Hospitals as Vectors: The Trouble With Nosocomial Infection
Well, let me turn just a little bit more immediately to the nosocomial infection issue. I’m going to quote now from the "Emerging Infections": probably should have this as a handout but it’s just a page and a half out of the book that I was just showing to you a moment ago…At least 5% of the hospital admissions patients come out with a disease they didn't have when they went in.
Twenty thousand (20,000) deaths annually!
I think that number’s gone up since this report was written. Patients recovering - an extra 10 days of hospital care. Hospital acquired infections account for an extra 5 to 10 billion dollars a year in additional medical related expenses. And then you can find some of the specific categories in which this occurs. Many factors which increase nosocomial infection in a hospital are inherent in any health care setting; not only are persons with serious infections frequently admitted to hospitals, providing an intra-hospital source of pathogenic organisms, but these people also tend to be immune compromised. What’s not mentioned in this chart is that a hospital is also a place of very concentrated use of antibiotics; therefore no surprise that you’re going to see the emergence of and continued selection of antibiotic resistant organisms in that kind of setting.
In addition, there are invasive procedures, especially the use of catheters, which gravely enhance the risk of nosocomial infection in the very process. So a whole constellation of factors. What can be done about it? Probably the most comprehensive statement appeared in the January 17, 1946 issue of JAMA, which is an issue devoted to emergent infections, and you get a lot of the further statistics and recommendations; but first of all there needs to be a system. There needs to be a systematic approach, a recognition that this is a problem, that the angels of mercy are also angels of death and disease willy nilly. The system for rapid detection and reporting of resistant micro-organisms, when we’ll get to the point of routine screening of health care workers for nasal carriage of infectious disease, I’m not sure, but I think it’s in the cards: I think the next major scandal that can be attributed and then the lawsuits that will follow. So it’s a rather unpleasant prospect. It may mean severe dislocations in employment and employ-ability, but I don’t see how this can be eventually avoided.
In addition, there are invasive procedures, especially the use of catheters, which gravely enhance the risk of nosocomial infection in the very process. So a whole constellation of factors. What can be done about it? Probably the most comprehensive statement appeared in the January 17, 1946 issue of JAMA, which is an issue devoted to emergent infections, and you get a lot of the further statistics and recommendations; but first of all there needs to be a system. There needs to be a systematic approach, a recognition that this is a problem, that the angels of mercy are also angels of death and disease willy nilly. The system for rapid detection and reporting of resistant micro-organisms, when we’ll get to the point of routine screening of health care workers for nasal carriage of infectious disease, I’m not sure, but I think it’s in the cards: I think the next major scandal that can be attributed and then the lawsuits that will follow. So it’s a rather unpleasant prospect. It may mean severe dislocations in employment and employ-ability, but I don’t see how this can be eventually avoided.
