are discarded after use, and each room is assigned its own stethoscope to prevent the transfer of microorganisms. Using these and other relatively inexpensive measures, the hospital has significantly reduced the number of patients who develop deadly drug-resistant infections, long an unaddressed problem in American hospitals.
The federal Centers for Disease Control and Prevention projected this year that one of every 22 patients would get an infection while hospitalized — 1.7 million cases a year — and that 99,000 would die, often from what began as a routine procedure. The cost of treating the infections amounts to tens of billions of dollars, experts say….
Dr. Richard P. Shannon, who championed a program to reduce catheter infections at Allegheny General Hospital in Pittsburgh, was able to show administrators that the average infection cost the hospital $27,000. He demonstrated that reimbursement payments for weeks of extended treatment were not keeping pace with actual costs. “I think it was assumed that hospitals didn’t mind treating these infections because they were getting paid for it,” Dr. Shannon said….
It is the screening and isolation of patients that draws the most debate. Screening presents an upfront cost for hospitals, and administrators worry that keeping patients in isolation will further clog emergency rooms and reduce the quality of care. Some researchers believe that improving hygiene and surgical practices alone may be equally effective.
In guidelines released last year, the centers recommended that other precautions be taken first and that hospitals resort to screening high-risk patients if they cannot otherwise reduce their infection rates. The guidelines are endorsed by the American Hospital Association, which believes that hospitals must be able to tailor plans to varying needs.
Others do not see the issue that way. Betsy McCaughey, who became a hospital infection crusader after serving as the New York lieutenant governor, said it was paradoxical that the centers encourage hospital screening for H.I.V. but not for bacterial infections, which are associated with seven times as many deaths. Ms. McCaughey said the agency “is largely to blame” for the failure to contain drug-resistant organisms.
“Their lax guidelines,” she said, “have given hospitals an excuse to do too little.”
There is an old saying, “You get what you measure.”
Fighting Hospital Infections a Stethoscope at a Time
Posted by Jacob Goldstein, The Wall Street Journal Health Blog, July 27, 2007
Here’s the thing about MRSA, the nasty, drug-resistant staph infection common among hospital patients: It’s insidious. Many patients carry the bug (pictured) without showing any signs at all, which makes it especially tough to tackle….
Better patient screening has been helped by rapid tests that allow hospitals to identify the bug within hours, the WSJ reported last month. A New Jersey intensive-care unit that started screening all its patients cut its rate of newly acquired MRSA infections nearly to zero….
I think we need universal health care. But it isn’t quality care by legislation or by flipping a switch. We need to carefully evolve from the complex system of incomplete incentives to perform well - to the system we think we mean by universal health care - with appropriate incentives for proper, top-of-the-game care.
Having indigent patients dumped in unpleasant parts of cities tells us we are not measuring well. We may think we have quality care available as needed, but we don’t give much thought to what behavior we encourage - by who, against the interests of who, at what social cost.
