Last week, Tim e-mailed me about his posting on hospital infections. It took me a while to listen to the show on Fresh Air that he was talking about. This is complicated stuff that goes way back to Semmelweis .. and even the CDC has compelling tales to tell about this man who died before anyone could say "oops, you were right" and how relevant such tales remain today.
Hospital infections do seem to rise, but I'm not sure that there is one clear reason for it. A few observations:
a) Patients in hospitals are sicker now than they ever have been. This is a confounding variable that I'm not sure that Michael Berens (who was featured in the Fresh Air story) accounted for. (His articles appear in the Chicago Tribune .. but it costs $$ to see them.)
We're doing a BETTER job in haircare in general. No kidding. Patients leave the hospital much sooner, and we are able to keep many patients OUT of the hospital altogether .. by managing their illness at home with the help of visiting nurses and/or frequent visits to (or from!) the physician. So as the proportion of very ill patients to not-so-ill patients int he hospital increases, their susceptibility to infection increases dramatically. Indeed, it is the very ill patients who are more likely to be the sources of resistant organisms.
b) Berens is right, however, that nurses are spread awfully thin in the hospital, and that people with much less training are doing work previously done by nurses. The nurse of today cares for double the caseload of a nurse from 1975 … and we've done little to make the job easier with information technology.
But hospitals aren't necessarily the villains here either. Losing money is a tradition for most hospitals .. especially academic centers .. as the payers squeeze every last dollar out of the hospitals.
c) Hand-washing can certainly increase, but there are other obstacles to infection control as well. Our stethoscopes carry potentially dangerous organisms from patient-to-patient. Yet no one has come up with a good method of cleaning them between patients (hmm .. the stethy-condom .. now there's a million-dollar idea!) ..
I don't want to come off as saying that Berens is blowing this all out of proportion .. but I will say that it's been over a year since a patient I've cared for in the hospital has become infected while they were an inpatient. The nursing shortages are palpable and annoying, but I have not seen patient care significantly impacted. The nurses I work with are dedicated and passionate about their work. Do they make mistakes? Of course they do .. as do all humans .. but I think that blaming the increase in infections on the structure of nursing care in hospitals is too simplistic.
d) Finally, of course, is a reminder that antibiotics are overused. If there was one smoking gun to the increasing rate of infections in hospitals, I would argue that it is over-treatment …both inpatient and outpatient … of infections that would likely respond to narrower-spectrum agents.