DC Medical Malpractice & Patient Safety Blog

Progress is being made in the national effort to let patients know which hospitals do the best job in preventing infections. But patient safety advocates are worried that some of the early reports of hospital-specific data may be overly rosy because of fudging in the way that infections are counted.

Last week we wrote about how infections acquired from intensive care units are more dangerous for children than adults. Most hospitals have made progress in addressing the issue of infection control, and a report issued recently by the Department of Health and Human Services promotes transparency in that effort.

HHS compared hospital ICUs across the country in terms of central line associated bloodstream infections (CLABSIs), which research shows are highly deadly but highly preventable with good care. The information for each hospital is posted on the federal Hospital Compare website, updated quarterly. In the future, infections in addition to CLABSIs will be included.

The Centers for Disease Control and Prevention (CDC) estimated that 18,000 patients developed CLABSIs in the ICU in 2009. As many as 1 in 4 of these patients die. The CDC death toll for all hospital-acquired infections is estimated at 100,000 annually; such infections might cost as much as $45 billion.

Consumer advocates, including the Safe Patient Project of Consumers Union, lobbied for years to enable a hospital infection-tracking system. That organization estimates that 2 million patients a year contract an infection in the hospital.

Since January 2011, hospitals have been required to report ICU-acquired CLABSIs to the CDC in order to receive payment from Medicare. Most states that require infection reports use the same system.

As part of the national campaign, a recent California report was rosy: According to California Watch, rates of infections from catheters are nearly half the national average. But there’s a caveat here that other states embrace as well: Hospitals might be under-reporting the incidence of infections. State authorities are reviewing results of an in-depth infection-reporting audit of four types of infections reported by 100 hospitals. But a lack of funding compromises its ability to fully vet all hospital-generated reports.

As Consumers Union noted, the new reporting requirements apply to hospitals that participate in the Centers for Medicare and Medicaid Services (CMS) “pay-for-reporting” program for all patients, not just those covered by Medicare. Most U.S. hospitals participate because their Medicare payments are higher.

To determine how well your hospital stacks up in the infection-control department using Hospital Compare, Lisa McGiffert of Consumers Union advised comparing its rank with the national benchmark. “If your hospital is no different than the national benchmark, that means too many patients are still suffering and dying from infections that could have been prevented with better care,” she said. “The benchmark for success that hospitals should be striving to reach is zero.”

Reports on surgical site infections will begin in 2013. The CDC estimates that such infections account for 1 in 5 hospital-acquired infections. Catheter-associated urinary tract infections also will be tallied as of 2013.

Given our propensity to pop an antibiotic at the first sign of a sniffle—and much of the medical establishment’s willingness to gratify this often unwise habit—it’s hard to believe that the use of antibiotics to fight infection has been common practice for only a couple of generations.

Like all medications, they come with risks of side effects, but in the right circumstances, antibiotics are truly wonder drugs. They’re so wonderful, however, that we overuse them. The problem then becomes not just one of risky and/or unpleasant side effects, but of reduced efficacy.

The more frequently antibiotics are used, the better bacteria become at resisting them. It’s simple evolution—survival of the fittest bacteria. The fitter (stronger) the bacteria, the more compromised the antibiotics. In order to keep up with the demand of increasingly resistant bacteria, new compounds must constantly be developed. The old ones simply don’t work anymore.

Antibiotic resistance occurs when humans ingest the drugs more frequently and for disorders they are not meant to address. But one contributor to this diminishing-effects scenario is not the direct result of human behavior—it results from the routine use of antibiotics in agriculture. They’re given to livestock to prevent disease and promote growth. That practice has been called into question often in recent years.

As explained in the Los Angeles Times, last year, the American Medical Association (AMA), the World Health Organization (WHO) and other medical groups warned that “the misuse of antibiotics in food animal production may be creating a serious problem for human health by fostering development of drug-resistant bacteria."

Further, some studies showed that taking antibiotics out of animal feed "made antibiotic-resistant bacteria less prevalent in both animals and people with no ill effects for animals or ranchers."

Earlier this month, the FDA put its foot down on some unapproved uses of antibiotics for livestock. The agency prohibited use in certain animals of one class of antibiotics called cephalosporins, and prohibited using the drugs for purposes other than their original intent (called “off-label” or “extra-label” use) except for animals that are rarely consumed by humans.

It wasn’t the first time the FDA attempted to curb the use of antibiotics in animals. In 2008, the FDA made a move to limit off-label antibiotic use in livestock, but wussed out in the face of opposition by agricultural interests.

Congressional Rep. Louise Slaughter (D-N.Y.) is a microbiologist who has written legislation addressing antibiotic overuse. In a statement about the latest action, she said, "We need to start acting with the swiftness and decisiveness this problem deserves. With over 1 million Salmonella cases in the U.S. each year, at least 30,000 Americans will contract cephalosporin-resistant bacteria every year. I'm glad the FDA is finally acting but how many Americans have needlessly been sickened in the meantime?"

The new rules take effect April 5, but as in 2008, there’s a comment period in the interim. Comments received last time helped sway the FDA against enforcing the restrictions. So if you care about antibiotic resistance, you might want to weigh in about the latest proposal. Link here to read a Q&A about general antibiotic use in animals and specifically this action. To submit comments, link here and include the docket number FDA-2008-N-0326.

There’s been a lot of good news lately about what hospitals are doing to protect patients: Many have improved their infection control practices, many are looking at the value of “hospitalists” (doctors who practice exclusively with inpatients) and many have embraced palliative care.

Yet for every two steps forward for patient safety, it appears as though many hospitals are taking at least one step back. As reported last week in The New York Times, a federal report concluded that hospital employees recognize and report only 1 in 7 errors, accidents and other events that harm Medicare patients.

An even more shocking revelation in the report by Department of Health and Human Services investigators is that once hospitals do investigate preventable injuries and infections, they seldom change their practices to thwart them from recurring. This despite the fact, as HHS Inspector General Daniel R. Levinson pointed out, that Medicare reimbursements to hospitals are contingent on them tracking such errors and adverse events, analyzing and addressing them.

“Adverse events” are those that cause significant harm experienced by patients as a result of medical care.

As the Times reported, “Despite the existence of incident reporting systems,” Levinson said, “hospital staff did not report most events that harmed Medicare beneficiaries.” And, he said, some of the most serious problems, including some that caused patients to die, were not reported.

The report found that “hospitals made few changes to policies or practices” even after employees reported harm to patients. In many cases, hospital executives told federal investigators that the events did not signify any “systemic quality problems.”

Among the problems enumerated were:

• medication errors;


• severe bedsores;


• hospital-acquired infections;


• delirium caused by overuse of painkillers; and


• excessive bleeding linked to improper use of blood thinners.

Levinson estimated that more than 130,000 Medicare beneficiaries experienced one or more adverse events in hospitals in a single month, and that many hospital administrators knew that hospital staff were underreporting them.

Whereas once hospital employees were afraid to admit mistakes for fear of reprisal, that doesn’t seem to be the problem here. Rather, Levinson said, it’s that hospital employees don’t recognize “what constitutes patient harm,” nor do they realize that certain events harm patients and should be reported. And sometimes they just assume someone else will report the episode, they believe it to be so common as to be insignificant or they assume it is an isolated event unlikely to be repeated.

For more information about hospital errors, and what you can do about them, see this page on our website.

In response to the confusion described by the HHS report, Medicare officials said they would develop a list of “reportable events” hospital employees could use to eliminate questions about what’s required and what isn’t. In addition, the Medicare agency said, hospitals should give employees “detailed, unambiguous instructions on the types of events that should be reported.”

You mean they haven’t already done so?

Article first published as Two Steps Forward, One Step Back in Hospital Patient Safety on Technorati.

Unless the patient needs really intensive, round-the-clock care, most hospital-type care can be done in the patient's home -- where it's safer, more comfortable and less expensive. That lesson is so well accepted that it was written into the federal health care reform law -- to provide financial incentives for outfits called Independence at Home Organizations.

The problem is that the rules for the new home care organizations are supposed to go into effect on January 1, 2012, but Medicare is behind on writing the rules. So there will be delay in getting this started. The current rules discourage moving hospital-style care home because, among other things, Medicare won't pay for home visits.

An internist named Jack Resnick, M.D., writing an op-ed in the New York Times, talks about his own practice on New York City's Roosevelt Island, caring for infirm and elderly patients. He makes a persuasive case for the home care organizations, writing:

Patients who are treated at home by a doctor and nursing staff who know them intimately and can be available 24/7 are happier and healthier. This kind of care decreases the infections, mistakes and delirium, which, especially among the elderly, are the attendants of hospital care. And it is far more efficient.

Yes, you read the headline correctly. Transplanting feces from healthy patients into patients with horrible infectious diarrhea is rapidly becoming standard medical practice because of its dramatic positive results.

Contracting an infection from Clostridium difficile (C. difficile) can be deadly. About 6 in 100 hospital patients become infected with the insidious bacterium. People who use proton-pump inhibitors also seem to be at greater risk factor for infection. So says a recent study published in the New England Journal of Medicine.

The study’s authors hope that its findings will promote efforts to prevent this extremely common cause of health-care related infectious diarrhea.

A day after that study hit the news, their wishes seem to have come true.

In a “say what?” solution to the horrors of C. difficile infection, the American College of Gastroenterology reported that transplanting fecal material containing healthy bacteria into C. difficile patients can bring relief even to elderly, debilitated people for whom previous courses of treatment had failed.

As reported on MedPage Today, 9 in 10 “fecal microbiota” transplants were successful. The definition of success was patients who had no recurrence within three months. On average, it took six days for their diarrhea to resolve, and four weeks for their fatigue to resolve.

What seems contrary to common sense – even physicians posting comments on the MedPage story were making bathroom humor jokes – appears to be the new gold standard of care for C. difficile infections. Stool bacterial population of patients with recurrent C. difficile infections, apparently, is completely different from that of normal people. “Therefore,” the study’s lead author said, “it would make sense that if you performed a massive bacterial replacement, that might very well reverse that condition and allow for a cure in people who were otherwise not curable.”

The study is poised to change how gastroentologists – physicians who specialize in disorders of the the stomach, intestines and associated organs – practice.

C. difficile infections are notoriously difficult to treat. Recurrence rates are as high as 1 in 2 patients. Earlier fecal transplant studies showed promise, but their results were derived from only a single treatment center. The new study involved five different U.S. medical centers.

The patient/subjects involved in the new study, according to MedPage Today, had failed an average of five different medication courses before receiving the transplant.

At the risk of someone claiming “too much information!” the question arises: What was the source of the transplanted material? More directly, who were the donors? Most were members of the same household as the patient; only one patient had no relationship with the donor.

One interesting result was that two patients experienced improvement in their pre-existing conditions; one with arthritis and one with sinus allergies. Four patients developed new disorders – peripheral neuropathy (nerve damage involving numbness and pain in hands and feet), Sjogren's syndrome (an immune problem involving various symptoms), rheumatoid arthritis and idiopathic thrombocytopenia (abnormally low blood platelets of unknown origin). One patient, who was in hospice care, died.

Study subjects did not seem to find the idea of a fecal transplant unpleasant. "They're desperate people seeking desperate measures so they didn't have much of a problem with it,” said the study’s primary author. “We have to stop thinking of stool as a smelly inert substance; it's an incredibly biologically active substance."

When you get up close and personal with your cellphone, what are you exposing yourself to, literally? Dangerous radiation? Maybe. Nasty germs? Most certainly.

Two studies examining different potential hazards of cellphones have been in the news lately. One concerns the ongoing debate about the radiation risks of extended close contact with your phone, and the other concerns its hospitality to surface germs.

The first study involved members of the advocacy group Environmental Health Trust and was published in the journal Electromagnetic Biology and Medicine. It says that exposure measures per FCC guidelines underestimate how much radiation most people receive from their cellphones, according to a story in the Los Angeles Times.

The study authors say that current assessment methods use a large, liquid-filled plastic model of the adult human head, but that more than 9 in 10 people have smaller heads and therefore higher proportional exposure than what is assessed. Most important, children receive twice as much microwave radiation to the head as adults, the study estimates, and 10 times the amount to bone marrow.

Not to mention the possible exposure to other body parts when, say, a phone is stowed in your pocket.

The scariest possible side effect of cellphone use is brain cancer, although whether microwave radiation from cellphones can damage DNA and cause cancer is a subject of debate. See the National Cancer Institute fact sheet.

The Electromagnetic Biology and Medicine paper requests that the cellphone industry use a different method to certify phones for use, one that considers different sizes of users, and those who are pregnant.

A Danish cellphone study found no relationship between cellular telephone use and the incidence of cancer, but the British Medical Journal found problems with some aspects of that study.

Bottom line, there are passionate researchers on both sides of this issue and we really have no definitive science to argue conclusively that cellphones do or do not pose a radiation risk. As in most things, moderation is in order. Use cellphones only as necessary, and store them, ideally, away from your body.

In contrast, it's unequivocal that your phone goes with germs like peanut butter goes with jelly.

As reported on WebMd, 9 in 10 cellphones in a United Kingdom study served as host to bacteria including E. coli. And the reason is simple: People don’t wash their hands after using the toilet.

In this study, the E. coli came from fecal bacteria, which can survive on hands and surfaces for hours.

The researchers studied cellphones in 12 cities across the U.K. and asked users about their hand hygiene. Here’s what they learned:

• 9 in 10 phones were carriers of bacteria


• 8 in 10 hands were carriers of bacteria


• 16 in 100 hands and 16 in 100 phones bore E. coli bacteria.

Still, nearly everyone said they washed their hands with soap where possible, leaving the researchers to conclude that people tend to lie about hygiene habits.

If dirty hands are touching cellphones, they’re also touching other surfaces. Said one of the researchers: “They're spreading fecal bugs on everything they touch really."

"We didn't ask people whether they'd used their phones in the toilet. That might be something that would be interesting to study," she said.

Well, interesting is an interesting word, but it definitely would be illuminating, probably in ways most people don’t want to know.

Wash your hands. Often. It’s really just that simple.

The headline is no joke. It's what experts think is the explanation behind vision-ruining infections in the eye that happen occasionally with injections into the eye of a drug used to halt the progress of macular degeneration.

As the thinking goes, if the doctor is talking during the time he or she is drawing the drug from the vial into the syringe, tiny droplets of the doctor's saliva can then be transmitted into the patient's eye.

Another cause of eye infections in patients who get these injections is less than sterile conditions in the pharmacies that take a single vial of the drug and divide it up into the tiny doses for individual eye patients.

Whatever the cause, the infections known as endophthalmitis happen in about 1 in 1,000 injections of both of the commonly used drugs for the wet form of macular degeneration: Avastin (also used in cancer treatment) and the far more expensive Lucentis.

Read this New York Times piece for more on the subject, and about how a raft of publicized cases of infections with Avastin seems to be driving much of the eye injection business to Lucentis despite its higher price -- $2,000 a dose compared to only $50 a dose for Avastin.

It’s enough to make you want to shrink-wrap yourself in your hospital bed.

A report published in the American Journal of Infection Control concluded that as many as 6 in 10 uniforms worn by hospital caregivers tested positive for potentially dangerous bacteria.

Swabs of the uniforms of 75 RNs and 60 M.D.s at a 550-bed university-affliliated hospital yielded cultures containing multidrug-resistant germs including methicillin-resistant Staphylococcus aureaus, or MRSA – also known as the “super bug.”

That’s not a compliment.

According to AboutLawsuits.com, MRSA infections represent more than 60% of hospital staph infections, and the Centers for Disease Control and Prevention tally some 126,000 hospital MRSA infections every year, resulting in about 5,000 deaths. Some researchers believe that the number of deaths every year from MRSA in the U.S. is about 20,000 if community-acquired infections are included.

As you might imagine, the number of infection-related lawsuits filed against hospitals also has increased in recent years.

Even if the clothing itself does not present an immediate risk of disease transmission, the results are disturbing for what they reflect about antibiotic-resistant strains in close proximity to hospital patients — the people most vulnerable to contracting disease.

The key message here for hospital staff isn’t necessarily to wash your uniform; it’s to practice what every thinking health caregiver has been preaching for years: Wash your hands.

“Any clothing that is worn by humans will become will become contaminated with microoganisms,” said Russell Olmsted, president of the Association for Professionals in Infection Control and Epidemiology. “The cornerstone of infection prevention remains the use of hand hygiene to prevent to movement of microbes from these surfaces to patients.”

The World Health Organization pegs the risk of health care-associated infection in some developing countries at as much as 20 times higher than in developed countries like the U.S. But they’re still relatively common here, they can be deadly and they are expensive to treat. Prevention is the only way to guarantee patient safety.

As we’ve reported before, if you or a loved one is scheduled for a hospital stay, ask in advance for a copy of the facility’s infection prevention and control program. And if a hospital or clinical caregiver forgets, don’t be too timid to ask that person to wash his or her hands before attending to you.

Check out this graphic display of some of the statistics of hospital hazards. Infections, malpractice, errors due to poor record keeping, medication errors, mistakes due to sleep deprivation of trainee doctors: It's all displayed here, courtesy of a group called Medical Billing and Coding Certification.

It’s an unfunny truism that if you want to avoid getting sick, stay out of the hospital. But that may be starting to change for the better.

The unacceptably high number of hospital patients who contract an infection after admission has long been in the news. We have covered the topic frequently.

According to federal estimates, 1 in 20 people admitted to a U.S. hospital develops an infection – or about 1.7 million people every year. Such infections represent a top 10 cause of death in this country; approximately 99,000 people die annually from hospital infections, at a health-care cost of $33 billion.

Scrutiny of this problem has generated policy changes – Medicare, for example, no longer foots the bill when inpatients are infected by microbes from catheters and intravenous lines. And, per the new federal health-care legislation (the Affordable Care Act), soon subsidies will be withheld to hospitals that fail to reduce their infection rates.

In a bit of good news from this patient safety front, many hospitals have committed to solving the problem and boast demonstrable results. As reported in the Los Angeles Times, a three-year campaign to reduce the incidence of hospital infections in California has saved lives, cut costs and institutionalized best practices to ensure continued vigilance and good results.

At the midway point of the campaign, the program has seen reductions of:

• ventilator-associated pneumonia by 41%;


• catheter-related urinary tract infections by 24%;


• blood poisoning by 11%.

About $11 million has been saved, and about 800 lives.

The health threat is particularly acute these days, thanks to the increasing use of outpatient clinics. That means hospitals are reserved for the sickest patients, and the sicker the patient, the more vulnerable he or she is to infection.

In California, Anthem Blue Cross is often the target of consumer and health advocates who have challenged its substantial health-care premium increases and its history of questionable recissions (dropping policyholders from coverage after the discovery of an expensive medical condition). But even this often soulless corporate entity acknowledges the unacceptable cost of hospital infections, and has funded the statewide Patient Safety First program with $6 million.

The company says it has recouped nearly double its investment in the program through reduced health-care spending. And its corporate parent, WellPoint, Inc., says it won’t increase payments to hospitals in 14 states that don’t meet its standards of infection control, readmission rates and other practices.

Some of the program elements employed by hospitals are:

• establishing and following safety checklists and documenting every step;


• frequent hand-washing by staff;


• more frequent brushing of patients’ teeth;


• enlisting respiratory therapists to swab the mouths of patients on ventilators several times a day;


• eliminating unnecessary procedures.

If you or a loved one is to be admitted to a hospital, ask if it has an infection-control checklist, and if so, ask to see it. After admission, make sure staff members wash their hands before they tend to you or your loved one. Ask when catheters and ventilators were last sanitized. Hospitals that care about your safety should not object to such scrutiny

As Dr. James Cleeman, an expert on health-care quality, told the L.A. Times, “Nobody should go into a hospital and wind up sicker than when they went in.”

Hospitals are subject to clear standards and procedures for infection control, but germs don't care whether they live in an operating room or a medical office exam room.

The Centers for Disease Control and Prevention (CDC) do. It recently issued "Guide to Infection Prevention for Outpatient Settings: Minimum Expectations for Safe Care" for all manner of ambulatory care centers, including doctors' offices and outpatient testing and lab facilities.

Among the most basic practices such facilities should follow are:

• Develop and maintain infection prevention and occupational health programs.


• Assure sufficient and appropriate supplies necessary for adherence to standard precautions (hand hygiene products, personal protective equipment, injection equipment).


• Assure at least one individual with training in infection prevention is employed by or regularly available to the facility.


• Develop written infection prevention policies and procedures appropriate for the services provided by the facility and based upon evidence-based guidelines, regulations, or standards.

Patients generally are not aware, nor should they be, if their health-care providers have undergone the necessary training to adhere to these guidelines. But they're common sense, and if anything seems amiss when you visit your doctor--say, the nurse doesn't wash her hands before offering a thermometer--ask what measures are being taken to protect you from someone else's germs.

As an increasing number of patients being tested for prostate cancer contract potentially lethal drug-resistant infections, some physicians are rethinking their approach to prostate cancer screening.

Several studies released in the past year reveal that infectious complications from biopsies have more than doubled in less than a decade, and a growing percentage of patients who undergo needle biopsy tests are becoming critically ill and dying from bacterial infections, including sepsis.

A tissue biopsy of the prostate to detect cancer typically entails sending an ultrasound-guided needle about a dozen times through the rectum to collect specimens from the walnut-sized gland that sits under the bladder. The test carries an infection risk because the needle can take bacteria from the bowel into the prostate, bladder and bloodstream.

If the bacteria is resistant to antibiotics given at the time of the biopsy, the routine, 15-minute procedure can turn into a dangerous situation.

More than 1 million transrectal prostate biopsies are done in the U.S. each year to diagnose cancers in men whose screening blood tests suggest they may have the disease, but no studies have examined the risk of sepsis globally. Instead doctors are trying to gauge the scope of the problem from studies beginning to emerge from North America, Europe and Asia.

For example, a research team at the Odette Cancer Center in Toronto uncovered the emerging infection risk last year after examining more than 75,000 electronic records of biopsy patients treated in Ontario between 1996 and 2005.

The team discovered that the chance of being hospitalized within a month of the procedure had increased fourfold in less than a decade, reaching 4.1%in 2005 from 1% in 1996; of these, 72% were diagnosed with infections.

Source: Bloomberg News

You see them walking around hospitals, and sometimes even on the street: health care workers wearing surgical "scrubs." It's something of a fashion statement, but also a potential carrier of infections, yet no one has really carefully studied the problem to know for sure.

The old adage among patient safety advocates that “you can’t improve what you don’t measure" describes what we know about infection rates in hospitals. As long as little or no data on infection rates are collected, the problem tends to be sidelined.

There is no data about a possible link between hospital scrubs worn outside the operating room and infection rates. Scrubs can carry harmful pathogens, and because the transmission modes of drug-resistant pathogens are more prevalent than previously thought and are no longer confined to hospitals, some patient safety advocates say it’s time hospitals addressed the issue.

One such group, the Empowered Patient Coalition, which works on patient education and empowerment issues, wants hospitals and other health care organizations to start by gathering data on scrubs in their facilities and by looking at the data about the types of pathogens that are found, and then developing policies to keep both their workers and the public safe.

But, the group says, for such a policy to be effective, a hospital would have to:

1-Promote a culture where the policy is the norm, not an additional burden.

2-Communicate the policy efficiently to staff using supervisors who believe in the action.

3-Ensure that ignoring the policy will have consequences and would be considered an employment standards issue.

Source: University of Southern California Reporting on Health

Hospitalized patients are right to be terrified of getting a serious infection from the hands of their doctors or nurses. But is there any option to barking at everyone who comes in your room: "Did you wash your hands?"?

Yes, says gastroenterologist Steven Kussin, author of the forthcoming book “Doctor, Your Patient Will See You Now.”

Here's the problem Dr. Kussin identifies if you ask the "did you wash your hands" question:

Doctors or staff members who respond “no” are guilty of a grave medical lapse. If they didn’t wash and then lie to you, they’re also guilty of a grave ethical lapse. Either way, the question raises their defenses and their hackles. Instead, if you didn’t witness a hand-washing ritual, then assume it didn’t happen. You’ll probably be right. Physician hand-washing compliance runs about 33 percent.

And his answer, in a letter to the editor in the New York Times:

If you show them, they will wash. When they, or anyone, approach your bedside, give them notice of your intent. Hold out a bottle of sanitizer with a big smile. As you squirt them say: “I know how busy you are, and I am sure you’ve already done this a million times a day. But I’m terrified of those infections I’ve been reading about. I hope you’re O.K. with this.”

That’s it. Easy, pleasant and effective.

Good advice. I have more about avoiding infections in the hospital, and other avoidable medical harms, in my patient safety newsletter, which you can read here.

Medical mistakes account for between 18 and 45 cents of every health care dollar spent in the U.S., and a medical error or adverse effect occurs in one out of every three hospital admissions, researchers say.

According to studies published in the journal Health Affairs, the single most expensive cause of harm is infection after surgery, with more than 252,000 infections costing $3.36 billion reported in 2008, while pressure ulcers (bedsores) are the most common preventable event, with with nearly 375,000 cases in 2008 costing $3.27 billion.

Following a shocking 1999 report that showed that as many as 98,000 people die annually due to medical mistakes, hospitals have tried to reduce such adverse effects, but serious mistakes persist. In 2006, for instance, medical mistakes contributed to as many as 187,135 deaths and 6.1 million injuries that cost between $393 billion and $958 billion.

“There are some examples of excellence; we have many [intensive-care units] that have eradicated central line infections. But surrounding those examples of excellence we have serious adverse events going on,” said Dr. Mark Chassin, president of the Joint Commission, a nonprofit organization that accredits health care programs. “Every week in the United States, up to 40 patients undergo a procedure meant for somebody else or the wrong body part,” he said.

The costliest medical errors were:

1. Infections after surgery (252,695 in 2008, cost $3.36 billion)

2. Pressure ulcers - Bedsores (374,964 in 2008, cost $3.27 billion)

3. Complications from noncardiac implants and grafts (60,380, cost $1.07 billion)

4. Complications from lower back surgery (113,823, cost $1 billion)

5. Excessive bleeding complicating a procedure (78,216, cost $680 million)

Source: National Journal

You’ll find more information about the Health Affairs studies here.

The number of bloodstream infections in intensive care units (ICUs) caused by tubes inserted into major blood vessels decreased significantly between 2001 to 2009, but unacceptably high rates of infection are still occurring for patients in other hospital units and for dialysis patients, government researchers say.

Central lines are tubes that are usually placed in the large veins of the neck or chest to deliver medicines and nutrition. Infections of these lines, which are largely preventable, can become serious problems, with death rates of 12-25%.

An estimated 18,000 ICU central-line infections were recorded in 2009, down from 43,000 in 2001, according to a report by the Centers for Disease Control and Prevention (CDC). This 58% decrease means that in 2009, between 3,000 and 6,000 deaths were prevented and as much as $414 million saved. And if the decrease in these ICU infections was steady from 2001 to 2009, as many as 27,000 lives and as much as $1.8 billion may have been saved.

(Note: These numbers are rough estimates. The 2001 figure of 43,000 infections could have been as low as 27,000 and as high as 67,000.)

According to the CDC, much of the decrease resulted from campaigns to improve techniques for managing the lines in ICUs, where they are most frequently used. Infections involving bacteria such as staphylococcus can be avoided with simple measures like washing hands, wearing sterile gowns and drapes, and following the proper techniques for inserting and maintaining the lines.

However, researchers noted that central line infections still occurred far too often, affecting 80,000 patients a year and killing at least 10,000. In addition, of the 350,000 patients who received dialysis in the U.S. in 2008, about 37,000 suffered central-line infections. Such infections are the second leading cause of hospital stays and death in people on dialysis after cardiovascular problems.

Peter Pronovost, MD of Johns Hopkins Hospital, a pioneer in patient safety, developed the simple "checklist" for using central lines in ICU patients, which was proven in a landmark study in the New England Journal of Medicine to cut the infection risk to close to zero.

Source: The New York Times

You can read an abstract of the study here.

The state of Maryland is putting some financial sting in its efforts to get hospitals to lower the number of patients who contract deadly infections while hospitalized.

Nine hospitals are being fined a total of $2.1 million for having higher than usual infection rates.

The hospitals are: in the Washington, DC area: Prince George's Hospital Center, Shady Grove Adventist, Montgomery General, Doctors Community and Washington Adventist, plus University of Maryland Medical Center in Baltimore, St. Joseph Medical Center in Towson, Civista Medical Center in La Plata and Memorial Hospital in Cumberland (now part of the Western Maryland Health System).

Twenty-three hospitals - including Holy Cross, Howard County General, Suburban Hospital and Johns Hopkins in Baltimore - did better than the state average and will receive small bonuses.

The list of all hospitals included in the survey and their infection rates for fiscal year 2010 can be found by clicking here and then click on this line on the web page: Hospital Infection Related PPC Rates, FY 2010.

The state's effort is more ambitious than just infections. It follows a set of 49 PPCs: Potentially Preventable Complications. It sets up payment incentives and fines to encourage hospitals to reach goals of making patient care safer.

More than two dozen hospitals in Ohio that collaborated to reduce hospital infections and drug mix-ups saved $12.8 million in health care expenses by doing so, according to a recently released report. The Solutions for Patient Safety initiative, launched by a coalition of business and hospital groups in January 2009, included 17 hospitals acute care hospitals and eight children’s hospitals.

The report said hospitals were able to achieve the changes by sharing successful data-collection techniques and best preventive medical practices with one another.

Seventeen central Ohio hospitals cut methicillin-resistant Staphylococcus aureus (MRSA) infections by 42% and catheter-related central line associated bloodstream infections (CLABSI) by 37%, thereby avoiding an estimated 918 patient days in the hospital and preventing 14 deaths. Meanwhile, the eight children's hospitals cut surgical infections by 60% and adverse drug events by 35%, preventing more than 3,500 children from being harmed while in the hospital and saving $5.3 million in medical costs.

Two processes - hand hygiene and "scrubbing the hub" - emerged as critical to significantly reducing infection rates for MRSA and CLABSI. Hand hygiene was the primary area of focus for the collaborative’s efforts to reduce MRSA infections, and an inverse relationship between hand hygiene and incidence of MRSA was observed. Since the beginning of hand hygiene data collection by specially hired observers in September, the rate of compliance with washing hands upon entering and leaving a patient’s room, even while wearing gloves, has improved by more than 20 percent. For CLABSI related infections, the observers identified a critical point of infection transmission related to the length of time the “hub” (the access point in a catheter where fluids and medications are administered) is cleaned.

Source: American Medical Association News

You can read the report here.

The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) are warning healthcare professionals that sharing blood glucose monitoring machines carries the risk of transmitting the hepatitis B virus (HBV) and other infectious diseases. Their simple advice: One monitor per diabetic patient.

In recent years, the number of reported HBV outbreaks linked to blood glucose monitoring has increased, particularly in nursing homes and assisted-living facilities, but also in any setting (e.g. clinics, health fairs, schools, camps and senior centers, among others) where blood glucose monitoring equipment is shared, or where those performing the monitoring do not follow basic infection control practices.

While stressing that reusable fingerstick lancing devices should never be used for more than one person to avoid the risk of transmitting bloodborne pathogens, the FDA and CDC also maintain that the glucose meters themselves can also pose an infection risk, since it can be difficult to ensure that blood has been completely removed from these devices. They point to a 2005 multicenter survey that indicated that 30% of blood glucose meters used routinely in the surveyed hospitals had detectable blood on their surfaces.

Therefore, the FDA and CDC advise that whenever possible, blood glucose meters should be used for one patient only. Otherwise, meters should be cleaned and disinfected after every use to prevent carry-over of blood and infectious agents. In addition, hands should be washed and gloves changed between patients.

Source: FDA Patient Safety News

Infectious disease specialists are raising the alarm over a variant of the e.coli bacteria that is resistant to most of the antibiotics used to treat bladder infections and could be responsible for more than 3,000 deaths a year.

E.coli ST131, an aggressive strain of multi-drug-resistant e.coli bacteria, may be responsible for as many as 1 million bladder infections a year, according to a recent study conducted by Dr. James Johnson, an infectious disease expert at the Veterans Affairs Medical Center in Minneapolis.

E.coli ST131 is one resistance gene away from being untreatable, Johnson warns. “I think it’s high time to worry. Before, resistant strains were wimpy. Now, we have a winner,” he says.

Although e.coli is best known as the intestinal bacteria that causes diarrhea when people eat tainted meat or vegetables, such as spinach, it actually occurs more often outside the intestines, causing far more infection and death. Extra-intestinal e.coli is responsible for about 80 percent to 90 percent of the urinary tract infections that occur annually.

Most e.coli variants respond to common treatments: guzzling gallons of water, swilling quarts of cranberry juice, and, if all else fails, heading to the doctor for a quick course of antibiotics. However, Dr. Johnson’s study determined that although the e.coli ST131 strain accounted for only about 17 percent of e.coli isolates overall, it accounted for more than 50 percent of bacteria resistant to more than one antibiotic, including the top two types used to treat most urinary tract infections, or UTIs, and also was responsible for nearly 70 percent of resistance to the biggest guns of mainline UTI treatment, fluoroquinolones and extended-spectrum cephalosporins.

E.coli ST131 probably caused the most significant multi-drug resistant e.coli infections in the U.S. in 2007, the year Johnson studied, constituting a serious public health threat.

Dr. Johnson’s findings add to the growing concerns about drug-resistance in common infections such as UTIs. New UTI guidelines that will restrict the use of fluoroquinolones for large infections are expected to be issued by the Infectious Diseases Society of America this fall.

Source: MSNBC
You can read an abstract of Dr. Johnson’s study here.

Infections in the large-bore tubes that keep patients in intensive care units alive are often lethal but readily preventable. A simple checklist of sanitary practices was proven to cut the rate of these "central line infections" to nearly zero. But that was in one chain of hospitals in Michigan. What about the rest of the country?

Peter Pronovost, the Johns Hopkins safety guru who ran the study in Michigan proving that these infections could be eliminated, was given big grant money by the U.S. government and private foundations to spread the learning to the other 49 states. So what has he found? Here's an excerpt from what he wrote recently in the Journal of the American Medical Association:

Hospital enrollment in the program has been surprisingly slow. In many states, less than 20% of hospitals have volunteered to participate. Some hospitals have reduced infection rates, most have not. Some hospitals claim they use the checklist, despite having high or unknown infection rates. Some hospitals are content to meet the national average, despite evidence that these rates may be reduced by half. Some hospital administrators say their patients are too sick; these infections are inevitable. Yet, intensive care units in several large academic hospitals have nearly eliminated CLABSIs [central line infections]. Some hospitals blame competing priorities for their inattention to these infections. If these lethal, expensive, measurable, and largely preventable infections are not a priority, what is?

Perhaps most concerning is the response from nurses in participating hospitals when asked: "if a new nurse in your hospital saw a senior physician placing a catheter but not complying with the checklist, would the nurse speak up and would the physician comply?" The answer is almost always, "there is no way the nurse would speak up." Doubly disturbing, physicians and nurses uniformly agree patients should receive the checklist items. What other industry would
accept a routine safety violation that is associated with the deaths of tens of thousands of patients and not be held accountable? The US health care culture still does not support the questioning of physician behavior.

That last sentence is perhaps the most chilling -- because it shows, once again, that many patients are going to be doomed to preventable injuries and death until the medical culture begins to change, and doctors get off their pedestal and join the rest of the team trying to keep patients safe.

Memorize the name of this antiseptic wash and make sure your hospital uses it: chlorhexidine.

Research continues to pile up that diligent but inexpensive efforts by hospital staff can greatly cut the annual toll of an estimated 100,000 lives lost to hospital infections. The latest simple step involves greater use of the antiseptic chlorhexidine to wash patients before surgery.

In two studies reported in the New England Journal of Medicine, post-surgical infections were cut dramatically when either of two steps were taken:

* Disinfect the patient's skin just before surgery with a chlorhexidine-alcohol rub -- instead of the usual iodine prep.

* Have the patient shower for several days before surgery with a chlorhexidine-based soap, like Hibiclens.

Read more on this antiseptic at Wikipedia.

See Pam Belluck's article in the New York Times for more details on the new studies.

My book, "The Life You Save," lists simple ways patients can help reduce their risk of getting infections in the hospital, including chlorhexidine soap. So the latest studies are only confirming the wisdom of this advice. But because many hospitals don't yet do this, you should ask questions and make sure they have plenty of chlorhexidine on board.

The deadly MRSA infection, estimated to kill 19,000 Americans every year (more than the toll from AIDS), has been virtually wiped out in Norway, with three simple steps:

As described in a recent Associated Press article:

Norway's model is surprisingly straightforward.

-- Norwegian doctors prescribe fewer antibiotics than any other country, so people do not have a chance to develop resistance to them.

-- Patients with MRSA are isolated and medical staff who test positive stay at home.

-- Doctors track each case of MRSA by its individual strain, interviewing patients about where they've been and who they've been with, testing anyone who has been in contact with them.

Step No. 1, ratcheting back on antibiotic prescriptions and relying more on the old tried-and-true ones, won't go over well in America, where the prescription drug industry pushes all of us into a newer-is-better and more-is-better approach.

But step No. 2 -- test and isolate -- has been proven to work by itself to virtually wipe out the spread of MRSA once it gets into a hospital, by isolating people who are carriers.

The problem is that people can carry the bug on their skin without harm; a deadly infection only happens when it gets into the body of an already vulnerable patient. The answer: do nasal swabs of all incoming patients when admitted to the hospital to see if they are carriers, and if so, isolate them in special units.

Does your hospital do this? If not, you should ask why not. The safest hospitals in the United States do nasal swabs of all incoming patients at the time of admission. It's for their safety and everyone else's.

The CEO of Beth Israel Deaconess Medical Center in Boston is speaking out about his hospital's efforts to prevent deadly infections. The question is: How come few other hospital executives are talking about their efforts? Are they not making vigorous efforts? Or are they obsessed with secrecy, as so many in the medical industry are?

Paul Levy posted his hospital's numbers on reducing "central line" infections -- the infections that patients in ICUs get in the large-bore tubes that have to be inserted to monitor activity in the heart and deliver medicines to really sick people. When these infections occur, the already sick patient often dies. Pioneering work by Dr. Peter Pronovost proved that rigorous hand washing and other sanitation practices can reduce these infections to close to zero.

Mr. Levy is justifiably proud of Beth Israel's hard work at getting its infection rate down. But he wrote a blog entry that talked about his disappointment that others have not joined in. Here's an excerpt:

The response to my public and private entreaties in this realm has been silence -- from hospital professionals, from insurance executives who care about a transformation of this industry, and, indeed, from public advocacy groups who care about access to care and the quality of care delivered. Some observers attribute the medical profession's lack of engagement to an underlying fear of transparency. And yesterday, a world expert in this field, whose wisdom and advice I treasure, told me that he has come to accept gradual progress in quality and safety improvement, citing the kind of training doctors get, which does not emphasize these areas. That such a person has become content with gradual changes in the status quo is an indication of what it must be like to beat your head against this wall of recalcitrance for several decades.

My advantage, being without medical training and having had but a short tenure in this field, is that I retain a sense of outrage. Our collective failure to approach this problem using well established methods of process improvement -- including publication of current performance results -- represents a moral and ethical lapse by the clinical and administrative leadership of the medical establishment in this city. Why? Simply put, a profession that takes an oath to do no harm is, by inaction or incomplete action, doing harm. We are causing people to die who should not die. What would we call that if we saw it happening in other sectors of society?

Here's the full blog entry, which has comments below it.

I learned about Mr. Levy's blog from Consumer Union's excellent blog at their Safe Patient Project website.

A new report from Public Citizen proposes 10 cost-cutting, patient safety measures that would save an estimated 85,000 lives and $35 billion a year. The report, "Back to Basics," analyzed the results of scientific studies of treatment protocols for chronically recurring, avoidable medical errors.

In contrast to the high-tech tests and procedures that many experts blame for staggering increases in the nation’s health care costs, most of the reforms in Public Citizen’s report involve fundamentals as simple as practitioners consistently washing their hands, sufficiently tending to patients to prevent bed sores, and following simple safety checklists to prevent infections and complications stemming from operations.

Many of the proposals on Public Citizen's list are the same that I discuss in my book, "The Life You Save." The only difference is that I believe patients and families can do their own health care reform at home to implement many of these safety measures. I discuss examples of things patient advocates can do at the bedside to help prevent pressure ulcers (bed sores), injuries from falls, blood clots, infections and medication errors. See Chapter 12: "Your Personal Advocate, in the Hospital and Out," and Chapter 13: "The Scandal of Infections in Hospitals and Other Health-Care Facilities, and What You Can Do."

Here is more from Public Citizen's news release announcing their new report.

Aside from the tragedy of needless deaths and injuries, the financial toll of failing to follow accepted safety procedures is astounding. Severe pressure ulcers cost an average of $70,000 apiece to treat. A catheter infection costs $45,000. Each instance of ventilator-associated pneumonia costs $5,800. Collectively, avoidable surgical errors cost an estimated $20 billion a year, bed sores $11 billion and preventable adverse drug reactions $3.5 billion.

"There are many incentives to order expensive tests and procedures and too few rewards for providing basic, sensible care," said David Arkush, director of Public Citizen’s Congress Watch division. "As the largest investor in the nation’s health care system, the federal government should ensure that fulfilling basic patient safety standards is a condition of receiving federal reimbursements. And the government should pay providers for doing the right thing. It will save money in the long run."

Public Citizen proposes that health care providers:

• Use a checklist to reduce avoidable deaths and injuries resulting from surgical procedures (saves $20 billion a year);

• Use best practices to prevent ventilator-associated pneumonia (saves 32,000 lives and $900 million a year);

• Use best practices to prevent pressure ulcers (saves 14,071 lives and $5.5 billion a year);

• Implement safeguards and quality control measures to reduce medication errors (saves 4,620 lives and $2.3 billion a year);

• Use best practices to prevent patient falls in health care facilities (saves $1.5 billion a year);

• Use a checklist to prevent catheter infections (saves 15,680 lives and $1.3 billion a year);

• Modestly improve nurse staffing ratios (saves 5,000 lives and $242 million a year);

• Permit standing orders to increase flu and pneumococcal vaccinations in the elderly (saves 9,250 lives and $545 million a year);

• Use beta-blockers after heart attacks (saves 3,600 lives and $900,000 a year); and

• Increase use of advanced care planning (saves $3.2 billion a year).

Swine flu testing is the latest example of an important issue for informed patients. Patients need to understand that some medical tests are valuable if there is a "positive" finding, but not much good at all if they are "negative." The problem is that the test is "insensitive," which means a negative result can miss the disease that's really there -- a "broken alarm."

For swine flu, in every 100 patients who actually have flu, the various brands of "rapid flu" tests will have a "positive" result (meaning the patient has the flu bug) for as few as ten of the 100 patients, or as many as 69 of the 100 patients. Even with the higher accuracy, that means that a lot of patients are being missed by these "rapid flu" tests. These statistics come from a New York Times article quoting newly published studies and experts in the field including the Centers for Disease Control and Prevention.

A CDC official told the Times:

“We’re saying you need to understand the limitations of these tests,” Dr. Timothy M. Uyeki, an author of the C.D.C. guidance, said in an interview. “The clinician should not base a decision to treat or not treat on the basis of a negative result.”

Another classic example of an "insensitive" test is the "hemoccult" test for hidden blood in the stool. If it's positive, you need further workup. If it's negative, it doesn't give you a clean bill of health for colon cancer. That's why the standard screening test for colon cancer is a colonoscopy, which looks at the entire length of the colon with a video camera.

My book "The Life You Save" has a chapter about understanding medical testing and why you cannot necessarily rely on a negative test result.

The point is: A negative result doesn't mean you have a clean bill of health. Sometimes you have to pay attention to other signs and symptoms.

Several letters to the editor in the New York Times have good thoughts on the critical topic of reducing hospital-acquired infections. It's important not just to exhort hospital administrators to try harder, but to set up incentives that reward safety and punish harm. One incentive not discussed in these letters is a national mandatory disclosure system. That would require hospitals to measure and publicly report all their infections. Consumers would then be able to make intelligent decisions about which hospitals to seek care at.

As previously discussed in this blog, Consumers Union has been advocating such a disclosure system for several years and has made headway in various states, but a national system is needed.

Chapter 13 in my new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst, talks about, as the chapter title says: "The Scandal of Infections in Hospitals and Other Health-Care Facilities, and What You Can Do." Patients and family members can do a lot to enforce hygiene rules and avoid infection.

The news from Colorado that a drug-addicted surgery technician had exposed thousands of patients to the Hepatitis-C virus raises questions about the institutions' procedures for protecting patients.

According to news accounts, the surgery tech, Kristen Parker, swapped her dirty syringes, filled with saline, for clean ones filled with Fentanyl, in operating rooms at Rose Medical Center in Denver and Audubon Ambulatory Surgery Center in Colorado Springs. That way she could steal Fentanyl, a powerful morphine-based drug that is used for surgical anesthesia, and inject it into herself to feed her drug habit. Ms. Parker has just been charged in a federal criminal complaint.

The institutions are sending certified letters to 4,700 patients at Rose and 1,000 at Audubon advising them to get tested for Hepatitis-C. That's because Ms. Parker tested positive for Hepatitis-C, and several patients already have tested positive.

Hepatitis-C is a virus that causes chronic liver infection in about 75 to 85 of every 100 persons who get an acute infection. A few of those who get chronic infection go on to develop cirrhosis or liver cancer. There is no known cure for Hepatitis-C infection.

The Colorado Springs Gazette reports:

Parker worked at Rose from October 21, 2008 until April 2009. She resigned on April 20 from Rose, but the hospital refused to accept her resignation and instead fired her.
She went to work for Audubon shortly after being fired from Rose. She worked there from May 4 until Monday, said Dr. J. Michael Hall, Audubon's medical director.
Hall said certified letters are being sent to all patients who had outpatient surgery at the center's Circle Drive and Union Boulevard location May 4-July 1 advising them they may have been exposed and with instructions on what to do.

Surgical technicians are not licensed health care providers. Yet because their job involves preparing operating rooms for surgery, they have access to powerful drugs, so it's foreseeable the job can attract addicts. A similar incident occurred in Washington, D.C., a few years ago, where a tech at a major hospital was caught swapping out syringes filled with powerful pain reliever drugs for plain salt water so that he could inject himself with the narcotic drugs.

According to the Gazette:

Prior to being hired at Rose, she [Ms. Parker] submitted to a pre-employment blood test which tested positive for hepatitis C. She was allowed to start work but hospital officials counseled her about the disease and exposure possibilities.
Rose placed her on administrative leave following an incident in which a co-worker was pricked by a needle in Parker's pocket on March 23, 2009.
According to the affidavit, Parker quickly disposed of the needle and denied any use of narcotics. She was allowed to return to work after a drug screening test came back negative.
The hospital placed her on administrative leave again after a co-worker reported seeing Parker in an operating room to which she was not assigned. She was tested again for drugs and this time the results were positive for Fentanyl.

The questions yet to be answered include:

1. Why hire someone positive for a contagious disease like Hepatitis-C and give them access to needles which can spread the disease?
2. Why not fire her the first time she was found with a needle?
3. Why did the second institution hire her so quickly after she was fired by the first? Were references checked? Shouldn't she have been required to advise the surgery center who her most recent employer had been?
4. Should there be a central data bank so that health care employers can find out about fired or disciplined employees, so they cannot easily travel from job to job? There is such a data bank for licensed health care workers, but perhaps it should apply to unlicensed ones as well.

A new report from Consumers Union says too many patients are still dying every year from needless errors. The report makes a number of proposals for how reforms could be instituted to improve patient safety. A starting point will be to change the health reform debate in Washington from one of just access and money to one focusing on quality and safety.

Nearly 10 years ago, the Institute of Medicine estimated that nearly 100,000 people died each year from preventable medical error. Has there been any substantial improvement in the last decade? The Consumers Union report says the frustrating answer is "We don't know" -- because systems to methodically measure and report harm are still not widely in place.

What should consumers push for?

* A national system with mandatory reporting of all infections acquired in health care facilities and other harms from preventable errors.

* More widespread adoption by hospitals of computerized systems for ordering and dispensing drugs to cut medication errors.

Those are the key steps called for by the Consumers Union report. Here's one more that I advocate in my new book, The Life You Save: Nine Steps to Finding the Best Medical Care -- and Avoiding the Worst -- a "single payer" system. How would having a government-paid health care system help with safety? For starters, it would allow much easier monitoring of quality and errors. Instead of cobbling together data from dozens of insurance companies about how patients did at a particular hospital, all the data would be centralized and could be easily analyzed and compared. That way, problems with care could be more easily identified before tragedies occur.

Salmonella, which causes serious gastrointestinal illnesses that can be life-threatening, was found in pistachios last week, according to the Los Angeles Times. The FDA has issued warnings for consumers to stop eating all foods containing pistachios, while investigations are underway.

Although salmonella contamination in pistachios is yet to be confirmed, Setton Pistachio of Terra Bella Inc., the nation’s second-largest pistachio processor, has voluntarily recalled more than 2 million pounds of nuts that it shipped out last fall. Kraft Foods Inc. and Kroger have also recalled some of their pistachio products.

Consumers are advised to stop eating pistachio products and monitor the investigations as more reports become available.

An online service called inSPOT allows patients who test positive for STDs to use a website to notify sexual partners, anonymously if they so choose, of the possibility that the partners were infected. A report done by the San Francisco Department of Public Health finds that since 2004, 30,000 people have used the service to send 50,000 notifications of all sorts of diseases contracted through sexual activity.

This project has enormous potential health benefits because embarrassment and a desire to remain anonymous are factors that can prevent people from notifying past sexual partners of their risk of contracting the disease. Of course, as Dr. Richard Rothenberg of Georgia State University notes in the article, it is difficult to track the effects of the project because of confidentiality issues. Nevertheless, the project is valuable:

However, it may be difficult, if not impossible, to study the impact on health because the service is confidential, Rothenberg said. "I think we, and the authors, must be content with the idea that this appears to be an acceptable method to fulfill the moral imperative of notification, and it has a chance to be a better approach than what we currently do," he said.

Laura Landro, in her column "The Informed Patient," discusses the problem of adults neglecting to get vaccinated for new illnesses. Not only that, but adults forget or are unaware that some childhood vaccinations lose efficacy after some time and need to be re-done. Skipping pre-travel vaccinations is also a common error.

Part of the problem is insurance: not only is vaccination for the very young more likely to be encouraged, but it is also more likely to be covered by insurance providers.

The whole column is worth a read, but here are some disturbing statistics Landro cites:

-only 2.1% of adults are vaccinated for tetanus, diphtheria and whooping cough, despite the existence of a combination vaccine for all three.

-only 1.9% of adults have been vaccinated for shingles. The shingles vaccine is recommended for all adults over 60.

-only 10% of women from 18 to 26 have received the vaccine for human papillomavirus, which can lead to cervical cancer, and which most insurance providers will cover.

One-third of new HIV cases in the U.S. are due to injection drug use, and HIV/AIDS has decimated the African-American community in particular. That is why it is no surprise that the NAACP and other advocacy groups chose Thursday--which was National Black HIV/AIDS Awareness Day--to call on Congress to repeal a ban on federal funding for needle exchange programs. There is some political controversy over this ban, because many politicians are afraid to look like they are supporting drug use, but public health advocacy groups are generally in favor of repealing the ban because of the demonstrated effects of needle exchange programs.

A quote from a supporter of repeal from the article:

Anthony Fauci, director of NIH's National Institute of Allergy and Infectious Diseases, on Wednesday said that he supports needle-exchange programs. In a separate statement, Fauci said the high rates of HIV/AIDS among blacks require "drastic action." He added, "In particular, black leaders -- religious, secular and political -- have a key role to play in reducing the stigma often associated with HIV/AIDS and influencing African-Americans to get tested, counseled and treated" (Crary, AP/Seattle Times, 2/6).

MRSA or methicillin-resistant staphylococcus aureus, a "superbug" infection usually contracted in hospitals, is now being transmitted during male-male sexual encounters. This news comes just a few months after MRSA was discovered in some Virginia schools. As the linked pages note, MRSA is highly drug resistant and can be deadly. It comes in many strains and is often difficult to treat, requiring expensive antibiotic regimes. The discovery of MRSA in schools and among sexually active gay men is disturbing because it indicates that this "superbug" is no longer an exclusively hospital-based phenomenon and may start becoming more common in the general population, where researcher Binh Diep says it would be "unstoppable."

In San Francisco, researchers found that sexually active gay men were 13 times more likely to have MRSA than sexually active heterosexuals. It is passed on in the same way as other sexually transmitted diseases: unprotected and skin-abrading sex.

The best way to avoid getting MRSA in any fashion is through simply practicing good hygiene and washing with soap and water. This is why, as this blog has discussed before, it is vitally important for healthcare professionals to wash their hands before examining or treating patients.

An article in the New Yorker by Atul Gawande highlights the simple ways in which hospitals can be made less dangerous places for their patients. A checklist to make sure intensive care doctors and nurses handle catheters correctly has been proven to dramatically reduce the risk of deadly infections. Gawande focuses on the work of Peter Pronovost, MD, an intensive care specialist at Johns Hopkins Hospital who consults with hospitals around the country to spread his gospel of routinizing simple procedures. For example, on catheter infections, Pronovost's work was first published in December 2006 in the New England Journal of Medicine. In 108 ICU's across Michigan, they were able to virtually wipe out catheter-based infection by enforcing a required checklist of five interventions: hand-washing before handling a catheter, full-body draping when inserting a central venous catheter, scrubbing the skin with chlorhexidine, avoiding catheters in the groin, and removing unneeded catheters as soon as possible. All hospitals should implement these simple ideas which can prevent deadly infections and save lives. Dr. Pronovost is a pioneer in patient safety research.

Recently, a 17-year-old in Bedford County, Virginia died of an infection known as MRSA . MRSA stands for “methicillin-resistant staphylococcus aureus” and is also referred to as a “staph infection” or a “superbug.” MRSA is a particular kind of staph infection that is resistant to common antibiotics. The MRSA bacteria was found in many other schools in Virginia as well as over the country, and Bedford County schools were closed down as a result.

These developments are unusual and surprising because MRSA generally turns up in hospitals, rather than in schools or other places in the community.

Things to know about MRSA:

1)It is spread through skin-to-skin contact. Alternately, it can be spread through surfaces or objects that many people have touched or through personal items such as towels.

2)MRSA is easy to prevent but can be difficult to cure. Basic hygiene is the number one factor in preventing this infection. Hand-washing is especially important. Other factors include keeping personal items clean, using disinfectants and being careful about use of antibiotics. Overuse of antibiotics is what prompts bacteria to evolve into resistant strains.

3)As most MRSA cases occur in hospitals, it is important to be especially vigilant about the hygiene about those around you if you or a loved one is admitted to the hospital. Do not be shy about asking if doctors, nurses, or other caretakers have washed their hands. Lack of such basic measures has led to deaths in the past, as can be seen by examining the case of Maureen Daly and others.

Another useful resource are these FAQs about schools, kids and MRSA.