A few months ago my grandmother fell down and broke her arm. (Before anyone asks, she is fine now. They set the bone and she was in a sling for a couple months, but fully recovered.) The day after she fell I went to visit her in the hospital. She was admitted to Yale New Haven hospital and was staying in a bed in one of their general wards, about six floors up from the main entrance. Yale New Haven has an excellent reputation and is regarded as the best hospital in the immediate area.
However, there is something that really struck me in a bad way upon visiting: it really seems the hospital could be doing a lot more to keep germs out. Upon entering, I came to a receptionist. She was barely paying attention, asked me to sign in and gave me a laminated pass (which I can only guess how many people had touched and how many rooms it had been to.) She didn’t look me over to see if I looked reasonably clean or even if I appeared queezy and feverish. I could have been coughing and had a runny nose and she probably would not have objected.
After getting the pass, I walked down the hall toward the elevators. Before getting on, I stopped in the mens room and spent several minutes scrubbing my hands and forearms. This was not required, of course, but there as a men’s room there so I figured it was a good idea. Unfortunately, the lavatory had an air-type hand dryer with a nasty looking button to start it. I pushed that with my elbow. Then I kicked the door open (because it had a door, as opposed to the kind of lavatory where the door is open and there is a turn going in to keep it private).
As I approached the elevator, I encountered the first sign that the hospital cared at all about germs: a station where alcohol-based hand sanitizer is dispensed. Depsite having washed my hands, I also used the hand sanitizer. Of course, this was not mandatory and I saw plenty of people walk by without using it. It seems it was little more than a suggestion, although a damn good one.
The elevator was operated with the standard grubby-looking plastic push button. One would think in this day and age, there would be a better way, like some kind of proximity sensor you wave your hand in front of, but apparently this had either not occurred to the hospital or was not a priority. The elevator, like all construction in the hospital, was made of the standard materials: rough plastic paneling, dry wall and so on. I think I would have felt a bit better if more things had been made of stainless steel or porcelain, which give bacteria nothing to cling to and are easy to clean, or, better yet, anti-microbial copper plated material.
Am I overreacting?
Obviously I’m not a doctor and perhaps I should bite my lip when it comes to such healthcare policy, but the fact of the matter is that hospitals are well known for being breeding grounds for infection. The term is nosocomial infection: infections developed by hospital patients (and sometimes staff) primarily due to the conditions within the hospital.
It’s not hard to see why this would be a problem. A hospital places a large number of people in a small area, many of whom have weakened immune systems or are already very sick. Many have been opened up for surgery and others use devices like respirators and catheters, which provide an easy way for bacteria to enter the body.
These infections can be even worse than those normally encountered in every day life. Because the same bacteria is prone to repeatedly infecting those receiving medical care, there is an extremely high incidence of antibiotic resistant bacteria. Indeed, some of the worst, most aggressive multi-antibiotic resistant bacteria strains seem to have initially evolved in hospitals or other healthcare facilities. Even those that are of relatively minor concern to healthy individuals can take root in the hospital system and become persistent problems, easily spreading from hospital to hospital as staff, patients and equipment is transferred.
Yes, it is a huge problem!
In the United States alone, close to one hundred thousand deaths occur per year as a direct or indirect result of nosocomial infection. More than a million and a half people are diagnosed with them, and while most survive, a nosocomial infection can turn an otherwise routine two day hospital visit into weeks of intensive care. Untold billions are spent on treating these infections per year. The problem is not just American, however, but exists in every industrial country. In many EU countries, upwards of ten percent of admitted patients will come down with some form of nosocomial infection. Even Switzerland, despite having a healthcare system often cited as one of the best in the world, has an extremely high rate of nosocomial infection, with upwards of 14% of hospital patients becoming infected.
Like so many problems in the healthcare field, nosocomial infections have far reaching effects on the system as a whole. Their expense drives up the cost of healthcare as a whole. When patients have to stay longer to recover, more beds are occupied. The time and efforts of doctors are spent treating these infections. Insurance rates are driven up. The increase in antibiotic resistance means that ever more exotic and expensive antibiotics need to be used.
One thing that is well known about nosocomial infections is that the vast majority are preventable. It’s impossible to ever get the number down to zero, because it would not be fiesable to completely sterilize everything in a hospital and provide all patients with complete atmospheric isolation from everyone else. Moreover, many would prefer the small risk of infection if the alternative were to be completely kept away from family and treated with telemanipulators.
But just cutting down on nosocomial infections by 75 or even 50 percent would mark a massive improvement in patient care and a huge financial savings for healthcare providers. Methods of reducing nosocomial infections are well established. They include extreme vigilance of visitors, requiring everyone to wash their hands frequently, better isolation of patients, frequent cleaning and sanitation of all surfaces, the use of anti-microbial surfaces and so on. Most hospitals do practice these to some extent, but the differences can be demonstrated by the fact that some hospitals do vastly better than others when it comes to nosocomial infection rates and that implementation of rigorous programs to control infection have been demonstrated effective.
Why, then, are extremely rigorous programs for cleanliness and infection control universal?
I believe the answer is simple. The hospitals generally don’t have much economic incentive for them. When someone enters a hospital and acquires an infection, they need to receive a great deal more treatment, including antibiotics and extended stays. Someone has to pay for that, but it’s not the hospital itself. In the United States and other countries with private health insurance programs, the money comes from the insurance provider. The hospital not only does not hurt financially, but benefits from the infection as a chance to sell more services.
This problem does not go away with nationalized healthcare. Even if the hospital is government administrated, the hospital and its management are not directly responsible for the costs. They just send the bill for the services up to the government to be paid.
Here, therefore, is my proposal: if you enter a hospital without an infection and acquire it while at the hospital, or if a surgical wound becomes infected, despite being properly dressed and cared for after the procedure, the hospital foots the bill for all treatment that is directly or indirectly associated with the infection and is required to provide any treatment necessary regardless of the cost.
Is this an unfair burden? I don’t think so. In criminal law, the burden of proof is usually “beyond reasonable doubt,” but in civil law, where the question comes down to who is financially responsible for something, the burden is often just probable fault. If you go to a hospital and get an infection, it’s not unreasonable to presume that there was probably something that could have been done to prevent it. Since its the job of the hospital to provide safe and effective care, if you get an infection, they have failed to do so and should have to pay for the costs resulting.
This entry was posted on Wednesday, September 26th, 2012 at 6:38 pm and is filed under Bad Science, Good Science, Misc, Politics, personal. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
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