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Hospital-Acquired Infections Can Kill

Report details mistakes that led to death of patient

MONDAY, Oct. 14, 2002 (HealthDayNews) -- Hospitals are supposed to heal, not kill.

But that's exactly what happened to an elderly man undergoing elective surgery who died after falling ill with two hospital-acquired infections.

Although the man was very sick before he was admitted -- he had metastatic lung cancer -- the hospital may have made mistakes that led to his dying sooner rather than later.

The case is profiled in the October issue of the Annals of Internal Medicine as part of its continuing series on medical errors that might have been avoided. The series was prompted by a 1999 Institute of Medicine report that said studies showed that between 44,000 and 98,000 Americans die each year because of mistakes by medical professionals in hospitals.

The story of the man's death also illustrates the mounting problem of hospital-acquired -- or nosocomial -- infections. The study's lead author, Dr. Julie Gerberding, was recently named head of the U.S. Centers for Disease Control and Prevention (CDC).

According to the Institute of Medicine report, the most common type of errors involve medications. But infections are the most serious, resulting in greater suffering and economic costs.

"The big question being dealt with here is much bigger than it appears. The greatest majority of ill effects is through causing infections," says Dr. Robert W. Haley, a professor of internal medicine and chief of epidemiology at the University of Texas Southwestern Medical Center in Dallas.

"They affect anywhere from 2 to 10 percent of hospital patients, which is a huge number, and they have very great cost. The average cost now of bacteremia [bacteria in the blood] is over $10,000," he says.

The 78-year-old man profiled in the new article fell prey to the two most common hospital-acquired infections: a urinary tract infection and pneumonia.

The man had several risk factors, yet hospital staffers waited a full 24 hours after the onset of a fever before starting antimicrobial therapy. The delay may have cost the man his life.

The tools to control hospital infections are out there but they're not used enough, Haley says.

The business community has long used a set of quality-control measures developed by W. Edwards Deming that was credited with turning around Japanese industry after World War II.

"He formulated a huge body of very useful techniques for controlling errors on assembly lines," says Haley, who spent 10 years as head of the CDC's hospital infections program. "That body of information has been applied to the medical errors field and, by proxy, to the hospital infections field. However, it is not clear what of that is really useful for reducing infections."

Probably more useful are various techniques that were studied by the CDC in the 1980s that led to a set of recommendations.

"They took a random sample of U.S. hospitals, some of which had started infection-control programs and some of which hadn't. And they looked at what happened over five years among hospitals that had implemented infection-control programs and those that had not implemented such programs," says Haley, who was involved with the project. "They found that certain types of activities in an infectious-control program were associated with falling infection rates and others were not."

On average, the CDC study showed a 32 percent reduction in serious hospital-acquired infections. Some hospitals experienced a much greater reduction.

What were the components of the successful programs?

First was having an ongoing program to monitor the rates of the most important types of infections to know if the rates were going up or down. For the past 30 years, the CDC has had a benchmarking program. About 70 hospitals routinely report their infection rates so other hospitals can make comparisons. It sounds straightforward, but only a tiny minority of hospitals are doing this.

"This hospital [profiled in the article] is more typical than we would like to think," Haley says. "The majority of U.S. hospitals do not have effective infection-control programs."

Thanks to shrinking profit margins, many hospitals feel they can't afford these controls. The most expensive component of any infection-control system is the personnel.

"You have to have one infection-control practitioner for every 200 beds," Haley says. "It's the only quality improvement practice that has been proven to be effective, but it's a highly developed epidemiologic activity. It's not just coming around collecting data."

And that costs money.

The latest article suggests that in addition to these techniques, some quality-control measures advocated by business groups might apply to a hospital setting, such as "root-cause analysis," for instance. Infections that result in death could be reviewed by local infection-control teams, regardless of the hospital's overall infection rates.

"Mainly, we need to be benchmarking infection rates," Haley says. "I would be surprised if 25 to 30 percent of hospitals are doing it, and it has been proven to reduce things by about one-third."

What To Do

For more information on medical errors, including a link to the Institute of Medicine report, visit the Agency for Healthcare Research and Quality. For more on hospital-acquired infections, check the U.S. Centers for Disease Control and Prevention.

SOURCES: Robert W. Haley, M.D., professor, internal medicine, and chief, epidemiology, University of Texas Southwestern Medical Center, Dallas; October 2002 Annals of Internal Medicine
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