Memo From The Editor

Wash up?

Marianne Dekker Mattera

That's a question every doctor should be asking every time he or she sees a patient in the hospital. And you need to be asking whether the nursing staff and residents have washed their hands. And you need to be asking about the training of the cleaning staff. And you need to be asking about infection control procedures and rates.

If you don't, your patients may die.

I know you've heard all this before, but things are getting way out of hand. According to the Centers for Disease Control and Prevention, hospital-acquired infection is the fourth leading cause of death in this country. Only heart disease, cancer, and strokes kill more Americans. A CDC study put deaths linked to hospital infections in 2000 at 90,000. But a Chicago Tribune study released this summer estimated 103,000 such deaths in the same year.

Even worse, the newspaper study pegged 75,000 of those deaths as preventable.

How could they have been prevented? By better infection control practices in the nation's hospitals. The Tribune investigation cited a number of telltale statistics:

• Since 1995, three out of four hospitals in the US have been cited for unsanitary conditions.

• Hospital cleaning staffs have been cut by 25 percent since 1995.

• Infection control personnel have been cut by an average of 20 percent since 1999, bringing the number of infection control personnel below the CDC's recommendation of one for every 150 beds in most US hospitals.

Add to those statistics the fact that nurses are so rushed that they may be neglecting basic hand-washing practices, and the likelihood that one of your patients will pick up an infection is incredibly high. If you're lucky, it'll be an infection that responds to medication. If you're not lucky, it won't respond to medication or it won't be detected before it kills.

Most hospitals don't disclose infection rates, so how are you to know what your facility's track record is?

One thing you can do is to listen closely when you're in the hospital. Spend a few extra minutes while you're on rounds and see what people are talking about. Any complications that don't quite make sense? Any discussions about patients who need to be kept longer because they've developed an infection?

Another thing you can do is talk to the infection control personnel. Ask about the rate of nosocomial infections over the past year. Ask to see records. Ask if they know whether the cleaning crews have suffered any cutbacks. Ask what kind of training new cleaning staff are given.

Bring the topic up at medical staff meetings. If you haven't been able to get satisfactory answers to the questions you've asked of the infection control officer, suggest that the medical staff put in a formal request for a review of the hospital-acquired infections over, say, the last two years.

Your patients deserve such diligence on their behalf. They come to you because they're sick. When you tell them that they have to go into the hospital, they believe that doing so will make them well, or at least better. Not one of them expects to come out worse than when he went in. Not one of them expects that he won't come out at all.

You owe such diligence to yourself as well. The Chicago Tribune story was trumpeted all over the media this summer. Sure, it's a "hospital" story, not a "doctor" story. But don't for a minute think that patients don't personalize every bit of health news they hear. And whether it's a story about medical errors or hospital-acquired infections, it's immediately applied at the my-doctor-and-me level. You can't afford to allow scare headlines to taint your relationship with your patients. And you can't afford to allow conditions at your hospital to taint your relationship with your patients.

In short, you can't afford not to know about the infection rates at your hospital. You can't afford not to do all you can to improve them. And that action has to come right down to the personal level; remember, wash up.

 

Marianne Mattera. Memo from the Editor: Wash up?. Medical Economics 2002;21:7.