Most people don’t go to the hospital thinking they’re likely to get sick. But for years, about 10% of hospital patients acquired illnesses such as gastroenteritis, meningitis, pneumonia, urinary tract infections, hepatitis and surgical site infections during their hospital stay.
Thanks to increased monitoring of U.S. health care facilities, the infection rate is declining – to about 5% — but the risk remains unacceptably high.
The source of infections in 90% of the cases is the spread of bacteria. Part of the problem may be a lack of completely sterile surgical instruments or items like catheters. However, by their very nature hospital patients tend to have compromised immune systems, which can leave them at greater risk of infection. Some patients also become infected through their hospital roommates.
The ICU is considered the area of the hospital where infection is most likely to occur. Studies show that the incidence of HAIs – also known as “nosocomial” infections — in the ICU is 2 to 5 times higher than in the general in-patient hospital population. The most common form of ICU-related infection (about 62%) is pneumonia, followed by urinary tract and bloodstream infections.
With effective interventions, the infection rate can be reduced by a third – but not completely eliminated.
The consequences of HAIs can be quite severe. About 100,000 patients – 5% of the total infected — die annually. Survivors are treated with anti-viral and anti-fungal medications but they may endure years of follow-up treatment, multiple surgeries and even permanent disability.
Children are at even higher risk for HAIs, according to a 2017 study. In most states they are not allowed to be treated with antibiotics, complicating effective treatment. On average, children that contract HAIs have 20% longer hospital stays. Their mortality rate is also substantially higher.
Some infections have become antibiotic-resistant, leaving adults more at risk, too. A study released last April found that 14% of hospital patients had ‘superbug’ antibiotic-resistant bacteria on their hands or nostrils early in their hospital stay. Nearly a third of tests for such bacteria on objects that patients commonly touch also came back positive.
In 2015, the Center for Medicare and Medicaid Services (CMS) began fining hospitals that failed to meet its standards for addressing HAIs. A whopping 22% of hospitals fell into the CMS category of “worst performing” hospitals, resulting in a 1% fine deducted from their reimbursements.
A year later, 23% of hospital fell into the “worst performing” category, many of them repeat offenders. CMS has begun publishing the names of the hospitals in an attempt to shame them into improving their record. Progress is slow.
Lack of transparency remains a major problem. A report published in The New York Times on April 2019 found that the Centers for Disease Control was refusing to publicize evidence of infection “outbreaks” at US hospitals. Officially, the CDC says it doesn’t want to create a public panic that might force some hospitals to close when the risk is relatively small.
But critics say the public needs to be protected from further harm. “[Patients] might not get up and go to another hospital, but patients and their families have the right to know when they are at a hospital where an outbreak is occurring,” Lisa McGiffert, an advocate with the Patient Safety Action Network, told the Times.
Last November, some 34 children were infected during an adenovirus outbreak at a hospital in New Jersey. Eleven deaths were traced to the outbreak. Health inspectors traced the problem to a lack of employee hand-washing. After three subsequent inspections revealed that the hospital was still in “substantial noncompliance,” the state ordered the facility to stop accepting admissions, in effect, closing it down.
It’s a rare example of public health authorities cracking down on hospital with a high rate of HAIs. But it took the death of nearly a dozen innocent children and a media investigation to protect the public from harm. How many more need to die for patients to feel confident that a hospital stay won’t end up killing them?