Hospitals: Come Clean

by Michael Koskoff
The Hartford Courant

October 24, 2007

A patient who enters a hospital for a routine procedure should not have to face risks that may be as high as those for soldiers in a war zone, but that is just what is happening.

A new report by doctors at the Centers for Disease Control shows that Americans entering medical facilities are at significant risk of contracting deadly hospital-acquired infections, known as HAIs. According to the new study, one of the most virulent of the killer bugs – a drug-resistant germ called methicillin-resistant staphylococcus aureus – is sweeping hospitals, nursing homes and other health care facilities throughout the nation.

According to Journal of the American Medical Association, nearly 19,000 people died in the United States in 2005 from MRSA. A total of 94,000 became infected from the lethal bug. The mortality rate is double the rate researchers had previously associated with these infections – infections generally contracted while hospitalized for unrelated medical issues.

Some studies put the risk of death from all hospital-acquired infections at 100,000 per year. That is more than the annual number of deaths associated with HIV/AIDS, Parkinson’s disease, emphysema or homicide.

Worse than this alarming mortality rate is the sad fact these deadly infections could have been prevented. Medicare is threatening to withhold payments to hospitals for treatment of these infections because it considers them “preventable.” To prove the point, a hospital in Pittsburgh reduced its surgical infection rate by an impressive 78 percent. Likewise, hospitals in Scandinavian countries have eliminated hospital-acquired infections almost completely.

What have they done?

Hospitals with proven infection reduction rates screen all health care workers and high-risk patients with nasal swabs on admission to the hospital. Those infected with harmful bacteria are treated in separate areas of the hospital so as not to infect other patients. All surfaces are tested and scrubbed routinely. Instruments such as blood pressure cuffs are discarded after use. Hospital personnel wear gloves and gowns as the norm.

These hospitals also strictly enforce basic hygiene procedures. Astonishingly, one of the most obvious practices – thorough hand washing – is not practiced routinely in many medical facilities, despite the requirements. These rules must be strictly enforced.

What can patients do?

Based on our experience with patients contracting infections at medical facilities, these eight steps seem obvious:

• Request a nasal swab and culture on admission to a medical facility.
• Know your risks. Ask the hospital about recent infection outbreaks. (The pre-admission and surgical consent forms you must sign will mention the risk of infection, so you should demand more information and make a note on the form if it is not provided.)
• Insist, in advance, that all health care workers wash hands before treatment (use of gloves is not enough).
• Insist on an antiseptic shower before surgery.
• Be aware of your hospital environment and sanitation procedures. Speak up if something doesn’t seem right.
• Avoid unnecessary invasive procedures – ask about available alternatives.
• Ask your doctor about potential immunity problems resulting from overuse of antibiotics.
• Report any outbreak you know about to the state health department.

With a deadly outbreak such as MRSA, it is clear that more stringent enforcement is needed. The primary responsibility rests with the hospitals of our state that have allowed these bacteria to fulminate for years without enforcing adequate control measures.

To police the hospitals, the Connecticut Health Department should to be given the enforcement power and resources it needs. Besides heroic efforts by the state health commissioner, his staff and new Connecticut laws requiring the reporting of hospital infection rates, the health department needs adequate funding.

The shroud of secrecy over hospital infection rates must finally be lifted as patients entering the hospital each day put their lives on the line. Provisions of the new law requiring public disclosure of these rates must be implemented – now. Every patient is entitled to the option of avoiding a hospital with a high rate of infection. Mandatory public reporting is also an effective way to encourage hospitals to implement diligent prevention measures.

Lastly, the “right to a clean environment” should be added to the Connecticut Patients’ Bill of Rights, and applied to all patients in Connecticut hospitals and nursing homes.

Patients and their families should not have to accept war zone risk simply by walking through the doors of a hospital.

Michael Koskoff is an attorney with the Bridgeport and New Haven law firm of Koskoff, Koskoff & Bieder. The firm has represented dozens of people with hospital-acquired infections.