The problem:

Over the last few years, public attention has been focused increasingly on the problem of nosocomial or hospital acquired infections (HAI’s). Why is there so much concern? A study by the CDC published in the March/April 2007 issue of the journal Public Health Reports, estimated that 1.7 million hospital patients per year ― 4.5 of every 100 admissions ― become infected, causing or contributing to the deaths of nearly 100,000 people per year. (IHI.org) 100,000 people per year is about 1/5 of the total deaths from cancer per year in the US, or about the same as the total stroke or accidental deaths. Or, another way to understand the size of this number, picture the population of South Bend Indiana, dying every year of mostly preventable causes. This is an epidemic.

Hospital acquired infections may be the sixth leading cause of death, but many people do survive, only to experience long, difficult recoveries, sometimes with devastating surgeries, or permanent disability. Each time a patient becomes infected it adds an average of $30,000.00 to the charges for their hospital stay, money that is no longer reimbursed by Medicare. So it is not surprising that there are many initiatives seeking to reduce the incidence of these infections.

Burn patients, patients who are on ventilators, certain types of surgery patient particularly those with diabetes, and patients with a central line inserted are most likely to get these types of infections, but they are an increasing problem for all sorts of patients. In 2008, the US Government Accounting Office issued several reports calling for a greater role for the Department of Health and Human Services to obtain reliable data on HAI’s from inpatient settings and outpatient procedures and to prioritize prevention practices. Link and Link

What works to prevent these infections?

Researchers are working to find effective means of reducing the incidence of nosocomial infections. Some of the best practices coming out of recent studies include

  • Following the infection control policies already in place, like washing hands, improper sterilization of equipment, etc.
  • The incidence of ventilator associated pneumonia (VAP) can be reduced by 50% if patients’ teeth are brushed 3 times a day, even if they are unconscious. Link
  • Bathing intensive care patients daily with antibacterial (chlorhexidine) reduces catheter-associated bloodstream infections. Link
  • Performing laparoscopic surgery instead of open incision procedures Link
  • All the little places we touch without thinking: pens, paper, wristwatches, doctor’s white coats, sink taps, bed rails, etc. have to be looked at as sources of cross-contamination.

But some of the changes that would help the most are very difficult to accomplish. These involve changing the physical configuration of hospitals and health care settings. Research suggests that single-patient rooms can reduce infection rates up to 45%. This can require new building or expensive remodelling. Or, simply halving the bed space in a given unit. I’ve seen this done in some facilities, where they appear to have decided after the fact and given each patient a really big room. In some older hospitals, handwashing sinks are located far from the patients, so staff either wash less than they should or use the patient bathroom, a source of contamination. Clean wheelchairs, walkers and canes must be stored apart from used supplies – this requires more space. Link

The American Institute of Architects’ 2006 Guidelines for Design and Construction of Health Care Facilities lists Single-bed rooms as the minimum standard for typical nursing units in general hospitals, based on US federal guidelines. Link

 

Initiatives currently underway

  • The IHI has targeted some types of infections for zeroing out. They are focusing on infections that can be reduced by following evidence-based procedures or by simply not violating the policies that are already in place. IHI.org
  • The Department of Health and Human Services has made it a national priority to increase transparency of healthcare so consumers can make informed decisions. This means better reporting about quality of care. Link
  • A conference on Healthcare Transparency and Patient Advocacy will be held in Lexington, Kentucky on November 20, 2009. According to this article, a key goal of the conference is to make information on hospital-acquired infections more widely available to the public.
  • At least 22 states have enacted laws requiring public disclosure of hospital acquired infections. A good summary of the current laws is available on AboutHealthTransparency.org. Link
  • A few of the new hospital buildings being built with all or mostly private rooms:
    • St. Mary Medical Center in Long Beach, CA Link
    • Rockingham Memorial Hospital Link
    • Medicare Hospital-Acquired Conditions Initiative Link
    • Dublin Methodist Hospital, near Columbus, Ohio Link
    • Simi Valley Hospital, Simi Valley, CA Link
    • Children’s Hospital, Pittsburgh, PA Link
    • Kaiser Permanente’s new Santa Clara hospital Link
    • Mayo Eugenio Litta Children’s Hospital in Scottsdale, Arizona Link
    • Henry Ford West Bloomfield Hospital in Michigan Link

The public transparency initiatives will probably do the most to accelerate progress, along with hospital’s new understanding of the savings possible when infections are reduced.