Hospital-Acquired Infections

 During a recent hospital visit, a MD making his rounds performed a brief patient examination in my presence. He introduced himself to me, we shook hands, he performed his exam and shook hands with both of us before departing the room. At no time did he wash his hands. Nurses were the subjects of my previous blogs with this same title, but I had already read complaints from other staff about doctors who don't follow hand washing procedures. Since doctors give nurses and other clinicians orders that they are supposed to follow, this creates an awkward situation.

GE has produced the graphic below, with supporting details here.

GE produced this graphic in support of their Healthymagination program, which includes the Smart Patient Room. Their press release at the May 2011 first anniversary of the program reports $700 million spent on R&D thus far, so Jack Welch's hospital-acquired infection has had quite an impact. Doctors and even visitors are not allowed to exempt themselves from hospital hand washing procedures when the Smart Patient Room technology is present. There are relatively low-tech solutions which have produced a decent level of compliance, e.g., the Targeted Solutions Tool, but I favor the medical error reporting system that is part of the Smart Patient Room technology.

From the above graphic, you can see why Medicare/Medicaid is proposing that hospitals and clinicians not be reimbursed for HAIs. The savings to the programs would be significant. Also, this is part of the push for electronic medical records, with electronic entries made in a patient's records for the sake of prevention of many sources of errors, e.g., patient identification, administration of the correct drug in the correct amount and at the correct time, confirmation that all surgical tools and sponges have been removed from a patient before suturing, etc.

The figure below from Infection Control and Hospital Epidemiology 32(4):388, 2011 (pdf). is cited as an indication of what is probably happening now. Since this and other studies are retrospective based on laboratory and patient discharge data, current national numbers await definitions for HAIs and standardized laboratory testing.

The five year trend for ten hospitals in the Duke Infection Control Network indicates that the incidence of Clostridium difficile has surpassed methicillin-resistant Staphylococcus aureus because the incidence of the latter has been dropping. The efforts made for MRSA control now need to be extended to C. difficile.