Preventing hospital infections would save lives—and billions

According to the Washington Post, the hospital industry is expected to announce a deal with the Obama Administration today to reduce health care spending by nearly $155 billion as part of a national health reform package. Hospital groups, including American Hospital Association, the Federation of American Hospitals and the Catholic Health Association, have reportedly agreed to smaller payments for Medicare and Medicaid services, and less reimbursement for caring for the uninsured, if and when health reform is enacted.

So far, however, health care reform proposals have not sufficiently addressed a key aspect that would save money and the lives of thousands of patients: Preventing hospital infections. On that note, our own Bill Vaughan, policy analyst for Consumers Union issued the following statement about the deal:

While the expected pledge by hospitals is a step in the right direction, there is a more important pledge patients and consumers need from our hospitals: stop the preventable deaths of 100,000 people a year from hospital acquired infections. According to the Centers for Disease Control, the cost of treating these infections is about $35-$45 billion per year. If even half of this spending was avoided, in over ten years we would have more than the amount of money in this deal.

In their spring letter to the White House pledging savings, the hospital industry said it would do more to fight infection. Today we have no proof that those pledges will result in fewer deaths and injuries. American consumers need to know which hospitals are doing a good job and which are just giving lip service. National health reform should include the public reporting of all hospital infection rates. That is the only way to ensure that the pledges become reality.

An American dies every 5 minutes from a largely preventable infection acquired in a hospital setting. That is the equivalent to a jumbo jet crashing every other day. If we had those kinds of casualties in airplanes every day, either people wouldn’t fly or we would be working on air safety 24 hours a day.

Yet each day these preventable deaths and other life-long injuries continue in our hospitals. We know that these infections are largely preventable—but for too many hospitals, it continues to be business as usual. These deaths, injuries, and wasted billions can be almost totally prevented.

It’s important that hospitals are pledging to save money, but today they should also pledge to save lives. We need to end infection, publicly report on each institution’s infection rate, and save about $40 billion a year in reduced costs of treating infections.

—Kevin McCarthy, associate editor

Learn more about Consumers Union’s efforts to prevent hospital infections and medical errors through the Safe Patient Project, and sign the petition to help make medical errors public. And we'd like to hear from you: Have you or a loved one been harmed by a costly hospital error or infection?

Comments

[Health care pro]

It's called oversight...bosses...supervisors. We need people in the profession to oversee and make sure Nurses, doctors, techs, cnas, any direct patient contact personnel do their job. Wash your hands, use universal precautions, ditch the lackadaisical attitudes, and most importantly - Stop wearing scrubs outside of the facility. Direct patient care personnel should be wearing paper scrubs between patients and not wearing hospital garments outside of the hospital for fashion sense.

[Scott]

Dog Saliva. This is a preventive measure for MRSA...Have you ever seen or heard of a cute little pup with MRSA.

Fight bacteria naturally.
Lets bugs eat bugs...I'm just saying.

[Luke]

Hmm.

Infection control is expensive, and hard to do.

The largest driver of medical cost inflation in the last 20 years has been the use of more and more disposable one-use sterile instruments, drapes, gloves and other equipment. The biggest factor pressing against better control measures at this point, is the consistent cost-cutting that Medicare and insurance companies demand - hands go unwashed and cleaning is incomplete in hospitals these days, because you can't physically do those things perfectly and constantly and see the number of patients required to make health care economics viable for providers. If we followed the proper hand washing regimen for each patient during rounds, we'd be there for 50% more time. If congress wants that improvement, they have to pay for it, rather than cutting the Medicare payments all the time and expecting people to just work it out. There is a tension there that we try to resolve, but it isn't easily resolved. Cheap care is the enemy of safety in many situations.

In a wider sense, further infection control measures at many institutions these days may involve initial quick improvements, to bring them in line with centers of excellence, but there is a threshold beyond which progress is hard to achieve, because it is massively disruptive. Real infection management that would be effective, would require separate rooms for patients as they entered the ED - no shared waiting space, no open ward space - with associated clean and sterile equipment, gloves, gowns, etc. Patients would need to have samples taken for cultures and then treated with full precautions until they could be cleared. Visitors should undergo chemical cleansing at point of entry and be masked, gloved and gowned too. We do it to protect our food in well-maintained meat factories - if we want the best in hospitals, this is what it looks like.

There is such a thing as community-acquired MRSA infection, and not wishing to cause undue distress, Alan, but it is just as possible that your father acquired it before he entered the hospital, or from a visitor, as the environment itself.

Even after all of that, your article discusses 'preventable infections', but what you mean is infection that is preventable (a) in healthy individuals, (b) with the hindsight that the patient is going to get infected. There are plenty of conditions that we can treat when we know about them, or in at-risk situations, but we can't protect against everything, all of the time. Can you imagine the cost and physiological complications of giving every patient a full range of anti-biotics/anti-virals/anti-fungals as they enter a medical environment?

Add to that the fact that by definition, there are sick people in a hospital, infection control will always be hard, and the most vulnerable among us will be in those hospitals, waiting to be infected by *something*.

To non-medical folks, you should know that it is not an acceptable assertion that infection as a cause of death means that preventing that infection will ultimately save the life of that patient. It just means that bacteria got there first. An ill patient with multi-system organ failure might be overcome by infection first, due to their vulnerability, but we can't stop infection and stop them from dying by that alone. Patients with HIV die of infection, but that's not the underlying cause of death. My grandmother's death certificate describes infection as the CoD, but she had many other problems that brought her to the hospital first, and it was evident that she wasn't going to leave.

Infection control is not cheap, is not easy, and if we could do easy things to save lives and make more money, every hospital in the country would be doing it.

"If we had those kinds of casualties in airplanes every day, either people wouldn’t fly or we would be working on air safety 24 hours a day."

It turns out, that we really are working on infection reduction and patient safety 24 hours a day. It's 9pm... I've been working since 7am on research on this topic, trying to introduce effective protocols to reduce post-operative wound infections, and I've got several more hours of work before I knock off and do it again tomorrow. Thousands of my colleagues nation-wide are doing the same thing, day-in, day-out. That's not to even mention the exceptional staff who spend their days actively enforcing, encouraging and facilitating best-practice standards in our hospitals.

Bill, Kevin - sensational short articles berating the wrong people and ignoring the complexity of the topic won't change the world, why not work with us and try to improve the situation?

[Sarah S.]

No one thing is going to prevent these kind of infections. I work at a large hospital, and I can tell you, it comes from a whole bunch of things: rooms not being cleaned as often or as thoroughly as needed, too much equipment going in and out without being cleaned off (or ideally disposable), people not washing their hands properly, and the patients' visitors not following the isolation precautions. For example, I have seen so many times patients with MRSA/VRE being discharged in the morning, the housekeeper doing a bare minimum cleaning (maybe wiping down the bed and mopping the floor), and leaving oxygen tubing or dressings in the room which get used on the next patient, meal trays and equipment being taken in and out of the rooms, bathrooms shared between isolation and non isolation patients. If they would invest in a housekeeping staff that was trained in infection control and people were held accountable for disinfecting things and washing their hands properly, I bet it would drop significantly.

[Lori Nerbonne]

It's refreshing to see such an accurate commentary on how hospitals have had misplaced financial priorities.

We are seeing cutbacks in staffing of infection-prevention professionals (according to infection control professional organizations like APIC) as hospitals are realizing reduced profits. This is short sighted and will only add to the precious lives and money lost.

Public reporting of infection rates for every U.S. healthcare facility will expose those hospital leaders and boards who are not investing in prevention efforts for infections and it will give healthcare consumers, public health departments, and even insurance companies the information they need to steer patients to higher quality facilities.

Lori Nerbonne, RN, BSN
NH Patient Voices
Bow, NH

[Scott]

MRSA is a distinctly unkind infection. It's fairly easy to make it not spread through hospitals simply by washing one's hands well and on a regular basis.

Just washing hands would save considerable amounts of money by preventing its spread.

[Alan]

I'm totally in favor. My father just passed away in February from MRSA. None of the hospitals of course would take any responsibility, each blaming the other.