Hospital Acquired Infections:
American hospitals’ “dirty little secret”
Hospital acquired infections, which are also referred to as “nosocomial”
or “healthcare acquired” infections, have been recognized
for over a century as a critical problem affecting the quality of
healthcare and a principal source of adverse healthcare outcomes.
Among all of the major complications that occur during hospitalization,
nosocomial infections account for more than 50%. 1
 Hospital
acquired infections affect around 2 million individuals every year,
resulting in approximately 90,000 annual deaths in the United States
alone.2
Incredibly, hospital infection deaths represent
the fourth leading cause of death among Americans (behind heart
disease, cancer and strokes), and nosocomial infections kill more
people in our country each year than car accidents, fires and drowning
combined. 3 Currently in the United States, a patient
dies of a hospital acquired infection every six minutes. 4
“The number of people needlessly killed by hospital infections
is unbelievable, but the public doesn’t know anything about
it” said Dr. Barry Farr, a leading infection-control expert.
“For years, we’ve just been quietly bundling the bodies
of patients off to the morgue while infection rates get higher and
higher.” 5
And yet at the same time, the agency that inspects American hospitals
to insure that all federal safety and quality standards are met,
claims that 90% of these facilities are in good or acceptable compliance
in infection control! 6
The Centers for Disease Control and Prevention (CDC) defines a
nosocomial infection as a localized or systemic condition (1) that
results from an adverse reaction to the presence of an infectious
agent(s) or its toxin(s) and, (2) that was not present or incubating
at the time of admission to the hospital. For most bacterial infections,
this means that the infection usually becomes evident 48 hours or
more (the typical incubation period) after admission to the health
facility. Surgical site infections (SSIs) occur within 30 days after
an operative procedure, and between 12% and 84% of SSIs are only
detected after patients are discharged from the healthcare institution. 7
 Nosocomial
infections have for years been falsely characterized by the healthcare
industry as random and inevitable byproducts of lifesaving care.
Almost all of these infections, however, are not “unavoidable
complications” and don’t “just happen.”
The healthcare industry's penchant for secrecy and a lack of any
meaningful oversight cloak the extent of the problem that exists
in our nation’s hospitals. It is interesting to note that
even the term adopted by the CDC—nosocomial—was intended
to obscure the true source of the germs (it is derived from Latin
and means hospital acquired). CDC records show that the term was
used to shield hospitals from the “embarrassment” of
germ-related deaths and injuries. 8 (See, Lack of Disclosure).
A 2002 Chicago Tribune undercover investigation found that in the
year 2000, nearly three-quarters of deadly hospital acquired infections
were preventable, the result of unsanitary facilities, germ-laden
instruments and unwashed hands. 9 The industry's desire for secrecy
also obscured a disturbing trend which the Tribune investigators
found buried within government and private healthcare records: Infection
rates are soaring nationally, exacerbated by hospital cutbacks and
carelessness by doctors, nurses and other healthcare personnel. 10
 The
vast majority of all nosocomial infections are transmitted by contact
from patient to patient via the hands of healthcare workers (HCWs),
and this type of transmission is well-documented. 11
The hands of HCWs are only transiently contaminated however, and
appropriate hand hygiene measures are sufficient to remove the pathogens
and to stop the transmission to patients. In other words, hand washing
is the simplest and most effective method to reduce the incidence
of nosocomial infections. 12 Despite this well established
relationship, compliance with hand washing has consistently been
unacceptably poor among all types of healthcare workers. 13
Currently, hand washing or hand hygiene rates in the United States
average 40 percent to 60 percent “on a good day,” says
Robert Weinstein, M.D., from Cook County Hospital in Chicago, 14
and that appears to be the historic norm. 15 According to most experts,
more than half to three-quarters of all nosocomial infections could
be prevented if healthcare workers strictly followed hand washing
procedures. 16
The CDC publishes various guidelines for the prevention and control
of nosocomial infections. These guidelines, however, are non-enforceable
due to the fact that the CDC is not a regulatory agency. Accordingly,
the CDC now estimates that as many as one-third of all U.S. hospitals
fail to follow its guidelines for hand washing and other basic infection
control precautions, even though strict adherence to clean-hand
policies alone could prevent the deaths of up to 20,000 patients
each year. 17
 Why
do our nation’s HCWs continually fail to adequately wash their
hands? The answer, unfortunately, remains extremely elusive. Some
of the reasons that have been suggested for such poor hand washing
include the lack of priority over other required procedures, insufficient
time, inconvenient placement of hand-washing facilities, allergy
or intolerance to hand-hygiene solutions, and lack of leadership
from senior medical staff. 18 (See, Why Don’t Doctors
and Nurses Wash Their Hands?).
Whatever the reason, hospital physicians appear to be the worst
offenders. The Annuals of Internal Medicine recently reported that
hand washing rates among hospital physicians still remain unacceptably
low at 57%, 19 although this finding demonstrates a slight improvement over previous studies. In their recent book entitled Internal Bleeding,
The Truth Behind America’s Terrifying Epidemic Of Medical
Mistakes, Drs. Robert Wachter and Kaveh Shojania boldly state, “[s]ome
of us can’t be bothered to wash our hands before examining
patients.” 20 Indeed, some studies show that the failure to
properly wash ones hands is inversely related to status: physicians
are less likely to wash than nurses' aides. 21
One might expect to find better hand washing rates among those
HCWs caring for an intensive care unit (ICU) or emergency room patient,
the exact opposite is true: hand washing rates in ICU’s are
consistently lower than other hospital areas. 22
The lack of hand-washing is responsible for almost all of the germs
spread in pediatric intensive care units. In fact, pediatric ICUs
experience up to three times the number of infections as other hospital
areas, including operating rooms. 23 It is true that overall infant
mortality rates continue to decline inside U.S. hospitals, however
records show the rate of lethal pediatric infections acquired in
hospitals is steadily rising. 24
At a 1997 conference of infectious disease experts, Dr. William
Jarvis, chief of the investigation and prevention branch of the
hospital infection program of the CDC stated, “Infections
are most often transmitted from patient to patient on the hands
of healthcare workers. If they would just wash their hands between
all patients, I wouldn’t be standing up here lecturing on
prevention.” 25
Last upate on: 10/03/06
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