Tuesday, June 8, 2010

Hospital acquired infections

On a trip to England last year, I saw hand washing stations outside each hospital ward, and surprisingly, most people were using them before they visited their loved ones. I remember, more than 20 years ago, the hoopla about MRSA in the hospital I worked in in London. We practiced barrier methods to keep the bugs from spreading and washed our hands relentlessly. People generally came to hospital to get rid of their infections, not pick them up. That’s how I remember it anyway.
Today, the chances of getting an infection while in hospital appears to be staggeringly high. The World Health Association estimates that any any given time, 1.4 million people worldwide are suffering from infections they got while in a healthcare establishment. Healthcare- associated infections (HAI) costs the US alone almost $7 billion each year. What is worse, some of these infections can be quite difficult to treat. The levels of antibiotic resistance is increasing and along with it our chances of having to take a more risky antibiotic to treat our infections. Unbelievable as it sounds in this day and age, people can and do die of infections that cannot be treated with known antibiotics. Antibiotic resistance makes hospital visits that much more scary. Imagine you go in for a life-saving procedure, for a burst appendix perhaps, and come out without your appendix but with a HAI that takes you weeks to recover from. Or imagine that you go in for a little liposuction and endure months of prolonged pain as a result of something you became infected with while in the hospital. These scenarios are becoming more common and with it, an increased reticence about going in for that operation in the first place.

Hospital acquired infections would be much less worrisome if many of them were not drug resistant. There are many efforts across the globe to better understand antibiotic resistance and to ensure we have drugs available for emerging resistance strains. Some bugs of concern, so-called Gram negatives, including the particularly nasty Acinetobacter are difficult to treat to begin with. WIth resistance accelerating to even newer antibiotics, there are few drugs in the pharmaceutical pipeline to keep up with resistance. MRSA still remains a problem even though it tends to stay out of the headlines these days. Once a hospital-acquired infection, MRSA is now just as likely to be contracted in the community. Infection control for some microorganisms has been improved in many hospitals. However, some centers still have a way to go. Just this week the Journal of the American Medical Association (JAMA) published an article that suggests lax infection practices may plague the nation's more than 5,000 outpatient centers. Patients coming in for day surgeries are leaving with more than they signed up for in more and more hospitals. U.S. Health and Human Services Secretary Kathleen Sebelius said in a statement that her department is expanding its hospital infection control action plan to include ambulatory surgical centers and dialysis centers.
Reporting infections is important and in general, is on the increase although some doctors still fail to report incidences at their hospital.

In the future it is conceivable that minor operations may not be widely accessible due t the high risks of acquired infections in the hospital. Patients may have to think twice about procedures we now take for granted such as C-sections, joint replacement surgeries and cosmetic procedures for example. With the risk of HAI growing, the future of medicine may see a very limited list of surgical options for patients in non-life-threatening situations.

For people interested in learning more about HAIs, there are a couple of places to go. The first is a website put together by Kimberly-Clark at www.haiwatch.com. Folks can sign up for newsletter and browse around for general information particularly on two of the most common HAIs; ventilator- associated pneumonia and surgical skin infections (SSI). The CDC also provides more information at http://www.cdc.gov/ncidod/dhqp/healthDis.html
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