It is the ultimate paradox of American health care: going to the hospital can kill you. Every year nearly two million hospital-acquired infections claim roughly 100,000 lives and add $45 billion in costs; that is as many lives and dollars as taken by AIDS, breast cancer and auto accidents combined. And with antibiotic resistance rising steadily, those numbers promise to climb even higher.

Even more staggering than the numbers is that most of these infections are preventable. The Institute of Medicine has long since determined that if hospital staff would make some minor adjustments to their routines—like washing their hands more—the problem could be significantly minimized.

Washington is now starting to crack down. On January 1 the Centers for Medicare & Medicaid Services (CMS) began requiring that all acute care facilities report the number of intensive care unit patients who develop bloodstream infections. Eventually the information will be made public, requirements will expand to include all types of hospital-acquired infections, and the level of Medicare reimbursement will be tied to how effective hospitals are at reducing infection rates.

Some medical centers have already taken the initiative and started making changes. A handful “have virtually eliminated some forms of infection that other hospitals still think are inevitable,” said Donald M. Berwick, who heads the CMS, in congressional testimony last year.

One of them is Claxton-Hepburn Medical Center, a rural hospital with a 10-bed intensive care unit in Ogdensburg, N.Y. It has nearly wiped out ventilator-associated pneumonia (VAP)—a hospital-acquired infection that occurs in 25 percent of all people who require mechanical ventilation—just by making a handful of changes to its protocol. Instead of laying patients flat, nurses keep them elevated at a 30-degree angle, which studies show is better for the lungs and does not, as previously thought, increase the risk of bedsores. Rather than leaving patients sedated, doctors now wean them from sedatives once a day to test their progress—another trick proved to reduce the length of stay. Nurses also take care to brush patients’ teeth every day and to clean their mouths and gums every few hours because oral infections often spread to the lungs. In the five years that followed the adoption of these practices, not a single case of VAP emerged.

Claxton-Hepburn is not the only hospital with success stories to share. In fact, dozens of New York–based hospitals—including ones much larger than Claxton-Hepburn—managed to cut their VAP rates in half by employing similar methods. And in Michigan 103 intensive care units eliminated catheter-related bloodstream infections during an 18-month study; hospital workers credited evidence-based practices and simple checklists. With solutions that cost less than the penalties, more hospitals are sure to follow Claxton-Hepburn’s lead.

This article was originally published with the title Beating Back the Bugs.

7 Comments

1. 1. nickheap 11:05 AM 5/5/11

   I would be very interested to know how the excellent positive changes you describe were discovered and introduced. Where did the simple ideas come from, why did people implement them? I am not a medic, I am am organisational change consultant, but I have read that even "simple and obvious" good practice, like hand washing can be very difficult to sustain in hospitals.
   
   Thanks,
   
   Nick (Web: www.nickheap.co.uk)

   Reply | Report Abuse | Link to this

2. 2. Pazuzu 09:19 PM 5/16/11

   How can you check on a hospital you might end up in?

   Reply | Report Abuse | Link to this

3. 3. GeneG 03:17 PM 5/17/11

   Handwashing and alcohol rubs for sanitizing hands between patient visits take time; of order 30 seconds, and do not inactivate all pathogens. One important omission is C. difficile which causes 21,000 deaths annually. They also irritate the skin. Consequently most healthcare workers bypass hand sanitation between patients more than 60% of the time. Moreover when they do sanitize they recontaminate the hands by touching surfaces in the room, or their clothing, or instruments, and pass infections and sometimes death on to the patient. The cost to the medical system exceeds $30 billion annually. Currently 27 states require hospitals to report infection statistics and anyone interested can get that data. The good news is that an excellent solution is on the way.

   Reply | Report Abuse | Link to this

4. 4. jgrosay 07:30 AM 5/18/11

   Bugs are much too clever and if you get rid of all the bacteria you're going to get fungi. If you get rid of all the fungi, you're going to get algae. If you get rid of all the algae, you're going to get something worse.
   Dr. Sidney M. Finegold, UCLA

   Reply | Report Abuse | Link to this

5. 5. Wayne Williamson 06:28 PM 5/19/11

   Seems like wearing and changing gloves from patient to patient would solve the hand washing issue...I've noticed dentists always do this now days...

   Reply | Report Abuse | Link to this

6. 6. foxinwinter 06:52 PM 5/20/11

   Medicine is one of the few products where the more you use, the more you lose. Going to the hospital may be more hazardous than staying out of it.

   Reply | Report Abuse | Link to this

7. 7. neofeign 09:48 AM 8/14/12

   I for one am glad to see others joining the battle
   
   Check out this TED talk regarding hospital inquired infections
   
   http://tedxtalks.ted.com/video/TEDxEdmonton-Randy-Marsden-Engi

   Reply | Report Abuse | Link to this