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Special Report
By Joyce Howard
Price
THE
February 25, 2007
Hospital patients
in the
These infections, many of which are drug-resistant, affect one in 20 patients
-- or about 2 million people -- each year, according to the Centers for Disease
Control and Prevention (CDC). Hospital infections are the eighth-leading cause
of death in the
Johanna Daly, 63,
of
"She walked
into the hospital as a healthy, beautiful woman. But she wound up there as a
quadriplegic on a ventilator. How could this happen?" asked her daughter,
Maureen Daly.
Mrs. Daly was a
victim of methicillin-resistant Staphylococcus aureus (MRSA), a particularly dangerous drug-resistant
bacterium.
The CDC estimates
there are more than 126,000 MRSA infections each year in
Mrs. Daly was
released from the hospital five days after her Jan. 20, 2004, surgery. But she
returned in mid-February "in great pain," Maureen Daly said.
"When the doctor opened the wound, he became alarmed, as all this
horrible, rotten-smelling pus came pouring out."
Maureen Daly
worried that her mother might lose her arm. But the surgeons in the hospital's
emergency room were much more concerned: They told Maureen Daly her mother's
life was in danger.
"They cut open her arm without anesthesia, explaining they could not
wait," Maureen Daly said. "I held her down, and the two of us became
covered in that horrible, foul-smelling liquid."
Maureen Daly said
she left the hospital after the second surgery, but returned after receiving a
call that her mother had been put on a ventilator and had a temperature higher
than 106 degrees Fahrenheit.
When her daughter
next saw her, Mrs. Daly was unable to move any part of her body except her
head. She remained in that condition -- on a ventilator and a feeding tube --
until her death on May 23, 2004.
"I never
could have dreamt something like this would happen ... it was so pitiful,"
Maureen Daly said.
The family
thought about suing the hospital, but Maureen Daly said it was not possible
because infection was listed as a risk that the family accepted in authorizing
Mrs. Daly's surgery. It is a common predicament faced by those contemplating
litigation.
The Hospital for
Joint Diseases did not respond to requests for comment on the Daly case.
Promoting
change
The AARP, the
nation's largest advocacy group for seniors, addressed the issue of hospital
infections in its January newsletter. The group's bulletin, titled "Dirty
Hospitals," examined why 90,000 Americans die each year from the
infections and offered tips on how to avoid them.
The elderly are
especially susceptible to hospital infections because "they go to the
hospital more and stay there longer" and may have weaker immune systems,
said Lisa McGiffert, head of the Stop Hospital
Infections campaign at Consumers Union. But she stressed that patient fragility
and vulnerability do not excuse exposure to hospital germs, which should not
happen.
The 54,500-member
American Hospital Association (AHA) also recognizes that infections pose a huge
problem.
"It's
absolutely clear from all the information we have that we are struggling
against the enemy of infections and that the bugs are getting stronger all the
time," said Nancy Foster, AHA's vice president
for quality and patient safety.
Betsy McCaughey, a health-policy analyst and former lieutenant
governor of
"Almost all
infections are preventable. We've worked with hospitals that have reduced
infections by 90 percent," said Mrs. McCaughey,
founder and chairwoman of the nonprofit Committee to Reduce Infection Deaths
(RID).
Changing
attitudes
Patient advocates
say that, for too long, hospitals were reluctant to disturb the status quo,
insisting that the infections were inevitable.
"That was
the prevailing attitude three years ago when our group started, but the culture
is changing," Ms. McGiffert said. "Our goal
is to get infections down to zero, and some hospitals are saying that is also
what they want."
One reason for
the change in attitude, she said, "is that there are public reporting laws
in 45 states." Previously, many hospitals kept such information private.
Ms. McGiffert said her organization has "heard from more
than 1,700 people [across the country] who have shared their stories"
about infections they contracted during hospital stays or about deaths of loved
ones that followed hospital infections.
Similarly, Mrs. McCaughey said her group gets "hundreds of e-mails
every day" about new infection cases.
"Every day,
patients are rescued from the brink of death by medical miracles and marvels.
But too many hospitals practice first-class medicine, but third-rate
hygiene," she said.
Mrs. McCaughey addressed this contradiction in an opinion piece
published Feb. 3 in the Los Angeles Times.
In the
commentary, she noted that CDC data show "astoundingly, over half the
time, physicians and other caregivers break the most fundamental rule of
hygiene by failing to clean their hands before treating patients."
The rise of
antibiotics
Mrs. McCaughey said the sharp rise in drug-resistant bacteria
correlates with a liberal use of antibiotics that began in the early 1970s.
Pointing out that bacteria "are largely spread through touch,"
she noted that doctors and nurses were once trained not to touch doorknobs,
cabinets, curtains and blood-pressure cuffs once they scrubbed their hands or
put medical gloves on. But Mrs. McCaughey said
medical personnel seemed to forget the need for strict hygiene as the use of
antibiotics increased.
"We rely on
technology to save lives, but sometimes this causes the system to forget the
basics," Ms. McGiffert said.
Ms. Foster said
the AHA offers a program "to help clinicians know when to use
antibiotics" in order to help prevent overuse. They need to know there is
a "narrow window," she said.
The Department of
Health and Human Services agrees.
"Taking
antibiotics for more than 24 hours after routine surgery is usually not
necessary and can increase the risk of side effects, such as stomach aches,
serious diarrhea and antibiotic resistance," it says on its Web site.
Hospital-acquired
infections invariably delay a patient's recovery, often requiring many weeks of
intravenous antibiotics or repeated surgeries to remove infected tissues.
'Wrong one'
Marcia Litov, 68, of
Mrs. Litov underwent a back-fusion surgery at
On the fourth day
of her hospital stay, Mrs. Litov said, she
"experienced pain starting from my abdomen and going around to my
back." She was slated to be released the next day, but asked that she
remain in the hospital until the source of the pain was determined.
Instead, Mrs. Litov was sent home the following day. Within 24 hours, the
pain became worse and she had a fever of 103 degrees Fahrenheit.
She called her
doctor, who told her to return to the hospital immediately. Mrs. Litov met with an infectious-disease specialist, who opened
her surgical wound, washed the area and took cultures. Mrs. Litov
says she was given an antibiotic before the strain of bacteria was identified,
which she says was the "wrong one."
Doctors
discovered that Mrs. Litov had a staph
infection, and it was "moving too close to the hardware from the back
fusion," so the hardware was removed, she said.
Mrs. Litov faced weeks of daily intravenous therapy at the
hospital, in a nursing facility and at home. After six weeks at home, she
"was very ill" and returned to the hospital.
"They found
... that I still had infection encapsulated in front of my spine," she
said.
After another
surgery, Mrs. Litov stayed at a nursing facility
until the end of May, where she took a daily regimen of antibiotics. By then,
she said, the infection was "cleared up, and they operated on me once more
to replace the hardware."
But more
infections followed, Mrs. Litov said. She said she
underwent "a total of nine operations," continuing until August 2004.
She also said she "suffered a lot of muscle deterioration," which
left her using a cane or a walker.
Of the Litov case, Debra Schindler, a spokeswoman for Union
Memorial, said: "In complex surgical cases, particularly of the spine,
patients are made aware that there remains a remote risk of infection. Union
Memorial has an excellent track record in managing that risk with data below
the national benchmark for hospital-acquired infections.
"But even
when the most intense efforts to eliminate the risk of infection are employed,
there are incidents, where various factors, when brought together, make it
possible for infection to occur. We regret the suffering Mrs. Litov endured as a result."
Increasing
awareness
CDC data on the
prevalence of hospital infections -- both for the nation and for individual
states -- were last published nearly a decade ago. The non-random sample of 270
hospitals showed that the infection rate climbed 36 percent between 1975 and
1996.
But it said
tracking infection sites was difficult because postoperative stays were often
shorter than the incubation period for Staphylococcus aureus
infections.
Late last year,
The mortality
rate for patients with hospital infections was nearly 13 percent. That compared
with a rate of 2.3 percent for patients without a hospital-acquired infection.
Ms. Griffin of
IHI said most of the nation's hospitals are participating in initiatives the
group has sponsored that are designed to prevent "unnecessary deaths and
harm in hospitals."
"Awareness
is increasing, but reporting is just beginning," Mrs. McCaughey
said. "Meanwhile, these infections are adding $30.5 billion to the
nation's health tab."
Copyright
2007 The 
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