Preventing Hospital-Associated Illnesses

The failure to timely diagnose and treat a hospital-acquired illness (HAI) can, of course, be considered medical negligence. If doctors and nurses stick their heads in the sand and fail to recognize the signs of a serious infection, it can tragically worsen the patient’s condition. That sort of neglect can form the basis of a viable malpractice claim.

As it turns out, infection rates vary considerably between hospitals. The difference in infection rates is now being traced to whether the hospital has adopted a culture of “attentive hygiene.” When hospitals take steps to improve that hygiene, infectious disease doctors and hospital quality and safety research groups are finding that most hospital associated illnesses can be prevented.
That doesn’t mean that every hospital-acquired infection is the result of the hospital’s mistakes.

However, the research does mean that in a case where hospital acquired infection has caused severe harm, it may be well worth investigating whether the hospital had any of these common sense infection control protocols in place, and more importantly, whether the hospital made a real effort to strictly comply with the protocols on a daily basis.
 

Hospitals Fined for Errors

Last month several California hospitals were praised by the federal Health and Human Services Agency. This month a dozen hospitals were penalized for significant errors. The California Department of Public Health (CDPH) announced twelve California hospitals have been assessed administrative penalties after it was determined the facilities’ noncompliance with licensing requirements caused, or was likely to cause, serious injury or death to patients. The department levied a total of $650,000 in fines for errors that occurred between 2008 and 2010. Most of the errors involved medication mistakes or surgical tools left inside patients after operations.

1. AHMC Anaheim Regional Medical Center, Anaheim, Orange County.
2. Contra Costa Regional Medical Center, Martinez, Contra Costa County.
3. Dominican Hospital, Santa Cruz, Santa Cruz County.
4. Emanuel Medical Center, Turlock, Stanislaus County.
5. Kaiser Foundation Hospital, San Francisco, San Francisco County.
6. Mills-Peninsula Medical Center, Burlingame, San Mateo County.
7. Palomar Medical Center, Escondido, San Diego County.
8. Pomerado Hospital, Poway, San Diego County.
9. Promise Hospital of East Los Angeles, Los Angeles, Los Angeles County.
10. Scripps Memorial Hospital – Encinitas, Encinitas, San Diego County.
11. Scripps Memorial Hospital – La Jolla, La Jolla, San Diego County.
12. Sharp Memorial Hospital, San Diego, San Diego County.

California law requires hospitals to report to the CDHP their noncompliance with their own policies and procedures. The CDPH investigates the reports and issues fines. If problems persist, the hospitals could lose their state operating license or their reimbursements from Medicare and Medi-Cal, California's Medicaid program.

In addition to administrative penalties, hospitals may be held responsible by the injured patient. When it is suspected that a hospital’s error injured a patient, the hospital’s policies and procedures are crucial to showing the hospital's accountability.  

HHS Recognizes Four California Hospitals for Progress Toward Eliminating Healthcare-Associated Infections

The U.S. Department of Health and Human Services has recognized 37 U.S. hospital and health care facilities for their efforts to prevent hospital-associated infections (HAIs), a leading cause of death in the United States. The awards recognizes individuals and institutions for their efforts to reduce ventilator-associated pneumonia and bloodstream infections associated with central intravenous lines.

HAIs are infections that are acquired while patients are receiving medical treatment for other conditions. One in every 20 hospital patients acquires an infection related to his hospital care. HAIs can have devastating emotional, financial and medical consequences.

“People enter a hospital expecting to get healthier, not sicker,” said Assistant Secretary for Health, Howard K. Koh, MD, MPH. “We applaud hospitals for their efforts in improving the quality and safety of health care for all Americans.”

Awards were conferred on two levels, according to specific criteria tied to national standards. The “Outstanding Leadership Award” went to teams and organizations that sustained success in reaching their targets for 25 months or more. The “Sustained Improvement Award” recognizes teams that demonstrated consistent and sustained progress over an 18- to 24-month period.

Of the 37 Initial award recipients one Northern California hospital -- Seton Medical Center in Daly City -- was recognized in the category “Achievements in Eliminating Ventilator-Associated Pneumonia” with an “ Outstanding Leadership Award”. Three Southern California facilities received “Sustained Improvement” Awards: St. Joseph Hospital, Orange; Huntington Memorial Hospital, Pasadena; and Palmdale Regional Medical Center, Palmdale.

 

Hospital Associated Illnesses: Pneumonia, Bloodstream and Urinary Tract Infections

Health care facilities - whether hospitals, nursing homes, or outpatient facilities - can be dangerous places. One risk is “hospital-associated illnesses,” also called "hospital-acquired illnesses." 1.7 million patients contract HAIs each year. In 2002, nearly 100,000 patients died from HAIs. The fatalities broke down as follows:

36,000- pneumonia,
31,000 - bloodstream infections,
13,000 - urinary tract infections,
8,000 - surgical site infections, and
11,000 - infections of other sites.

Many HAIs are caused by breaches of infection control practices and procedures, unclean and non-sterile environmental surfaces, or ill employees.

Ventilator-associated pneumonia (VAP) occurs in people who are on mechanical ventilation through an endotracheal or tracheostomy tube. VAP results when and infection floods the alveoli - small, air-filled sacs in the lung responsible for absorbing oxygen from the atmosphere. VAP is distinguished from other kinds of infectious pneumonia by the different types of microorganisms responsible, antibiotics used in treatment, methods of diagnosis, ultimate prognosis, and effective preventive measures. The organism associated with VAP is most often Pseudomonas.

Central line-associated blood stream infections (CLABSIs) are blood infections introduced by a central venous catheter, or tube placed in a large vein in a patient's neck, chest, or groin to administer medication or fluids or to collect blood samples.

Urinary tract infections (UTIs) afflict patients with indwelling urinary catheters, patients undergoing urological manipulations, long-stay elderly male patients and patients with debilitating diseases. The organisms responsible may originate from the patient’s own body or from a moist site in the hospital environment. Pathogens causing HAI UTIs tend to have a higher antibiotic resistance than simple UTIs.

Hospitals have sanitation protocols regarding uniforms, equipment sterilization, washing, and other preventative measures. Thorough hand washing and/or use of alcohol rubs by all medical personnel before and after each patient contact is one of the most effective ways to combat hospital associated infections. Careful use of antimicrobial agents, such as antibiotics, is vital.