Doctors Are the People Spreading Infections

While I know a few doctors that will disagree with me, they are the ones that don't use hand or equipment sanitation, refuse to wear gloves, and in general ignore good safety standards. Some of these same doctors are the ones insisting on touching patients and giving them comfort according to them. I say comfort my !@@, I would rather know that the stethoscope has been sanitized and see them wearing gloves, than using an unsanitized stethoscope and not wearing gloves.


Another writer on the internet and a patient advocate agrees with me. About two weeks ago now, I received an email from a wife asking me if she had been wrong in insisting that the doctor wash his hands, wear gloves in examining her husband who was in the hospital with second degree burns over approximately 25% of his body and third degree burns on about 5 percent.


She stated that she had to wear a special gown and gloves when visiting her husband and she was aware of at least two other patients in adjacent rooms that had MRSA and did not want it spread to her husband. I emailed her back immediately and told her by all means and stand between her husband and the doctor until she knew that the doctor has sterilized his stethoscope, hands, and put gloves on. The next day I received another email saying that the doctor had refused to see her husband and had sent a nurse practitioner in while he remained out in the hall. She stated that the NP had washed her hands and gloved up before taking the stethoscope out of the sealed packaging and then examined her husband.


After they had finished rounds the NP had returned to thank her for correcting the doctor even though he refused to do any of what she had requested. The NP stated as she left that he had seen both MRSA patients before entering her husband's room.  That made the wife feel much more positive about what she had insisted on and she knew she would stand her ground until she was sure there were no more MRSA patients on that floor. A week later because of his improvement, he was transferred to another hospital and she was thankful because everyone there followed sanitation rules and had set the rules she was to watch for herself and other visitors.


Yet the author of the blog that got me wrapped up in this, does not like gloves and apparently other safety precautions and feels that human contact is essential. I am sorry Dr. Sibert, but I think I could not let you be my doctor or anesthesiologist in this case. Just stay out of the operating room if you are afraid of wearing gloves. To my way of thinking, you are the unclean person.

Hospitals May Lose for Hospital-Acquired Infections

Hospitals are beginning to put standards and safety measures in place to prevent hospital infections. With the Centers for Medicare and Medicaid Services (CMS) and now other insurance companies refusing to pay for hospital-acquired infections (HAIs), this has forced the issue and hospitals are taking notice. When hospitals have their bottom line at issue, they will take action, which is a good thing for patients,


Although hospitals have balked at safety standards for decades, being able to put a dollar value on associated costs could help providers and payers justify investing in prevention measures. Even with implementation of quality improvement initiatives, an estimated $9.8 billion is spent each year for treating HAIs. This was the finding of a study published online September 2 in JAMA Internal Medicine.


Quoting from the abstract, “With surgical site infections contributing the most to overall costs (33.7% of the total), followed by ventilator-associated pneumonia (31.6%), central line–associated bloodstream infections (18.9%), C difficile infections (15.4%), and catheter-associated urinary tract infections (<1 i=""> This is something that should not be ignored.


“"Not paying for hospital-acquired infections or errors are an important part of the movement toward paying for quality, not quantity, of care," Mitchell H. Katz, MD, director, Los Angeles County Department of Health Services in California, concurs in an accompanying editorial. This study, however, will enable hospital administrators to better prioritize their spending by allowing them to compare the costs of interventions with the savings accrued by avoiding infections.”


Patient safety should have always been a priority, but has not been as long as hospitals were able to be reimbursed for their lack of safety procedures.

Hospitals Sharing Patients Spreads Bacteria

This isn't funny, but I had to laugh about how ironic this is after having written this blog about hospital greed. With some hospitals now gaming the system, they are creating some of their own problems with bacteria that are antibiotic resistant. Although not part of this study, I now understand why Methicillin-resistant Staphylococcus Aureus (MRSA) is spreading so rapidly and a recent New York City Hospital outbreak became so severe. Maybe hospitals that are gaming the system will pay more dearly and not be able to keep up with the diseases they are spreading.


This study is about the spread of vancomycin-resistant enterococci (VRE) in regional California hospitals (Orange County) and how fast it spreads. Although slower in general than MRSA, it is spreading when hospitals share patients. Maybe it is time for the Centers for Medicare and Medicaid Services (CMS) to investigate and relax their 30-day readmission restriction. This might reduce the speed with which MRSA and VRE are being spread. Then the hospitals could worry more about bringing these back into their own hospitals.


The researchers obtained 2006-2007 patient level admission and transfer data for all 29 adult acute care hospitals (3 children's hospitals were excluded) in Orange County (serving a total population of 3.1 million). Of the 29 hospitals, five are long-term acute care facilities (LTACs), which primarily treat patients who have prolonged high-level medical needs. The data included length-of-stay (LOS), location where patient was admitted from or discharged to, and an encrypted patient identification code that allowed researcher to track patient movement between hospitals. The model was constructed using probabilities generated from this real-world data by calculating hospital-specific proportions of 2006 patients discharged to the community, transferred from each hospital, or readmitted within 365 days.


The full study may be read here. It is studies like this that can poke holes in what CMS does and makes rules harder to cut the number of readmissions to hospitals. Until CMS can get hospitals and other care facilities to increase their safety standards, we will continue to see the spread of more diseases and even more severe resistance to antibiotics. Until hospital boards get on board with safety measures, this will only get worse.


The safety standards are many, but one of the most common is the lack of hand sanitation by doctors, nurses, and other hospital employees. I will not say one group is worst than the other because they are all lax and seldom wash their hands. The next area is the lack of equipment sanitation. I have never seen a stethoscope, a blood pressure cuff, or other piece of equipment that is used patient after patient go through any sanitation or cleaning. I hate to think of the cost involved, but maybe patients will need to start asking to have this equipment be removed from a sealed cellophane container before it can be used.