It often has been said that hospitals are the most dangerous places for sick people. Hospital acquired infections–also known as healthcare-associated infections (HAIs)–present a genuine health risk to patients, leading to prolonged hospitalizations and higher rates of morbidity and mortality. Working from data in a survey published this year in the New England Journal of Medicine, the Centers for Disease Control report that “on any given day, about 1 in 25 hospital patients has at least one healthcare-associated infection.” In 2001, the last year data was available there were about 722,000 HAIs in acute care hospitals in the United States. And of these cases, about 75,000 patients died from their infections.
Recently, the US Department of Health and Human Services established a plan called Healthy People 2020, whose goal is to “[p]revent, reduce, and ultimately eliminate healthcare-associated infections.” The Healthy People web site also points out that while HAIs are “among the leading causes of preventable deaths in the United States,” they are also “associated with a substantial increase in healthcare costs each year.” What is so frustrating about these infections and their tragic effects is how preventable they are.
The government claims that simply implementing the practices already in place (but are often overlooked) in hospitals could lead to a 70 percent reduction in certain HAIs, the most common are catheter-associated urinary tract infections, surgical site infections, bloodstream infections, and pneumonia. Of course, cases like these are often accidental, but the fact that about 400,000 people die every year due to hospital error makes the issue all the more urgent.
The most recent survey of HAIs, published (as mentioned above) in the New England Journal of Medicine, observes that the most commonly reported pathogen in such cases is Clostridium difficile, which causes flu-like symptoms including diarrhea and kills about 14,000 Americans every year. What makes this bacterium so dangerous is that it often attacks during courses of antibiotics, which are being prescribed at ever-higher rates. On top of this, the symptoms triggered by C. diff are often treated with antibiotics, meaning that patients may become more vulnerable to the pathogen while they are seeking treatment for the damage it has caused. This leads to infections that return in about 20 percent of cases, which often means additional hospital stays. Unfortunately, the high mortality rate linked with C. diffis often due to the fact that doctors treat any flu-like symptoms with antibiotics.
One solution to this problem, which this blog has covered before, is increased hospital transparency. The most popular has been a report card-style grading system in which hospitals are assigned letter grades based upon both publicly-available safety records and patient-written reviews. This bears some likeness to sanitation scores on restaurants in big cities, which has been credited with reducing food poisoning cases in both New York and Los Angeles over the past five to ten years. This project has been undertaken by a group called Leapfrog, but its sample size is still limited–about thirty percent of existing registered hospitals are included.
Again, HAIs are incredibly dangerous, and unfortunately they are often underreported and preventable.