The Disturbing Truth About Doctors and Your Medical Safety (AlterNet)

[marmar]

The Disturbing Truth About Doctors and Your Medical Safety

By Atul Gawande, AlterNet. Posted May 18, 2007.



One of the easiest ways to prevent the spread of hospital infections is also one of the most neglected.

One ordinary December day, I took a tour of my hospital with Deborah Yokoe, an infectious disease specialist, and Susan Marino, a microbiologist. They work in our hospital's infection-control unit. Their full-time job, and that of three others in the unit, is to stop the spread of infection in the hospital. This is not flashy work, and they are not flashy people. Yokoe is forty-five years old, gentle voiced, and dimpled. She wears sneakers at work. Marino is in her fifties and reserved by nature. But they have coped with influenza epidemics, Legionnaires' disease, fatal bacterial meningitis, and, just a few months before, a case that, according to the patient's brain-biopsy results, might have been Creutzfeld-Jakob disease -- a nightmare, not only because it is incurable and fatal but also because the infectious agent that causes it, known as a prion, cannot be killed by usual heat-sterilization procedures.

By the time the results came back, the neurosurgeon's brain-biopsy instruments might have transferred the disease to other patients, but infection-control team members tracked the instruments down in time and had them chemically sterilized. Yokoe and Marino have seen measles, the plague, and rabbit fever (which is caused by a bacterium that is extraordinarily contagious in hospital laboratories and feared as a bioterrorist weapon). They once instigated a nationwide recall of frozen strawberries, having traced a hepatitis A outbreak to a batch served at an ice cream social. Recently at large in the hospital, they told me, have been a rotavirus, a Norwalk virus, several strains of Pseudomonas bacteria, a superresistant Klebsiella, and the ubiquitous scourges of modern hospitals -- resistant Staphylococcus aureus and Enterococcus faecalis, which are a frequent cause of pneumonias, wound infections, and bloodstream infections.

Each year, according to the U.S. Centers for Disease Control, two million Americans acquire an infection while they are in the hospital. Ninety thousand die of that infection. The hardest part of the infection-control team's job, Yokoe says, is not coping with the variety of contagions they encounter or the panic that sometimes occurs among patients and staff. Instead, their greatest difficulty is getting clinicians like me to do the one thing that consistently halts the spread of infections: wash our hands.

There isn't much they haven't tried. Walking about the surgical floors where I admit my patients, Yokoe and Marino showed me the admonishing signs they have posted, the sinks they have repositioned, the new ones they have installed. They have made some sinks automated. They have bought special five-thousand-dollar "precaution carts" that store everything for washing up, gloving, and gowning in one ergonomic, portable, and aesthetically pleasing package. They have given away free movie tickets to the hospital units with the best compliance. They have issued hygiene report cards. Yet still, we have not mended our ways. Our hospital's statistics show what studies everywhere else have shown -- that we doctors and nurses wash our hands one-third to one-half as often as we are supposed to. Having shaken hands with a sniffling patient, pulled a sticky dressing off someone's wound, pressed a stethoscope against a sweating chest, most of us do little more than wipe our hands on our white coats and move on -- to see the next patient, to scribble a note in the chart, to grab some lunch.

...(snip)...

Rising infection rates from superresistant bacteria have become the norm around the world. The first outbreak of VRE did not occur until 1988, when a renal dialysis unit in England became infested. By 1990, the bacteria had been carried abroad, and four in one thousand American ICU patients had become infected. By 1997, a stunning 23 percent of ICU patients were infected. When the virus for SARS -- severe acute respiratory syndrome -- appeared in China in 2003 and spread within weeks to almost ten thousand people in two dozen countries across the world (10 percent of whom were killed), the primary vector for transmission was the hands of health care workers. What will happen if (or rather, when) an even more dangerous organism appears -- avian flu, say, or a new, more virulent bacteria? "It will be a disaster," Yokoe says. .....(more)

The complete piece is at: http://www.alternet.org/healthwellness/51949/?page=1

[jilln]

1. I thought surgical instruments were disposable these days

There's no excuse for not sterilizing everything properly for any kind of infection.

[riverwalker]

2. it's getting worse

To cut costs and improve profit,our hospital recently implemented a draconian campaign to stop nurses from calling in sick. It seems insane for a hospital to demand nurses crawl out a sick bed, come to work ill and spread disease to their patients, just so the hospital can save a few bucks. I'm talking about discipline for 3 or 4 absences per year for people who spend their days in the vomit, feces and blood of infectious disease for a living.
Maybe before entering any hospital, ask the board of trustees or the CEO if their nurses are punished and penalized if they call in sick.

[mnhtnbb]

3. A local hospital in Raleigh had this sign on its doors in mid-April:

Please do not visit our patients if you have a fever, cough, or diarrhea.


My 80 some year old uncle had back surgery in Los Angeles last year.
The surgery was a success and he was pain free. However, the wound
was leaking, and he went back a couple of times for dressing changes.
By the the third visit, he'd developed an infection. He spent
2 weeks in the hospital on IV antibiotics, and it was 6 months before
the wound finally healed. Although the original back pain was gone,
the pain from the infected wound was worse.

My uncle became a statistic for that hospital's infection control.