Report: CDC Off on Infection Deaths
CHICAGO -- About 103,000 deaths were linked to hospital infections in 2000 -- a figure
14 percent higher than government estimates -- and nearly 75 percent of the deaths
were preventable, the Chicago Tribune reported.
The national Centers for Disease Control and Prevention last year calculated 90,000
deaths in 2000 were linked to hospital infections, the fourth leading cause of death in
the United States behind heart disease, cancer and strokes.
Many of the deaths were caused by unsanitary facilities, germ-laden instruments and
unwashed hands, the newspaper said in early Sunday editions distributed Saturday.
According to the report, infection rates are soaring nationally, exacerbated by hospital
cutbacks and carelessness by doctors and nurses, and serious violations of infectioncontrol standards have been found in the majority of hospitals.
Since 1995, more than 75 percent of all hospitals have been cited for serious
cleanliness and sanitation violations.
Hospitals are not required to disclose infection rates, and most do not. Doctors are not
required to tell patients about risk or exposure to hospital germs.
To document the rising rate of infection-related deaths, the newspaper analyzed records
from 75 federal and state agencies, as well as internal hospital files, patient databases
and court cases around the country.
CDC officials said they believe most hospital infections are preventable, but the agency
has not arrived at a precise number.
The American Hospital Association said the last decade of unprecedented cost-cutting
and financial instability has impacted all areas of hospital care.
"It's had an effect on infection control and it's had an effect on our ability to recruit and
retain workers. It's had an effect on our ability to invest in new and updated equipment
as much as we would like to," said Rick Wade, spokesman for the AHA.
"It's also a question in front of society. How much do you want to invest in high-quality,
safe medical care?"
Among recent incidents in which hospital-linked infections were cited, the newspaper
noted a 1998 case in which eight children died at a Chicago pediatric medical center; a
1997 Detroit case in which four babies died in 1997; and an infection at a West Palm
Beach, Fla., hospital where 13 people cardiac patients died in the late 1990s.
July 21, 2002
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THE NATION
Preventable Hospital Infections Becoming a Deadly
Epidemic
Medicine: The problem is now the fourth leading cause of mortality among Americans.
By MICHAEL J. BERENS, CHICAGO TRIBUNE
Deadly infections fueled by poor sanitation, contaminated instruments and unwashed
hands in the nation's hospitals are needlessly claiming tens of thousands of lives
annually, according to an investigation by the Chicago Tribune.
While the hospital industry often characterizes deaths by infection as random and
unavoidable, the Tribune, in the first comprehensive analysis of patients' deaths linked
to infection in 5,810 hospitals across the nation, found otherwise. Not only are many
deaths by infection easily preventable, the newspaper said, but soaring infection rates
also have been exacerbated by hospital budget cutbacks in infection control staffs and
housekeeping services.
The problem has grown so severe that deaths linked to hospital germs now represent
the fourth leading cause of mortality among Americans, behind heart disease, cancer
and strokes, according to the Centers for Disease Control and Prevention. Infections
connected to hospital-based germs kill more people annually than auto accidents, fires
and drowning combined. "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 and president of the Society for Healthcare
Epidemiology of America.
"For years, we've just been quietly bundling the bodies of patients off to the morgue
while infection rates get higher and higher."
Infections that would be no problem for healthy people can become fatal for hospital
patients who are too old or too weak to fend them off.
The Tribune's analysis, which adopted methods commonly used by epidemiologists,
found an estimated 103,000 deaths linked to hospital infections in 2000. The CDC,
which bases its numbers on extrapolations from 250 hospitals, estimated there were
90,000 that year. Though the CDC does not attempt to classify any infections as
preventable, the Tribune examined federal health inspection reports and other public
documents in all 50 states to make its analysis. The paper found that in 2000--the latest
year health-care records were available nationally--75,000 of the deadly hospital
infections took place in conditions that were preventable.
The Tribune investigation uncovered disturbing and largely unreported cases of fatal
infections that might have been avoided had hospitals held themselves and their staffs
to adequate sanitation standards.
In a Detroit hospital, as doctors and nurses moved about the pediatric intensive care
unit without washing their hands, a germ killed four babies in the same row of bassinets
in the spring of 1997, according to interviews and court records. It took two full months
for administrators to close the nursery for cleaning.
Staphylococcus germs, common on the skin and in nasal passages, infected more than
100 cardiac patients at a West Palm Beach, Fla., hospital over the last four years, killing
13 of them. The survivors underwent agonizing surgeries and long rehabilitation periods
as rotting bone was cut from their bodies.
Eight Chicago children died in 1998 as germs from a South Side pediatric medicine
center spread into a hospital. Fever-ridden health-care workers who tended to patients
spread the germs, as did other workers who failed to wash their hands. The outbreak
was stopped months later after 36 workers, some with fevers and sickness, were
ordered to stay home.
The rare bacteria found in Chicago has since been linked to the deaths of dozens of
children in medical facilities in three states.
Hospitals are not legally required to disclose infection rates, and most don't. Doctors are
not required to tell patients about risk or exposure to hospital germs. There is little
government oversight in the area of infection in hospitals, which combines with the
industry's long-apparent penchant for secrecy to hide the problem.
The problems stretch far beyond isolated cases in specific hospitals. The Tribune's
investigation found systemic problems pointing to abysmal infection-control efforts
across the nation:
* Life-threatening violations of infection-control standards are common in hospitals.
Since 1995, the investigation showed, 75% of all U.S. hospitals have been cited for
serious cleanliness and sanitation violations.
* In thousands of cases, surgeons performed operations without washing their hands or
wearing surgical masks. In one case, records show, surgeries were performed in a
Connecticut operating room even while dust floated in the air and flies buzzed overhead
during open-heart surgery.
* Hospital cleaning staffs are overwhelmed and inadequately trained, which leads to
unsanitary areas where germs can grow and multiply, sometimes for years. Since 1995,
hospital cleaning staffs have been cut by 25%. In that same period, almost half of all
hospitals have been cited for failure to properly sanitize their facilities.
* Rampant payroll cutbacks have gutted staffs devoted to reducing infections. These
staffs have been cut by an average of 20% nationally in the last three years. A majority
of hospitals ignores the CDC's recommendation that hospitals have one infectioncontrol person for every 250 beds.
Budget cutbacks are cited as one reason infections are on the rise in the nation's
hospitals. Nurses report their hospitals are so understaffed that they don't always have
time to wash their hands between patient visits.
The problem is not likely to go away. The American Hospital Assn. predicts further
cutbacks in staff and patient care, leading to more infection-control problems.
About 1,700 American hospitals, about a third of the total, are operating at a loss. An
equal number are on the edge of bankruptcy, the AHA reports.
At Bridgeport Hospital in Bridgeport, Conn., germs flourished in areas that are supposed
to be the most sterile places in the hospital, according to a review of thousands of
pages of hospital records collected in a lawsuit and opened for public inspection by the
Connecticut Supreme Court last year.
The court case involved four patients who contracted infections inside the hospitals.
Operating Room No. 2, where one in five patients at times contracted infections,
epitomized the hospital's problem. The air was often contaminated by dust because of
faulty ventilation. Flies buzzed overhead during operations. Doctors wore germ-laden
clothes from home into the operating room. Many did not wash their hands before
operating.
"Bridgeport had a long history of high infection rates but corrective action was not taken
until it was too late," said Peggy Haering, an attorney who represented a patient in a suit
settled out of court. "What became clear is that these infections were preventable."
"Nobody here intentionally spread germs, but we've learned that even the smallest
breakdown in infection control can have devastating consequences," said hospital
spokesman John Capiello. The hospital has undergone a $30-million remodeling.
Infection rates have dropped to nearly zero.
The hospital-monitoring system is a checkerboard of local, state and federal regulators
who do little to encourage better infection control. All hospitals must have general
standards to quality for the federal Medicaid program, but each facility is allowed to draft
its own rules.
"Can you imagine the medical community outcry if even a single doctor died from germs
because of a failure to wash hands?" asked Mark Bruley, a forensic investigator who
studies hospital conditions for ECRI, a nonprofit laboratory near Philadelphia.