The Hospital is an Inherently Dangerous Place

Those are the bold words of Dr. Brad Spellberg, an infectious disease specialist (updated 7/24/14) at the Harbor-UCLA Medical Center in the US. He made the statement in a television interview last week in response to a report just released by the US Centers for Disease Control and Prevention, warning that drug resistant bacteria have become a “potential catastrophe” and that the hospital is the primary place that bad bugs strike.

When the interviewer expressed surprise at Spellberg’s remark, so at odds with our perception of hospitals, he explained it this way: “I do think that people need to understand that the hospital is an inherently dangerous place and it’s not because hospitals are dirty or doctors are lazy or anything like that. Think about it this way. You’re taking the sickest people in society, crowding them into one building, tearing new holes in their bodies that they didn’t use to have by placing plastic catheters in their bloodstream, their bladder, putting tubes into their lungs that can breathe for them, and we’re using very large quantities of antibiotics to treat infections. So that’s a perfect breeding ground to generate antibiotic resistant bacteria.”

The CDC report, Antibiotic Resistant Threats in the U.S., 2013, is the first ever cataloging of the number and types of antibiotic resistant infections across the country. The report concludes that staph bacteria, including MRSA, are one of the most common causes of healthcare-associated infections. Indeed, 48% of infection-caused deaths resistant to antibiotics were attributable to MRSA alone. Moreover, severe MRSA infections mostly occur during, or soon after, inpatient medical care. The CDC therefore considers MRSA a “serious” concern that requires prompt and sustained action to ensure the problem does not grow.

The report goes on to say that antibiotic resistance in healthcare settings is a significant threat to public health because patients are already vulnerable due to weak immune systems and underlying illness. For these patients, contracting an antibiotic-resistant infection is especially dangerous. A Canadian study published this year puts it in very concrete terms. Dr. Andrew Simor, head of infectious diseases at Sunnybrook Health Sciences Centre in Toronto, found that 1 in 12 people in hospitals across Canada were either colonized or infected with just MRSA and 2 other germs.

And just who are these 1 in 12 people? Do they fit any kind of profile or demographic? Indeed they do — their average age was just  over 70! In other words, the hospital is an inherently dangerous place —  for the elderly.

In a call to action the CDC says one of the things needed is better “protective behavior” in hospitals. CDC Director Thomas R. Frieden said that while some of these actions are already happening, “My biggest frustration is the pace of change. Hospitals are making progress, but it’s single digits in terms of the number of hospitals that are being very proactive.  The challenge is scaling up what we know works, and doing that fast enough so that we can close the door on drug resistance before it’s too late.”

Here’s the thing: we actually do know what works – we know how to make hospitals less dangerous, yet it seems that the proactive Vancouver General Hospital is one of the few places doing something that the CDC is calling for. Just last year, in an effort to reduce surgical site infections, the hospital conducted a pilot study with patients about to undergo major surgeries. They were treated with a photdisinfection system (MRSAid) to ward off germs. The findings, to be published in a peer-reviewed journal early next year, indicate a 39% reduction in infections. As a result, readmissions due to SSIs decreased from 4 to 1.25 cases a month, 553 patient bed days were freed up, 138 more surgeries could be performed, and the hospital reports a financial saving of almost 2 million dollars.

Because of this work the Vancouver General Hospital was selected as the recipient of the Innovation Award at the 2013 International Consortium for Prevention & Infection Control, a group that is endorsed by the World Health Organization. The goal of the ICPIC conference is to exchange best practices, highlight current research in the field and share innovations in infection control. This is the first time that a Canadian institution has been recognized for infection control innovation at ICPIC. MRSA infection CDC estimates 80,461 invasive MRSA infections and 11,285 related deaths occurred in 2011. They admit this is a huge underestimation of the true numbers because they didn’t include cases where MRSA wasn’t the direct cause if death – for example when the infection set in secondary to cancer, and death ensued.

This isn’t the first time our culture has had to face an enemy within.  In the 1990s we woke up to the fact that our homes, much like hospitals today, could be dangerous places too. In the case of the home, the predator that caused injury and death was most often an adult male. That state of affairs is no longer tolerated because we felt compelled to protect the innocent. Just 11 days ago the  CDC asked us to “protect” today’s innocent,  our elderly in hospitals. Dr. Ed Septimus, professor of internal medicine at Texas A & M Health Sciences Center in Houston and frequent spokesperson for the Infectious Disease Society of America, sums it up: “It’s up to us to make the recommendations in this report happen. If we do nothing but say ‘Here’s the problem,’ then the problem will continue to grow.”

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