Tuesday, November 14, 2006

Hospital-induced Infections

An op/ed appeared in today's New York Times raising the important issue of hospital-induced infections, “which account for an estimated 100,000 deaths every year.” The author, Betsy McCaughey, describes the spread of the deadly Staph infections: “Doctors and other caregivers who lean over an [infected] patient often pick up the germ on their hands, gloves or lab coats and carry it along to their next patient.” McCaughey has apparently given up, however, on the possibility of getting caregivers to wash their hands and change their gowns between patients. Indeed, she notes that “[e]arlier efforts to stop these infections by installing many more dispensers of hand cleanser and conducting a year-long educational campaign on hand hygiene had no effect.” Her current proposal is to screen all patients for the presence of the infection.

I have addressed this issue in two columns, Unclean Hands: How Patients Can Prevent Blatant Medical Malpractice and Hospital-Induced Infections: A Serious Crime Against Our Nation's Patients. In both, I have proposed that such infections continue to spread because many caregivers do not want to – and accordingly don’t – wash or disinfect their hands. The simplest solution is therefore to compel them to use the hand cleansers. Doctors and nurses often prefer to skip the hand-washing, knowing – as they do – that it is virtually impossible to trace a particular infection to a specific individual. Without accountability, in other words, there is no compliance.

But they can and must be held accountable. How? Here’s one possibility: Hospitals can require that before every medical interaction, every patient receive a form that explains to the patient that over 100,000 people a year die in hospitals because of the providers’ failure to observe basic hygiene around patients. The form should accordingly instruct the patient to pay attention to whether his provider washes her hands before touching him. Then, after the patient sees his doctor or nurse, he should be given the same form and asked to respond anonymously to the following questions: 1. Did each of your providers wash or sanitize her hands before touching you? 2. If not, please name or describe by appearance the providers who did not. 3. Did you say anything to your provider at the time about the failure to wash? 4. If so, was the provider receptive to your criticism? Doctors and nurses receiving more than one or two complaints on this score could be warned and ultimately observed by an internal health inspector. A failed inspection could result in suspension and ultimately termination. If the failure to use proper hygiene were treated as the malpractice that it is, then the inexcusably high mortality rates would likely drop.