INVESTIGATION: UNHEALTHY HOSPITALS ( From the Chicago Tribune Newspaper )

Infection epidemic carves deadly path
Poor hygiene, overwhelmed workers contribute to thousands of deaths
First of three parts.
By Michael J. Berens
Tribune staff reporter

July 21, 2002

A hidden epidemic of life-threatening infections is contaminating America's
hospitals, needlessly killing tens of thousands of patients each year.

These infections often are characterized by the health-care industry as
random and inevitable byproducts of lifesaving care. But a Tribune
investigation found that in 2000, nearly three-quarters of the deadly
infections--or about 75,000--were preventable, the result of unsanitary
facilities, germ-laden instruments, unwashed hands and other lapses.

The industry's stance also obscures a disturbing trend buried within
government and private health-care records: Infection rates are soaring
nationally, exacerbated by hospital cutbacks and carelessness by doctors and
nurses.

Deaths linked to hospital germs represent the fourth leading cause of
mortality among Americans, behind heart disease, cancer and strokes,
according to the federal Centers for Disease Control and Prevention. These
infections kill more people each year than car accidents, fires and drowning
combined.

Hospital infections often are preventable by adopting simple, inexpensive
measures. Strict adherence to clean-hand policies alone could prevent the
deaths of up to 20,000 patients each year, according to the CDC and the U.S.
Department of Health and Human Services.

"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."

Hospitals provide ideal reservoirs for germs, with temperature-controlled
environments and a steady stream of germ-carrying strangers pouring through
the doors each day.

Germs that wouldn't be harmful to healthy people in their homes or at work
can turn deadly for patients too young, too old or too weak to fight the
infection.

In Chicago in 1998, as fever-ridden health-care workers tended to patients
and as others worked without always washing their hands, eight children died
of an infection that spread from the Misericordia Home on the Southwest Side
into a hospital. The flulike outbreak, which the city of Chicago never
revealed to the public, was halted weeks later after three dozen sick
health-care workers were ordered to stay home.

In a Detroit hospital, as doctors and nurses moved about the pediatric
intensive care unit without washing hands, infections killed four babies in
the same row of bassinets, according to court records and interviews. But it
took three months for administrators to close the nursery for cleaning.

Staphylococcus germs thriving inside a West Palm Beach, Fla., hospital
invaded more than 100 cardiac patients, killing 13, according to court
records. The survivors underwent painful and debilitating surgery, as
rotting bone was cut from their bodies.

The health-care industry's penchant for secrecy and a lack of meaningful
government oversight cloak the problem. Hospitals are not legally required
to disclose infection rates, and most don't. Likewise, doctors are not
required to tell patients about risk or exposure to hospital germs.

Even a term adopted by the CDC--nosocomial infection--obscures the true
source of the germs. Nosocomial, derived from Latin, means
hospital-acquired. CDC records show that the term was used to shield
hospitals from the "embarrassment" of germ-related deaths and injuries.

To document the rising rate of infection-related deaths, the Tribune
analyzed records fragmented among 75 federal and state agencies, as well as
internal hospital files, patient databases and court cases around the
nation. The result is the first comprehensive analysis of preventable patien
t deaths linked to infections within 5,810 hospitals nationally.

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
315 hospitals, estimated there were 90,000 that year.

The CDC links infections to patient mortality both directly and indirectly.
Direct cases typically involve patients who specifically died of
complications caused by an infection. Indirect cases involve infections that
played a major role in a patient's death, but may not have been the primary
cause.

Though CDC officials now say they believe most hospital infections are
preventable, the agency has not arrived at a precise number.

The Tribune examined federal health inspection reports and other public
documents from 2000--the latest year health-care records were available
nationally--to estimate that 75,000 of the deadly hospital infections took
place in conditions that were preventable. Deaths were considered
preventable if patients contracted infections that were spread as the result
of deficiencies documented by state, federal or health-care investigators.

For every death linked to an infection, thousands of patients are
successfully treated each year. And many hospitals battle infections with
diligence and the latest technology.

But the Tribune investigation found that breakdowns occur more frequently
than patients suspect and that the consequences often are deadly.

Government and hospital industry reports analyzed by the Tribune reveal
that:

- Serious violations of infection-control standards have been found in the
vast majority of hospitals nationally. Since 1995, more than 75 percent of
all hospitals have been cited for significant cleanliness and sanitation
violations.

In thousands of cases observed by federal or state inspectors, surgeons
performed operations without washing hands or wearing masks. Investigators
discovered fly-infested operating rooms where dust floated in the air during
open-heart surgeries in Connecticut. A surgical assistant used his teeth to
tear adhesive surgical tape that was placed across an open chest wound
during a non-emergency procedure in Florida.

- Hospital cleaning and janitorial staffs are overwhelmed and inadequately
trained, resulting in unsanitary rooms or wards where germs have grown and
multiplied for weeks, sometimes years, on bed rails, telephones, bathroom
fixtures--most anywhere.

Because of cost-cutting measures, U.S. hospitals have collectively pared
cleaning staffs by 25 percent since 1995. During the same period, half of
the nation's hospitals have been cited for failing to properly sanitize
portions of their facilities, a shortcoming that can colonize new patients
with lingering germs.

- Hospitals are required to have professional staffs devoted to tracking and
reducing infections, but rampant payroll cutbacks have gutted those efforts.
These staffs have been reduced an average of 20 percent nationally in just
the last three years. Many hospitals disregard the CDC's recommendation of
at least one infection-control employee for every 250 beds.

For three months in 2000, for example, Illinois Masonic Medical Center
closed down its infection-control efforts because of lack of staffing,
federal inspection records show. The 507-bed North Side hospital now has new
owners and has hired three infection specialists.

The Tribune analysis of patient records shows that hospital-acquired
infections contributed to or were the direct cause of death for at least
four men and two women, ages 72 to 83, during the three-month period at
Illinois Masonic. Four patients had respiratory infections; two had an
infection that led to blood poisoning and caused inflammation of internal
organs. Hospital officials said they could not verify the deaths based on
the available information in state records, which omitted names.

Federal inspectors determined at the time that Illinois Masonic had adopted
a "complete disregard" for infection-control tracking. More recent
inspection reports have found no problems with Masonic's infection-control
program.