How Hospitals Can Kill You – Part II

This is part two of a three-part series. In part I we covered how hospital deaths, hospital-acquired infections, and related issues are the third leading cause of death in the US. Now we’ll look at the leading ways a hospital can result in death.

Hospital/Healthcare-Acquired Infections (HAI)

         There are many types of hospital-acquired infections. Patients who are already sick or have a compromised immune system are exposed to extremely dangerous viral, bacterial, and fungal infections.

Possible Pathways of Infection:

  • Airborne Pathogens
  • Main Pathways for Non-Airborne Infection
  • Central Lines
  • Catheter-Associated Urinary Tract Infections
  • Surgical Site Infection
  • Ventilator-associated Pneumonia
  • Adverse Drug Reactions
  • Other Common Hospital Errors
  • Injury from falls
  • Pressure ulcers (bed sores)
  • Blood Clots and DVT (Deep Vein Thrombosis)
  • Hospital-Induced Delirium and Post-Hospital Syndrome
  • Hospital-Induced Delirium
  • Post-Hospital Syndrome

          People generally know that they are susceptible to infection by visiting or being admitted to a hospital. Young children, the elderly, and persons with weakened immunity are the most likely to get sick.

          Other risk factors are long-term hospital stays, the use of indwelling catheters, the failure of workers to wash their hands, and overuse of antibiotics.

          In American hospitals alone, the Centers for Disease Control (CDC) estimates that HAIs account for an estimated 1.7 million infections. Of these infections:

And There’s More

          Patients who acquire infections from surgery spend, on average, an additional 6.5 days in the hospital. They are five times more likely to be readmitted after discharge and twice as likely to die.

          Surgical patients who develop infections are 60% more likely to require admission to a hospital’s intensive care unit. Surgical infections are believed to account for up to $10 billion annually in healthcare costs. (http://patientcarelink.org/improving-patient-care/healthcare-acquired-infections-hais)

Methods of Becoming Infected

          The most common types of  hospital-acquired infections are bloodstream infection (BSI), pneumonia (e.g., ventilator-associated pneumonia [VAP]), urinary tract infection (UTI), and surgical site infection (SSI). (https://emedicine.medscape.com/article/967022-overview)

Contaminated Hands

          “A number of infectious diseases can be spread from one person to another by contaminated hands. These diseases include gastrointestinal infections (such as Salmonella) and respiratory infections (such as influenza).

          “Disinfecting hands properly can help prevent the spread of the germs (like bacteria and viruses) that cause these diseases.”(https://www.betterhealth.vic.gov.au/health/ConditionsAndTreatments/handwashing-why-its-important)

          Most germs that cause serious infection are spread by people's actions. Studies show that on average, healthcare providers clean their hands less than half of the times they should.  (https://www.cdc.gov/features/handhygiene/index.html)

          A nurse or attendant seldom changes to a fresh pair of protective gloves every time they see a patient. Their hands are busy touching everything in the hospital, from the patient to the thermometer, to waste material, bedding, walls, door knobs, etc.

        Hands can pick up and transport loads of bacteria from room to room and from person to person. The answer is to wash them regularly with soap and water.

Airborne Pathogens

          The most dangerous HAI pathogens are those that have the potential to spread through the air. (Kowalski 2006). Many of these pathogens, such as Methicillin-resistant Staphylococcus aureus (MRSA), are now commonly called “superbugs”.

          They superbugs are nearly invincible to standard antibiotics and they pose an enormous threat to the health and well-being of anyone entering a hospital, especially a patient weakened by the condition that brought them to the hospital in the first place. (https://www.healthcarefacilitiestoday.com/posts/Hospital-infection-control-reducing-airborne-pathogens)

Main Pathways for Non-Airborne Infection

          There are four primary ways for infection to enter the body. The first is by central lines: this infection is caused by lines inserted into a large vein, which creates a highway for bacteria to get into the body. 

Central Lines

          Central line-associated bloodstream infections (CLABSIs) result in thousands of deaths each year and billions of dollars in added costs to the U.S. healthcare system. These infections are preventable and the CDC is providing guidelines and tools to the healthcare community to help eliminate CLABSIs. (https://www.cdc.gov/hai/bsi/bsi.html)

What are Central Lines?

          “A central line (also known as a central venous catheter) is a catheter (tube) that doctors often place in a large vein in the neck, chest, or groin to give medication or fluids or to collect blood for medical tests. You may be familiar with intravenous catheters (also known as IVs) that are used frequently to give medicine or fluids into a vein near the skin’s surface (usually on the arm or hand), for short periods of time.

         Central lines are different from IVs because central lines access a major vein that is close to the heart and can remain in place for weeks or months and be much more likely to cause serious infection. Central lines are commonly used in intensive care units.” (https://www.cdc.gov/hai/bsi/clabsi-resources.html)

Quarter Million Infections a Year

          CLABSIs lead to prolonged hospital stays and increased healthcare costs and mortality. An estimated 250,000 bloodstream infections occur annually, and most are related to the presence of intravascular (blood vessels, arteries, veins) devices.

         Of all the healthcare-associated infections, CLABSIs are the most expensive, accounting for approximately $46,000 per case. Most cases are preventable with proper aseptic techniques, surveillance, and management strategies. (https://www.ncbi.nlm.nih.gov/books/NBK430891/)

Catheter Associated Urinary Tract Infections

         Urinary tract infection (UTI) is an infection involving any part of the urinary system, including urethra, bladder, ureters, and kidney. UTIs are the most common type of healthcare-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter, which is a tube inserted into the bladder through the urethra to drain urine.

         Between 15-25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a catheter-associated UTI (CAUTI) is prolonged use of the urinary catheter. (https://www.cdc.gov/hai/ca_uti/uti.html)

          Urinary tract infections are the fourth most common type of healthcare-associated infection. An estimated 93,300 UTIs were recorded in acute care hospitals in 2011.

          UTIs account for more than 12% of all infections reported by acute care hospitals. Virtually all healthcare-associated UTIs are caused by instrumentation of the urinary tract.

         Catheter-associated urinary tract infections (CAUTI) can lead to serious complications that cause discomfort to the patient, prolonged hospital stays, increased cost, and even mortality. It has been estimated that each year, more than 13,000 deaths are associated with UTIs and CAUTIs. (https://www.cdc.gov/nhsn/pdfs/pscmanual/7psccauticurrent.pdf)

Surgical Site Infection

         This is an infection that occurs after surgery in the part of the body where the surgery took place. Surgical site infections (SSI) can sometimes be superficial infections involving the skin only. Other surgical site infections are more serious and can involve tissues under the skin at the site of the incision, the organs, or implanted material. (https://www.cdc.gov/hai/ssi/ssi.html)

Ventilator-Associated Pneumonia

         A ventilator is a machine that is used to help a patient breathe by giving oxygen through a tube placed in a patient’s mouth or nose, or through a hole in the front of the neck. Pneumonia may develop if germs enter through the tube and get into the patient’s lungs. (https:/www.cdc.gov/hai/vap/vap.html)

Adverse Drug Reactions

          Adverse Drug Reactions (ADRs) are unintended reactions caused by a drug at normal doses, during normal use. Our healthcare system can be described as a method of alleviating symptoms with drugs and invasive surgery, basically a disease maintenance system.

         Many drugs have the potential to cause all kinds of uncomfortable or painful side effects. Sometimes there is addiction, leading to long-term negative effects, or even death.

         Often a doctor may be in a hurry to get to the next paying patient, so they dole out pills without taking a serious look at the root cause. Potential conflicts the new drugs may cause with existing medications can also cause serious side effects.

         To be clear, this isn’t a case where the wrong prescription was issued, we’re saying you nearly died from a reaction you had from taking it as prescribed. Most of the time the drugs we are prescribed are relatively harmless, but the following statistics don’t lie...

Costs of Adverse Drug Reactions
         The impact and management of ADRs is complex and may cost up to $30 billion annually in the US alone. ADRs can increase costs due to hospitalizations, or even additional clinical investigations for more serious cases. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3853675/)

          ADRs are a leading cause of death in the US. Bruce Pomeranz and colleagues at the University of Toronto estimate that ADRs could account for more than 100,000 deaths in the US each year, making them the fourth most common cause of death after heart disease (nearly 750,000 deaths), cancer (530,000 deaths), and stroke (150,000 deaths). (https://www.nytimes.com/1998/04/15/us/study-says-thousands-die-from-reaction-to-medicine.html)

Want to read more? Part III is here.

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 Dr. Mike Carberry, D.C.