Doctors Must Wash Hands. U.S. hospitals have become an infection zone
McCaughey, Betsy
"Doctors Must Wash Hands" This problem has lieu Ignore secret is more like it. you've seen seertthe ploring you to use this hospital or that it has the best doctors, or the latest...
...Denmark and Holland have brought that figure down below 1 percent...
...are showing how possible it is to reduce infection...
...Newspapers run frontpage stories about patients who went into the hospital for routine surgery, contracted MRSA, and died or suffered terribly...
...The cost of prevention during that period: $9,984...
...deserve the same information...
...They also insist on secrecy, arguing that publicizing comparisons of hospitals' infection rates would be unfair to hospitals treating AIDS, cancer, and organ transplant patients who succumb to infection quickly...
...Hospital infections add an estimated $20 billion to $28 billion a year extra to the nation's health spending, enough to fund two-thirds of the cost of the new Medicare drug benefit...
...Recently, the Bush administration has shown some interest in wielding Medicare's market clout, though not specifically to reduce infection...
...Federal health programs such as Medicare pay 46 percent of the nation's hospital bills...
...Statistics don't convey the suffering...
...The result: no new MRSA infections in the next five months...
...Insurers pay...
...Yet the overall hospital infection rate in the U.S...
...you've seen seertthe ploring you to use this hospital or that e it has the best doctors, or the latest equip ent...
...It's time to make hygiene a central part of medical care again...
...They have real market clout...
...Let's hope so...
...What is unfair is keeping the public uninformed...
...Patients pay...
...That has led to new danger: infections that almost no drugs can cure...
...That's the wrong tactic...
...It's no wonder...
...We would have chosen another hospital with a better record...
...Though New York doesn't disclose hospital infection rates, in 1989 New York became the first state to publish information on how hospitals compared in another area—risk-adjusted mortality rates for cardiac bypass surgery...
...A few hospitals in the U.S...
...k Betsy McCaughey, former lieutenant governor of New York State, is a health policy expert at the Hudson Institute and chairman of the Committee to Reduce Infection Deaths...
...Patients of the 27 barred surgeons were more than three times as much in danger of dying during surgery...
...If you need an operation, wouldn't you want to know which hospital in your area had the lowest infection rate...
...The result...
...It was ripped to shreds by the hospital association," complained Jeanne Keller, a Vermonter, health care consultant, and supporter of report cards...
...That's what happened to Eunice Babcock of Connecticut, who went in for bypass surgery and got a staph (staphylococcus aureus) infection...
...The results...
...Numerous similar studies prove infection prevention is cost effective, but hospital administrators still claim they can't afford it...
...Secrecy Allows the Danger to Continue TWENTY-ONE STATES REQUIRE HOSPITALS to report infections that lead to serious injury or death, but most of these states have acceded to the hospitals' demands to keep infection reports secret...
...Who pays...
...It reduced overall infections by two-thirds and eliminated MRSA entirely from its orthopedic wing by improving hand washing, barring nurses from wearing jewelry, prohibiting visitors from sitting on patients' beds, ensuring that doctors changed white coats frequently, testing all patients for infection before they were admitted, and isolating patients carrying infection...
...It pays top dollar for dirty care...
...They are paying higher rates to hospitals that provide better care...
...Shadyside Hospital in Pittsburgh spent $114,320 extra treating 12 patients because they became infected with MRSA...
...She's right...
...24 THE AMERICAN SPECTATOR NOVEMBER 2004 Fighting Infection Saves Money CAN AMERICAN HOSPITALS AFFORD to take these precautions...
...Patients in the U.S...
...Hospitals are doing their best to prevent their infection rates from being disclosed...
...Good luck getting that information...
...Doctors' Dirty Hands THIS SUFFERING IS TRAGIC, because infections are largely preventable...
...In addition, non-emergency patients in these two countries are tested for MRSA before coming into the hospital, and those who test positive are treated to eliminate the bacteria—a process that keeps new germs out of the hospital...
...NOVEMBER 2004 THE AMERICAN SPECTATOR 25...
...Fair enough, but reports can be risk-adjusted to reflect these differences...
...That's tragic, but five times that many people die from infections they contract in the hospital...
...No scientific breakthrough is needed...
...Mercy Hospital in Oklahoma City lowered the risk of infection after cardiac, colon, and hysterectomy surgeries by 78 percent...
...Forty-four hospitals in the Pittsburgh region have reduced catheter-related bloodstream infections by nearly half, and a pilot program at the V.A...
...Most hospitals are dirtier places than they used to be...
...What has been lacking is the will to fight it...
...If you need an operation, wouldn't you want to know which hospital in your area had the lowest infection rate...
...Eighteen thousand people a year die prematurely because they lacked health insurance, the Institutes of Medicine estimate...
...As the November election nears, the question has to be asked: What could the next president ofthe United States do about the huge fatalities from hospital infection...
...Because a MRSA epidemic has evoked such fear and outrage that the public is demanding action...
...The federal CDC collects infection data from several hundred hospitals around the nation, but also promises hospitals not to disclose their infection rates...
...The single most effective way, according to the federal Centers for Disease Control and Prevention (CDC), is to get doctors and other caregivers to clean their hands in between treating patients...
...Infection prevention saves money...
...The one fact you don't see advertised is the number of patients who get infection while there...
...contract infections, and nearly 100,000 die from them...
...Britain's Broomfield Hospital was one of the first to act...
...exp Home res Y iplenitipgppractice This problem has lieu Ignore p secret is more like it...
...It's a good thing...
...Latter Day Saints Hospital in Salt Lake City, which already had an infection rate below the national average, reduced its rate by 50 percent, largely by improving pre-surgical procedures...
...Yet it can be virtually eradicated...
...Doctors clean their hands before treating a patient only 48 percent of the time, on average, research shows...
...An infection after surgery more than doubles the cost of a patient's care...
...Hospital there has virtually wiped out a deadly type of infection, methicillin resistant staph...
...Washington has been looking for ways to pay for Medicare's drug benefit...
...Intravenous (IV) and urinary tract catheters—tubes that enable liquids to enter or leave the body—are also extraordinary transmitters of infection...
...Then the hospital instituted rigorous infection-prevention procedures similar to those in Holland and Denmark...
...Plenty...
...Under political pressure, Prime Minister Tony Blair issued an edict that the British National Health Service must reduce infection...
...is at least as high as it was three decades ago, and there is some evidence that it may actually be increasing...
...Most of these victims have insurance...
...Contaminated equipment, such as wheelchairs, bedrails, stethoscopes, and blood pressure cuffs also allow dangerous bacteria to be transmitted from one patient to another...
...It's not unusual to be able to trace the bacteria in a patient's wound directly to the bacteria on a particular health care worker's hands, she explains...
...That's an outrage...
...Even at the best hospitals" the rate is only 60-70 percent, points out Dr...
...Hospital report cards work...
...The president should instruct Medicare to stop doing business with hospitals that have an infection rate double or triple the norm...
...0 N JULY 8, the Infectious Diseases Society of America called on Congress to provide incentives for companies to develop new drugs against antibiotic-resistant infections...
...We can't afford not to...
...In England, infection rates are now conspicuously posted at hospital entrances and in newspapers...
...Taxpayers who fund Medicare, Medicaid, and other government health programs pay...
...New York State proved it...
...Pay for performance" should be expanded to reward hospitals that substantially lower infection...
...are antibiotic resistant (up from 2 percent in 1974), and the problem is spreading...
...The British also see it that way...
...With report cards, hospitals that look bad "will be embarrassed at least, and may be forced to improve...
...New York University's Elizabeth Norman remembers that in the mid-20th century, when she and nurses of her generation trained, her hands were red and raw from scrubbing, and cultures were routinely taken from underneath the fingernails of hospital staff to make sure bacteria were not being spread...
...In technical jargon, the 27 surgeons had an average risk-adjusted mortality rate of 11.9 percent, compared with a statewide average of 3.1 percent...
...British medical care falls far short of American care by almost every measure, but hospitals there now are rushing to make infection control a top priority...
...Sadly, she has "watched the abandonment of simple practices that were once routine...
...In December 2002, the Vermont legislature considered a bill to make hospitals report annually on several quality measures, including infection rates...
...Sadly, even when politicians discuss health care, they stick to the same old script, talking about the uninsured...
...Astonishingly, Medicare pays the same fees to hospitals with the best care as it does to those with high infection rates...
...A frightening 57 percent of hospital staph infections in the U.S...
...The British are beginning to do that...
...Patients who manage to survive a serious infection sometimes go through months of pain and repeated surgeries to cut out infected tissue...
...The good news is that the war against infection is winnable...
...She was so close to death that doctors had to surgically remove her sternum, leaving her disfigured and unable to stand up ever again...
...Deaths declined for a different reason: hospitals forced their worst performing surgeons—those with low volume—to stop doing the procedure...
...Drugs or Hygiene...
...Employers who foot the bill for workers' health care pay...
...Deaths from bypass surgery dropped 40 percent, giving New York the lowest mortality rate in the nation for that procedure...
...Critics of report cards speculate that deaths went down in New York because hospitals avoided treating the sickest patients, fearing that high risk operations would bring down the hospital's grade...
...Pennsylvania and Missouri enacted laws this year for hospital infection report cards, but nearly everywhere BETSY McCAUGHEY else in the hospital industry is proving a formidable adversary...
...The death toll is higher than from AIDS, breast cancer, and auto accidents combined...
...On July 19, 2003, Medicare announced a "pay for performance" experiment in which a small number of hospitals would be eligible for a 2 percent bonus if they proved that they are providing superior care for heart attacks, pneumonia, and certain other illnesses...
...Just as no child should be trapped in a failing school, no patient should be treated in an infection-ridden hospital...
...Good luck getting that information...
...Hospitals in Holland and Denmark have done it by insisting on hand hygiene, decontaminating equipment such as beds and wheelchairs after patient use, and isolating patients who carry the germ—precautions people assume are taken everywhere...
...Pat Moore said about her son's death, "If I had known the hospital had a serious infection problem, Brad would never have been taken there...
...Patients with staph actually shed the bacteria in little flakes from their skin that are then carried on equipment and floor dust...
...These precautions are not taken by many American hospitals...
...Holding hospitals accountable is no different from holding public schools accountable...
...Beth Raucher, an infection expert at Beth Israel Medical Center in New York City...
...One of the most feared infections is MRSA (methicillinNOVEMBER 2004 THE AMERICAN SPECTATOR 23 DOCTORS MUST WASH HANDS resistant staphylococcus aureus) because most antibiotics do not tame it...
...A liberal reliance on antibiotics has replaced scrupulous attention to hygiene...
...Strict hygiene will curb the spread of infection, no matter how germs evolve...
...The American Hospital Association responded predictably, cautioning that "pay for performance" could become punitive...
...The evidence proves that's untrue...
...It merely perpetuates a race between scientists and germs that are constantly morphing to resist antibiotics—a race we may not always win...
...We all do...
...Patients "are dying from germs their physicians and nurses give them," warns Elizabeth Norman, headof New York University's doctoral program in nursing and an outspoken critic of the poor hygiene in hospitals...
...A few large employers and insurers are taking a new approach...
...Every year, more than two million hospital patients in BETSY McCAUGHEY the U.S...
...Patient advocates are calling for state governments to make that information public...
...Wisconsin also found that report cards motivate poorly performing hospitals to improve, according to a 2001 study of 24 hospitals there...
Vol. 37 • November 2004 • No. 9
