The good people at GE and JESS3 have come up with an HAI infographic. It’s pretty, and it conveys the horrible information that many of us already know — healthcare associated infections kill about 100,000 people a year, and add $35 billion a year to our collective health care bill (here in the US of A); 5% of hospital inpatients end up with an HAI.
So what do we expect the world to do with this infographic? The FDA has rolled out new cigarette package warnings, including graphic photos, that are presumably intended to so sicken potential purchasers of cigarettes that they drop the pack of cigarettes and run screaming from the counter. In more measured terms, the FDA says:
The introduction of these warnings is expected to have a significant public health impact by decreasing the number of smokers, resulting in lives saved, increased life expectancy, and lower medical costs.
But what is the expected public health impact of publishing this infographic?
I would like to see GE, and/or others, fund the public health campaigns that are needed to accompany the release of such information. GE is already doing some of that, to be sure, but a staggeringly large problem like the one identified here needs more attention. The federales are trying to move the needle by refusing to pay for the cost of providing health care services required due to HAIs. The government and providers are likely to be spending a lot of time and resources in line-drawing and finger-pointing, fighting over the dollars at stake, without pulling back and addressing root causes of HAIs in a systematic manner.
And what sort of campaign do we need in this circumstance? A consciousness-raising campaign, so that (1) the empowered patient can insist on provider transparency, and create additional market forces pulling or pushing providers away from the marketplace that has allowed the preventable HAI count to swell, and (2) engaged providers can work to prevent the preventable HAIs and communicate the value and quality of care that they can deliver to patients and potential patients.
One possible meeting ground for like-minded patients and providers on this issue is the Society for Participatory Medicine (yes, another shameless plug for the Society and its journal, blog — yes, this blog — and listserv). Join us!
Participatory Medicine is a movement in which networked patients shift from being mere passengers to responsible drivers of their health, and in which providers encourage and value them as full partners.
Again, the infographic may introduce the problem to folks who may not be aware of it, but the real work lies in solving the problem, not just realizing that there is one.
A version of this post first appeared on David’s home blog, HealthBlawg.
Thanks, David – and thanks to GE and JESS3 for giving some visual life to these (fatal) numbers!
Working backwards I get to some numbers I’ve always wondered about:
If 5% (1 in 20) of patients get an HAI, and that equals 1.7 million infections, it means we admit 20×1.7 million = 34 million patients per year to hospitals
The 99,000 who die = 5.8% of those who get one. So, when we hear that a loved one just got an HAI, there’s a 1 in 17 chance it’ll become hospital-acquired DEATH. (Yes?)
Plus, if an HAI averages 17.6 extra days in the hospital (2.5 weeks longer), that’s a nasty impact on income, family stress, parent or elder away from home, time spent by bedside advocates, etc. Ouch.
Good time to review the CDC’s video Hand Hygiene Saves Lives, with its simple but potent demonstration of how to INSIST (gently if possible, but INSIST) that EVERY hospital employee wash hands upon entering the room. Every time!
This problem is much more complicated than you can ever imagine. Washing hand will not solve the problem. It ready doesn’t matter what my opinion is either. The people who pay attention and use some common sense should have no problem. If you are however uneducated, obese, have multiple comorbidities and otherwise poor hygine yourself prior to admission you are at great risk of infection despite anyone touching you. Every study I have read regarding this barely touches the surface of the problem but the all draw the same conclusion…healthcare workers are the problem. Yet despite using a precautionary measure such as hand washing and antiseptic technique, infections are still on the rise. Poor hygiene, poor dental care, poor diets, alcohol over consumption and smoking are the real cause. If you look at healthy countries with less resources for healthcare per capita, they don’t have the same infection rates. Some these countries use our donated waste for their operating rooms and they still don’t have the same rates of infection. Hand washing ??? Yeah right!!! Btw I don’t shake hands any more and use aerosolized hand sanitizer between every patient( if my hands fall off someday I am going to be very unhappy).
Btw if a hotel gets infested with bed bugs, who is to blame???
Thanks for your note, @Realistic. I don’t have the data to discuss this knowledgeably so I hope someone who does will join in. What I said before was consistent with everything I’ve heard at conferences and in reports, but it might be wrong.
Having said that, I find it hard to imagine that being uneducated and with poor hygiene OUTSIDE the hospital makes it more likely that you’ll get an infection INSIDE the hospital – are you saying there’s evidence for that? It seems inconsistent with your other assertion that HAI rates are lower in countries with lower socio-economic status.
But again, I don’t have data tables at hand to compare, education-for-education, obese-for-obese, etc.
p.s. I’m glad that while you feel hand washing won’t solve the problem, you still do it…. thanks.:–)
“If you are however uneducated, obese, have multiple comorbidities and otherwise poor hygine yourself prior to admission you are at great risk of infection despite anyone touching you.”
If a fat, uneducated, dirty patient goes into the hospital without an infection and is not colonized with a microorganisme, and becomes infected 72 hours after admission, it is the hosptials fault. Patient hygiene has gone by the wayside in understaffed hopsitals with over assigned nurses. It’s easier and makes more money for the facility to treat the infections. The facts remain….85% of all MRSA comes is healthcare associated, so to blame patients for their own infections because of lack of education, being fat or failure to meet a hospitals clealiness standards is way off base. When doctors and Hospitals accept that most of these infections, MRSA C Diff and others are preventable with the appropriate steps and then takes those steps, Patients AND healthcare workers will be safer.
Microbiology 101 reminder from wikipedia: ‘A fomite is any inanimate object or substance capable of carrying infectious organisms (such as germs or parasites) and hence transferring them from one individual to another. A fomite can be anything (such as a cloth or mop head). Skin cells, hair, clothing, and bedding are common hospital sources of contamination.
Fomites are associated particularly with hospital acquired infections (HAI), as they are possible routes to pass pathogens between patients. Stethoscopes and neckties are two such fomites associated with health care providers. Basic hospital equipment, such as IV drip tubes, catheters, and life support equipment can also be carriers, when the pathogens form biofilms on the surfaces. Careful sterilization of such objects prevents cross-infection.
Researchers have discovered that smooth (non-porous) surfaces (e.g. door knobs) transmit bacteria and viruses better than porous materials (e.g. paper money).[1][2] The reason is that porous, especially fibrous, materials absorb and trap the contagion, making it harder to contract through simple touch’.
And, doc….a fomite doesn’t care what your education level is or what your weight is!
Also, hand washing ALONE will not fix the problem but it is a very important part of the solution.
Thanks for the additional info, Suzan.
In the spirit of participatory thinking, as we work together to solve these grossly intractable and lethal problems, I’d like to encourage us all (including myself) to bear in mind the different value of rationale (e.g. “Hand washing is obvious,” “Fomites behave this way”) and evidence. I had thought this was all obvious and proven, which is why I’m hoping to drag in someone who’s fluent in the evidence.
As I recall, last November an article in the New England Journal of Medicine covered how North Carolina had tried its darnedest for several years to reduce harm, with little result. I haven’t seen that article – has anyone here? I’m wondering specifically what measures they took re HAIs, and what the results were.
For instance, if they achieved 90% hand washing and there’s STILL no improvement in HAIs, that says indeed the problem lies elsewhere (in addition to handwashing).
153 VA hospitals all participated in a 2 year study in collaboration with the CDC. This study invovled using Active Detection and Isolation which included rapid PCR MRSA screening all incoming patients except psych patients, Isolation or cohorting all positive patients and contact precautions for positive patients. It also involved a cultural change from the top down promoting better housekeeping, reminding HC workers on handwashing or other precautions, and employment of MRSA officers. They reduced their MRSA rate in the general wards by 30% and a huge 70% in ICUs in just 2 years. These are the average reductions in MRSA in 153 VA Hospitals nationwide. This is what can be done with the correct approach, education and cultural change. This was such a success that this year their MRSA prevention program was expanded into their LTC facilities. Amazing work is being done…now if we can just get the Professional Infection associations and the CDC to recognize this proof that ADI works and act on it…..thousands upon thousands of lives will be saved every year.
These problems have been with us for along time, and it will take a long time to correct them. My concern is that we have not yet taken a decisive first step. As I have previously observed — Ten Years After “To Err Is Human” (HealthBlawg)http://j.mp/8zsLTU — the number of medical errors has not changed appreciably despite a decade of handwringing. Some very smart people have resigned themselves to the notion that the issue will not be rectified unless and until there is a wholesale change to the medical school curriculum, and a new generation of docs comes up through the system — Patient safety not taught in medical school? Lucian Leape Institute releases Unmet Needs: Teaching Physicians to Provide Safe Patient Care (HealthBlawg) http://j.mp/qVyhxW
Of course, such an approach consigns those of us in need of care today to continued exposure to unsafe conditions. There’s got to be a way to harness the information and expertise at hand so as to start preventing those preventable HAIs sooner rather than later.
Ten Years After “To Err Is Human” (HealthBlawg) http://j.mp/8zsLTU
To be fair, the federales will be awarding $1 billion in grants through the CMS Innovation Center’s Partnership for Patients. See: http://j.mp/nmVWHF
>quote
The two goals of this new partnership are to:
Keep patients from getting injured or sicker. By the end of 2013, preventable hospital-acquired conditions would decrease by 40% compared to 2010. Achieving this goal would mean approximately 1.8 million fewer injuries to patients with more than 60,000 lives saved over three years.
Help patients heal without complication. By the end of 2013, preventable complications during a transition from one care setting to another would be decreased so that all hospital readmissions would be reduced by 20% compared to 2010. Achieving this goal would mean more than 1.6 million patients would recover from illness without suffering a preventable complication requiring re-hospitalization within 30 days of discharge.
Achieving these goals will save lives and prevent injuries to millions of Americans, and has the potential to save up to $35 billion dollars across the health care system, including up to $10 billion in Medicare savings, over the next three years. Over the next ten years, it could reduce costs to Medicare by about $50 billion and result in billions more in Medicaid savings. This will help put our nation on the path toward a more sustainable health care system.
>end quote
Sounds like big numbers, but given the magnitude of the problem, most of these are fairly modest goals.
GE Healthcare released a white paper today, which provides some background on the issue, to accompany the infographic http://bit.ly/pRlc9v & I tweeted an invitation to @GEHealthcare to join the conversation here …
As one of the authors (and Vice President for Government and Industry Affairs at GE Healthcare IT)- of the GE Healthcare White Paper http://bit.ly/qPYT9d – that accompanied the infographic referenced on Healthblawg – http://bit.ly/qbKiMf, I’d like to thank David Harlow for his thoughtful observations and those of the others who commented on the initial post. GE Healthcare is committed to publicizing the highly preventable problem of HAIs through multiple approaches and channels. The infographic and the White Paper are just the start.
As David makes clear, we need to move beyond information to action. There are multiple ways to solving this problem and we will need all of them. One, of course, is to move beyond raising the visibility of the issue by demonstrating exactly why providers need to focus on this problem. This message must be coupled with the evidence-based point that a very high degree of success is well within our reach through a mix of approaches, including the checklists championed by Drs. Peter Pronovost and Atul Gawande – http://nyr.kr/7SauQw.
In addition, GE Healthcare is focused on solutions that can help hospitals and other providers tackle this scourge effectively, including a Patient Safety Organization – http://bit.ly/ocX0H4 – and IT solutions that help providers monitor patient safety indicators. The passion and engagement on this issue by the folks in this thread is terrific.
Mark, Thank you for joining the conversation, and we look forward to working together in moving from sharing information to taking action.