Hospitals cut medicine tube infections in study

[ERD50]

Some basic hygiene reduced infection rates to zero - they say there are 28,000 deaths/year attributed to this.

All this modern technology and knowledge, and it seems doctors/hospitals are forgetting what was learned in the late 1800's.

So, how do I find out about a hospital's or doctor's infection rates before I put myself in their care? I find it very scary that someone can go in for a relatively simple procedure, and die from complications because someone did not wash their hands.

-ERD50

full article here at (today.reuters.co.uk .......)
http://tinyurl.com/yb5tmw

Hospitals cut medicine tube infections in study Wed Dec 27, 2006 10:21 PM GMT19 By Gene Emery

BOSTON (Reuters) - Hospitals in Michigan nearly eliminated often-deadly infections involving tubes that deliver fluids and medicine to patients by stressing better hygiene and other preventive steps, a U.S. study showed.

The catheters cause about 80,000 bloodstream infections per year in the United States, infections so serious that up to 28,000 of the patients die. Fighting the infections costs about $2.3 billion annually.

Hoping to reverse that trend, 108 intensive care units in the state of Michigan joined a project launched in October 2003 that included procedures designed to reduce infection -- from better hand-washing to special cleaning and insertion procedures to removing unnecessary catheters when possible.

At the start of the study, there were 27 infections for every 10,000 days a catheter was in place, said the team led by Peter Pronovost of Johns Hopkins University in Baltimore.

After three months, the rate had dropped to zero. It stayed that low for the remaining 15 months of the study.

"All types of participating hospitals realized a similar improvement," the researchers said in the study to be published in Thursday's New England Journal of Medicine.

The decline was described as "remarkable" in a Journal editorial by Richard Wenzel and Michael Edmond of Virginia Commonwealth University.

They said the techniques should be embraced by all hospitals, which tend to adopt safety practices in a scattershot manner.

"We can no longer accept the variations in safety culture, behavior or systems of practice that have plagued medical care for decades," they said. "Imagine the effect if all 6,000 acute care hospitals in the United States were to show a similar commitment and discipline."

[Brat]

Once antibiotics became commonplace I think everyone became complacent. When I started school in the early 40s hygiene was a common lecture from parents and teachers. There were hand sinks in classrooms, for example.

Catheter placement wasn't obvious, at least to me. Removing it as early as possible is counter-intuitive for those who worry about administering meds.

The problem solving process is important and can be used in many settings.

[Meadbh]

ERD50, you have brought up a very important subject. Hosptialized patients are sicker nowadays and they have far more foreign bodies in them (central IV lines, ventilator tubes, etc). They are also being treated with multiple antibiotics, which encourage resistant bugs. Hence the rise of MRSA (multiple resistant staph aureus) and VRE (vancomycin resistant enterococcus). While "nosocomial" infections (those acquired in hospital) are not completely preventable, there are many opportunities for improvement and there is a real need to properly implement the basic tenets of infection control.

There is no universal requirement for hospitals to publish their own infection data. What you will find, in scientific papers and in presentations at forums like IHI (see below) are data from specific centres on specific populations of patients. Because the susceptibility to hospital acquired infections is quite different in (say) 35 year old truckdrivers versus 26 week premature infants versus 80 year old patients having colonic resection, we have to compare apples with apples.

Benchmarking one doctor against another is also prone to fallacy, unless you are looking at a specific surgical procedure performed without much associated hospital care. We know, for instance, that giving antibiotics just prior to opening the abdomen reduces the chances of a wound infection. But for a complex patient in intensive care, who may or may not have had a surgical operation, the factors that will reduce infection rates include whether the nurse elevates the head of the bed, whether the patient is weaned from sedation and ventilation daily, whether everybody who comes in washes their hands properly and/or uses hand cleansers, the distance between beds, which antibiotics are used, the patient's age, immune status, nutritional status, etc, etc. So there are many "system" factors at play. We have discovered that packages or "bundles" of interventions, such as the central line bundles shown on the CPSI website below, are key in preventing such infections.

The good news is that intensivists like myself actually do "get it" and we are working collaboratively to raise the bar against these infections. With considerable success, I might add. There are now multiple collaboratives of intensive care units involving hospitals across the US and Canada all working together on this problem. I'm heavily involved. And our efforts are paying off.

So what can you do, as a patient, to protect yourself?

Ask your doctor or health system whether it is involved in the IHI's 100,000 lives campaign or the new 5 million harms campaign, or, if you are in Canada, the Safer Healthcare Now! campaign. Ask what measures they are taking to prevent infections. Put pressure on them!!! When you visit the hospital, look out for bottles of hand cleanser, use them yourself, and watch how many staff do also. If they don't wash their hands before and after giving you care, politely request that they do. Read before you need admission and be prepared to ask about the antibiotics you will receive before surgery, what they will do to prevent infection in your central line, and how you will be mobilized quickly.

And make sure you get out of the hospital as fast as possible once you are at the convalescent stage. You are much safer at home!

Here are some relevant websites:

From the Centers for Disease Control:

http://www.cdc.gov/ncidod/eid/vol7no2/wenzel.htm

http://www.cdc.gov/ncidod/dhqp/nnis_pubs.html

From the Institute of Healthcare Improvement:
http://www.ihi.org/IHI/Programs/Coll...Infections.htm

From the Canadian Patient Safety Institute:
http://www.saferhealthcarenow.ca/Def...&contentId=184

[Rich_in_Tampa]

What Meadbh said.

Generally, hospital-based physicians such as intensive care specialists, hospitalists, and most surgeons are pretty attentive to the procedures which are advised. Where I work, probably half the patients I see are immunosuppressed. Handwashing is a life and death process.

[ERD50]

Thanks Meadbh and Rich. I saved that post and will check the links later. A wealth of info there.

thanks again - ERD50

[mykidslovedogs]

I know someone who came down with a staph infection after having a relatively, what was supposed to be simple, procedure to correct a hiatal hernia. One of the hospital staff mistakenly fed him eggs while he was still under mild sedation and very HUNGRY after the surgery. He wasn't supposed to eat for a certain period in time after the surgery. He was hospitalized for months, costing the insurance carrier over $1 million.

He is now almost recovered, after near death and two years of treatment.

I don't know the actual statistics, but I have heard that staph infections happen quite often and they are obviously very costly.

Just think how simple hygiene could cut healthcare costs by millions.

[Nords]

Originally Posted by Rich_in_Tampa

Generally, hospital-based physicians such as intensive care specialists, hospitalists, and most surgeons are pretty attentive to the procedures which are advised. Where I work, probably half the patients I see are immunosuppressed. Handwashing is a life and death process.

And it's the best way to keep their hands & stethoscopes freezing cold!

[Rich_in_Tampa]

Originally Posted by Nords

And it's the best way to keep their hands & stethoscopes freezing cold!

Secret's out, I guess.