Deadly germs take grim toll in hospitals

The week before Christmas was filled with excitement for 6-year-old Macenzie and her mother, Lacie Simmons.

The festive mood ended abruptly Dec. 20 when Simmons collapsed in the hallway of her parents' Grand Prairie home. When the EMTs arrived, Macenzie clung to her mother.

"I just need to take care of my mom," she repeated as she patted her mother's arm. It was the last time she saw her mother alive.

"Her blood pressure bottomed out, her heart failed and that was it," said Lacie's mother, Renee Simmons.

Within 26 hours, Lacie Simmons was dead. A preliminary autopsy showed that an infection killed her. Back surgery three weeks earlier had hardly slowed the single mother.

But her parents believe she picked up the infection after surgery to fuse two discs in her spine.

Anyone who goes into the hospital could end up the same way as Lacie, who was just 28 and healthy, Simmons said.

Each year, an estimated 2 million patients -- 1 in 20 people -- get a serious infection while hospitalized on an outpatient or inpatient basis, according to the Centers for Disease Control and Prevention.

More than 90,000 of these patients die, most often from infections acquired through intravenous tubes, catheters and ventilators. Treating them costs the country more than $4.5 billion a year.

Infections lurking in the nation's hospitals have been a well-kept secret for years because information is not publicly reported, said Lisa McGiffert, director of Consumers Union's Stop Hospital Infection Campaign in Austin.

"People need to understand that hospitals are full of bacteria," she said. "It lives in the environment, and nurses and doctors carry that bacteria from patient to patient."

Many hospitals already collect data and are trying to address infection rates with prevention programs. The Dallas-Fort Worth Hospital Council shares data on infection rates with medical facilities throughout the area.

At least 39 states have introduced legislation pushing hospitals to publicly disclose how many patients get serious infections, McGiffert said.

In Texas, Rep. Joe Straus, R-San Antonio, introduced a bill in the new legislative session to require reporting of methicillin-resistant staphylococcus aureus, or MRSA, which can cause deadly staph infections.

The Advisory Panel on Health-Care Associated Infections' recommendations focus on creating a reporting system that reduces infection rates, said Joel Ballew, director of government affairs for Texas Health Resources, a faith-based healthcare provider that includes Harris Methodist Hospital System, Presbyterian Health Care Resources and Arlington Memorial Hospital. The recommendations also seek to educate consumers and reduce healthcare costs.

Sen. Jane Nelson, R-Lewisville, Rep. Yvonne Davis, D-Dallas, and Rep Dianne Delisi, R-Temple, have filed bills that follow the recommendations. Their proposals call for a mandatory, phased-in reporting system, with central line bloodstream infections, surgical sites and respiratory infections measured first.

The last thing a sick person needs is another illness, which is why it's so important that steps are taken to minimize exposure to infections, Nelson said.

"We don't want people to be afraid to go to the hospital when they need to because they're afraid they'll come out sicker than when they went in," she said.

Four years after drug companies starting mass-producing penicillin in 1943, microbes that could resist it started cropping up, according to the Food and Drug Administration.

In the 1970s, the problem worsened as soldiers returning from Vietnam brought home penicillin-resistant gonorrhea. Since then, overuse of antibiotics led to a growing list of drug-resistant organisms. The Centers for Disease Control and Prevention estimates that, today, 70 percent of the bacteria that cause hospital infections are resistant to at least one antibiotic.

One of the biggest threats is the staph infection MRSA. Nearly three-fourths of patients' rooms are contaminated with the bacteria that cause it, according to the Committee to Reduce Infection Deaths, or RID, an advocacy group. A healthcare worker need only touch a contaminated cabinet or bedrail to spread the infection to the next person. White coats, stethoscopes and blood pressure cuffs can also carry bacteria.

Myron Skinner, a retired Fort Worth pathologist, got a staph infection after heart surgery in 2006.

Skinner was a robust 81-year-old who had spent a month traveling through Europe before coming home to have surgery. Skinner and his wife, Jane, expected him to recover without complications.

"When he went through the doors to surgery, I never thought I would not have another trip to Europe -- and neither did he," Jane Skinner said. "He was as chipper as he could be."

A week after surgery, his lungs filled with fluid and staph pneumonia set in, Skinner said. Doctors tried at least seven antibiotics before he died six weeks later.

Watchdog groups have taken a close look at how the nation's hospitals got so sick. The biggest culprit: lack of hygiene.

While CDC guidelines call for health professionals to clean their hands between patients and wear a mask, sterile gown and gloves while inserting an IV, in reality, it happens less than 50 percent of the time, according to the National Quality Forum.

"It's something our mothers taught us, but people get busy and don't realize they haven't washed their hands," said Dr. William Sutker, director of medical education for Baylor University Medical Center in Dallas.

Hand-washing could prevent 20,000 patient deaths each year, according to the CDC.

"We can't get rid of all infections just by washing our hands every time, but that will help," McGiffert said.

Jean Czajkowski's 80-year-old mother developed several infections after gallbladder surgery in 2005. Czajkowski said she watched a nurse insert a catheter in her mother, then touch monitors, bedrails and other objects throughout the room, all while wearing the same pair of contaminated gloves.

"I think the gloves give people a false sense of security," said Czajkowski, of Fort Worth. "The mentality of the healthcare professional seems to be that if they are protecting themselves with the gloves, they do not have to worry about what they touch and contaminate for the next patient, doctor, visitor or nurse."

Most hospitals collect infection data, but few report the results to a regulatory agency, accreditation board or the public, according to Consumers Union.

Since 1970, the CDC has had a voluntary reporting program. More recently, Hospital Compare, a Web site created by the Centers for Medicare & Medicaid Services, asked hospitals to provide data on quality control measures, such as the use of preventative antibiotics before surgery. But consumers say the data are often dated and of limited use.

Consumers don't know what they're getting into until they're hospitalized, said Dorrine DeChant of Fort Worth.

When her father, Tom DeChant, a 78-year-old retired postal worker, was admitted to a San Antonio hospital for the treatment of gastric bleeding, he expected to be released within a few days. But as the days turned to weeks and he grew more lethargic, it became clear something was terribly wrong.

On June 12, six weeks after DeChant was hospitalized, he died. After DeChant's death, his family learned the bacteria that causes Legionnaires' disease had gotten into the hospital's water system, infecting him and others.

Since then, Dorrine DeChant has pushed for legislation to require public reporting by hospitals. She sees the proposed legislation as a good start.

"Imagine if a Boeing 757 was crashing every day of the year with no survivors," DeChant said. "That's how many people die from hospital-acquired infections."

What is needed is a mandatory reporting system that is useful to consumers, McGiffert said. Hospitals are keen on pushing for process measures -- such as the number of patients given antibiotics before surgery -- when what they should be measuring is whether those processes work, she said.

"What people want to see is how likely it is I will get an infection at that hospital," McGiffert said. "Measuring processes doesn't translate into reducing infections."

Public reporting of infection rates has a dual benefit, said Star West, Texas Hospital Association's director of policy analysis.

"It gives hospitals an incentive to get infection rates down," she said. "But it also gives consumers information on which hospitals have the highest infection rates."

Most hospitals already keep tabs on the most serious infections, said Dr. Joseph Prosser, vice president and chief quality officer for Harris Methodist Fort Worth hospital. Less serious ones are managed and treated, but not tracked as much.

"We apply our resources to those truly life-threatening infections -- such as bloodstream or pneumonia -- that clearly have a much greater risk of death," he said.

Infection rates can vary from one hospital to another, making it difficult to compare medical facilities that treat many patients with compromised immune systems and conditions that make them vulnerable with those that do not, said Dr. Ken Smithson, vice president of research at VHA, a national healthcare alliance.

Consumers need to understand that not every infection acquired in a hospital is preventable, he said.

"Someone with a bullet wound is mostly likely to have an infection, and it's no slam on the hospital," Smithson said. "What is important is to subtract out cases that are not preventable so we can get an idea of what is preventable."

Pennsylvania, the first state to require public reporting, found that in 2005 an average of 1.2 per 1,000 patients got infections while hospitalized. Of the 19,154 patients who got sick, 2,478 died.

It's still too early to tell how effective this kind of public reporting will be, but, anecdotally, Pennsylvania is doing more to prevent infections than states without laws, McGiffert said.

Pennsylvania is getting patients off ventilators quickly, using urinary catheters less and deploying rapid response teams at the first sign of a patient's decline.

Testing is especially important because MRSA can be found outside of hospitals. It commonly appears as painful swollen skin infections. In 2003, the CDC found that 12 percent of people with MRSA had no contact with a hospital before the infection.

Information on MRSA is collected and given back to hospitals to alert them to increases in the infection, said Susan McBride, vice president of data initiative at the Dallas-Fort Worth Hospital Council.

"It's showing up in healthy athletes, in hot yoga studios and day-care centers." she said. "It's anywhere, anytime you have a lot of people in close proximity."

Lately staph infections rates have been pretty flat in hospitals, which means people are bringing them into medical facilities, McBride said.

Infections can be prevented through education, common sense and techniques that are clinically proven to be effective, McGiffert said.

"We can save a lot of lives pretty easily, if hospitals would just get right down to it," she said.

Area hospitals are trying to do just that by emphasizing hand-washing and other measures.

At Baylor, alcohol foam dispensers make hand-washing more convenient, Sutker said. Patients are also given cards encouraging them to ask their doctor about hand-washing.

The average additional cost for treating a patient who gets an infection is more than $15,000, according to Consumers Union.

"There's a great deal of focus on doing the right thing for the right patient at the right time," he said.

Such efforts may have come too late for Lacie Simmons, but her family hopes to spare others of the same fate.

"She was young, she was healthy," said her mother, Renee Simmons. "This should not have happened."

If you need a central line catheter, ask your doctor about one that is antibiotic-impregnated or silver-chlorhexidine coated to reduce infections.

If you need surgery, choose a surgeon with a low infection rate. Surgeons know their rate of infection for various procedures. If a surgeon refuses to tell you, consider choosing someone else.

Three to five days before surgery, shower daily with 4 percent chlorhexidine soap, available through pharmacies.

Ask your surgeon to have you tested for staphylococcus aureus at least a week before you are hospitalized.

Stop smoking well in advance of your surgery. Patients who smoke are three times as likely to develop a surgical site infection as nonsmokers.

On the day of surgery, remind your doctor that you may need an antibiotic one hour before the first incision.

Ask that you be kept warm during surgery. Patients who are kept warm resist infection better. Special blankets, hats, booties and warmed IV liquids can help.

Do not shave the surgical site. If hair must be removed, ask that clippers be used.

Ask your doctor about monitoring your glucose levels continuously during and after surgery, especially if you are having cardiac surgery. The stress of surgery often makes glucose levels spike erratically. When blood glucose levels are controlled to stay at 80-110 mg/unit, heart patients resist infection better.

If you must have an IV, make sure that it is inserted and removed under clean conditions and changed every three to four days. Alert hospital staff if any redness appears.

If you are planning to have a cesarean section take the same precautions as you would for any surgery. Women who have cesarean sections are 10 times more at risk for infection that those who give birth vaginally.

"Finally we cultured her and found she was the carrier."

I don't understand being a "carrier" here.

Are you saying she was a carrier (i.e., infection is not active but is present) but it wasn't actively infecting her heart tissues until the surgery put it there?

MRSA is everywhere. Staphylococcus aureus has become a problem not just from the over use of antibiotics but because people do not finish their cycle of antibiotics.

Staphylococcus aureus is part of the bodies normal flora,and a lot of people have picked up MRSA just out in public. A person just doesn't fall over dead two weeks after surgery. There had to be some sign of infection say like a fever that was ignored that lead to sepsis.

These infections are only the tip of the iceberg. Medical errors kill similar numbers every year.

I believe there should be greater transparency of information with regard to these sorts of events. As a consumer I'd like to have access to mortality rates, infection rates, etc. so I could make an informed choice of hospital/physician. However, there are those who say such a system will make it difficult for high-risk patients to receive treatment.

Are you saying she was a carrier (i.e., infection is not active but is present) but it wasn't actively infecting her heart tissues until the surgery put it there?

That was what I took it to mean from what the doctors said.

You can't sue a VA hospital, no matter how badly they screw up. She's having to fight the IRS right now because they say she should not be getting her husband's military pension because she is now on disability. Even though it was the VA who caused the the disability.

She's only getting a total of $739 per month to live on. It doesn't seem right that her husband was a Vietnam vet with 4 tours of duty to his credit earned that pension but it is denied her because she underwent what should have been a simple procedure and they KNEW there was a problem with their ventilation system in the operating rooms.

We've contacted our local senators and house reps and all we've heard thus far is that they're working on it. In the meantime she has lost her home to foreclosure and most of her belongings had to be sold.

Our country does not treat its veterans well.

I can't believe Pennsylvania is 50 times better than the national average.

Probably not that much better...I'd say their estimates are off, and go with Pennsylvania's actual reported rates, although the article does point out that hospitals that require reporting are believed to have better rates.

Probably not that much better...I'd say their estimates are off, and go with Pennsylvania's actual reported rates, although the article does point out that hospitals that require reporting are believed to have better rates.

It makes sense to me that requiring reporting will lower the incidence. It occurred to me after posting that the national average may include patients hospitalized multiple times per year, while PA is including infections per hospitalization. So that may account for some of the difference as well.

"The hospital knew they had a problem and still allowed surgeries to be performed. You've got to wonder why."

Hospitals are like the Airlines, you play the probabilities and hope you never have to pay off. OR's make big big bucks and if its not running the Docs go elsewhere. Follow the money it always leads to the truth.

know exactly what you mean. I have the same problem happening with my mother.

My prayers are with you and your mother for her to be able to overcome this horrible infection. My sister spent the better part of a year in the hospital as a result of this thing.

Here is Pennsylvania, the hospitals voluntarily cooperated to report medical errors and hospital-sourced infections. In a single year, they attributed 32,000 deaths to those two causes --- this is only in Pennsylvania.

The nationwide numbers must be staggering.

My mother is on 'Vancomycin' drip every 48 hours. It MUST run for at least 120 min. every time.

Vancomycin can be a nephrotoxic antibiotic it usually comes in a 250ml bag so to run it at 125ml/hr is normal. The max rate that an IV is run is generally 150ml/hr, unless they are in acute renal failure is a diuretic faze.

What is amazing is that she caught this infection in the hospital and now she is back in the hospital for another week while they rip off her insurance company for an infection they caused.

If you took your car to a dealer and while they had it there , they rippd the fender off. That dealership would pay to put the fender back on. You go to the hospital and get sicker because of their problem ,and they just keep sending out the bills.

Yo go to a Doctor and he makes a mistake, then you have to go back and he charges you to rectify his mistake.

Hubby recently hospitalized. They allowed the IV apparatus to be used for no more than two days before being replaced. He was on intraveinous Cipro the entire time as well. Continued on with the Cipro for another week after release from the hospital.

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