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StumbleDo No Harm: Hospital Care in Las Vegas:
State to investigate hospital infection findings
Gap called ‘staggering’ between what Las Vegas hospitals report and what is shown on billing records sent to the state
Carole LaRocca had surgery in 2003 and contracted a MRSA infection while at the hospital. Nevada law requires hospitals to report such infections as “sentinel” events and then investigate the causes to try to prevent future occurrences.
Monday, Aug. 9, 2010 | 2 a.m.
Do No Harm: Hospital Care in Las Vegas, Part 2
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- Hospital stay will stay with her always
- VA system stanching MRSA
- Hospital’s sanitation promises quickly forgotten
- Billing codes key to data analyzed on infections
- Where I Stand: Rise in infection rates, hospitals’ reticence are troublesome
- Editorial: Hospitals should do more to protect patients from deadly bacteria
- ‘We’re the ones who are in there. Our lives are entrusted to them.’
- Health board backs limits on disclosure of infections
- How best to stem spread of infection?
- St. Rose breaks ranks with disclosure on quality of care
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The Sun’s investigation into lethal bacteria in Las Vegas hospitals has identified more apparent underreporting by hospitals of the number of times patients are infected at the facilities.
Nevada law explicitly says that hospital-acquired infections are “sentinel” events — meaning facilities need to report them to the state and conduct analyses of how infections were caused to prevent them from occurring in the future.
Hospitals statewide reported 75 total infections as sentinel events in 2009.
But in its analysis of state records from 2009, the Sun identified 1,052 hospital-acquired cases of Methicillin-resistant Staphylococcus aureus, or MRSA, and Clostridium difficile, known as C. diff.
Assemblywoman Barbara Buckley, who was instrumental in getting the sentinel-events law passed in 2002, called the gap “staggering” between what the hospitals report and what is shown in their billing records on file with the state.
“There tends to be underreporting when there’s bad news to report. It’s human nature,” said Buckley, the current speaker. “But you can’t change practices if you don’t learn of the problem in the first place.”
The purpose of reporting sentinel events is to allow the state to examine the events, for consumers to learn about them and for hospitals to ensure they are not repeated, she said.
The Sun analyzed hospital billing records as part of its two-year investigation: “Do No Harm: Hospital Care in Las Vegas.” On Sunday, the Sun reported 2,010 instances in 2008-09 where patients were infected with MRSA or C. diff — deadly bacteria that thrive in hospitals.
The Sun asked the 13 Las Vegas-area acute-care hospitals to explain how they determine which infections they report as sentinel events. They did not answer the question.
When the Sun began reporting the results of its investigation June 27, it identified similar underreporting. In the wake of the newspaper’s findings, the Nevada State Health Division, which licenses hospitals and investigates complaints, conducted an analysis of the billing records and found that hospital patients suffered 342 preventable injuries or infections during the second half of 2009, all of which might fit Nevada’s definition of a sentinel event. During that time period, the hospitals reported only 44 sentinel events.
The hospitals said at the time that many of the injuries and infections identified would not qualify as sentinel events because they were not “unexpected,” as is required under Nevada law. The billing records do not include clinical detail required to determine whether an injury or infection is a sentinel event, they said.
The state is reviewing medical records on each of the 342 cases it identified to determine whether they should be considered sentinel events, said Richard Whitley, administrator of the state Health Division. Additionally, the state will review the MRSA and C. diff cases identified by the Sun, Whitley said.
Such hospital-acquired infections would be considered sentinel events that need to be reported, Whitley said.
“The standards are already in place, it’s the adherence to them,” Whitley said of apparent underreporting by hospitals. “Did they make an error in the billing? Then correct that. If it was a hospital-acquired condition, then do the review of it and the corrective action plan and report it as a sentinel event.”
Assemblywoman Sheila Leslie, D-Reno, said she is preparing legislation for the 2011 session that will clarify the definition of sentinel events and add transparency to the reporting. The Legislative Committee on Health Care also is considering legislation to bring more transparency to sentinel events reporting.
Dr. Ihsan Azzam, state epidemiologist, said he did not know the number of MRSA and C. diff cases until informed by the Sun.
MRSA infections are not reported to any health agency for the purpose of studying disease trends, “and if it’s not reported, I wouldn’t really know it existed,” Azzam said.
As a result of the Sun’s analysis, the state will, for the first time, study the billing data to calculate the number of bacteria infections in hospitals and compare those rates among the hospitals over time, Azzam said.
Whitley said the hospitals should be analyzing their own billing data to identify where and when the infections occur and to implement strategies to better prevent them.
“We want the hospitals to correct it and ideally be self-managing,” Whitley said.
The Centers for Medicare & Medicaid Services, the government’s insurance payer, no longer reimburses hospitals for complications arising from certain hospital-acquired infections.
Private insurance companies are moving in the same direction, said Leslie Johnstone, executive director of the Health Services Coalition, which includes about two dozen self-funded insurance plans in Nevada.
The Sun’s findings came as a surprise to Johnstone, who said the hospitals indicated to insurers that their infection rates were going down, she said. The Sun’s findings highlight the importance of transparency, she said.
“Then we don’t have to be subject to interpretation about whether their programs are working or not,” Johnstone said.
If insurance companies stopped paying for the hospital-acquired infections, then hospitals would realize quickly that it’s in their best interests to prevent them, she said.
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Maybe Hospitals will have to be redesigned with fewer surfaces and ban visitors.
"The hospitals said at the time that many of the injuries and infections identified would not qualify as sentinel events because they were not "unexpected," "
So when they EXPECT patients to get infected while at hospital, they don't report it. Based on the number of unreported infections, they EXPECT a lot of patients to get infected.
Wife got MRSA on spinal cord during disk surgery. 40 days in hospital and permanent partial paralysis and nothing i can do about it.
And hardly anyone i talk to knows what MRSA even is.
Part 1
To Paul02085 my condolences to you and your wife.
Paul's comment highlights the fact that MRSA isn't just an infection that either kills you or goes away. It destroys nerves, vital organs, connective tissue, etc.
The damage to Paul's wife's spinal cord is not unusual. I have a friend in California whose entire intestinal system was destroyed by MRSA, and she, too almost died.
Yesterday I wrote comments to Marshall Allen's MRSA article about how my friend died of HOSPITAL ACQUIRED necrotizing fasciitis, literally eaten alive by bacteria. In today's LVRJ, they have a front page Associated Press article which states that MRSA is now developing the same sort of toxins which produce necrotizing fasciitis, i.e. flesh eating bacteria. That story describes a woman's multi year battle to stay alive, and her doctors' battle to kill off the flesh eating bacteria as it destroyed her organs one by one. That AP story should be read by everyone, because it illustrates the grave consequences of infectious disease prevention negligence which we hear about in Las Vegas hospitals.
As to today's article by Marshall Allen, I want to make sure readers understand the nuance in his interview with termed-out Assembly Speaker Barbara Buckley. Cutting through Marshall's polite writing, Ms. Buckley authored and got enacted a law requiring Nevada hospitals to report to the State Health Division life threatening, hospital acquired infections like MRSA and C.diff, but Nevada hospitals and their lawyers are playing games and refusing to report these life threatening infections BECAUSE THE HOSPITALS SAY THE INFECTIONS ARE "EXPECTED" and thereby not required to be reported.
Understand what that means. The hospitals EXPECT patients to get life threatening infections which are floating around in the hospital.
Mr. Allen also writes that Assemblywoman Sheila Leslie is preparing legislation for the 2001 Session to try to close the loopholes which the hospitals are using to refuse to report MRSA, C.diff and other hospital acquired infection cases and the medical consequences of those infections, like Paul's wife's paralysis described above.
Part 2
My family's plan, with a person now fighting hospital acquired MRSA, and who have had friends die and suffer horrific physical injury from hospital-acquired MRSA, is to organize a formal group of "Hospital Infection Victims & Families" (got to get a catchier name) to force the Legislature to pass an even tougher law than Assemblywoman Leslie proposes.
The law the MRSA patients and their families will propose which will include (1) standing for patients and public interest groups to obtain mandatory injunctions against hospitals to enforce both reporting requirements and the VA's infection control procedures which have brought MRSA and c.Diff in their patients down to nearly 0%, (2) a requirement that separate medical billing codes for treatment of hospital acquired infections be created, used and the patients not be billed for those charges, and (3) such other and further relief as may be necessary to clean up the infectious disease mess in Nevada's hospitals, including giving patients and their families the explicit right to sue the hospitals for the costs resulting from those hospital-acquired infections, thereby relieving people like commenter Paul and his wife from the economic pain of Nevada hospitals' negligence.
We'll just see who will win the lobbying battle in Carson City in 2011, the MRSA patients and their families or the hospital lobbyists.
The reason I say that is the 2011 Legislative Session in Nevada leads into the 2012 Federal election campaign, and the MRSA patients and their families can hold all Nevada elected officials accountable if they conspire with the hospital lobbyists to allow this reckless infection spreading negligence to continue.
Great Job Sun. This is a very 'deep' problem that Nevada faces, but this is the first step, to confront it. This is what a good news organization does. Thank you.
Good I hope that the investigators sit these people down in one of those Infectious expected rooms to discuss this.
So when they EXPECT patients to get infected while at hospital, they don't report it. Based on the number of unreported infections, they EXPECT a lot of patients to get infected.
Your conclusion is short-sighted and I believe shows a lack of understanding of the advancements in medical care.
As medical technology advances and we're able to go further to pull patients from the brink of death there are consequences. Before we had cardiac bypass surgery folks who had heart failure were just flat out of luck and died earlier. It's the same with trauma-related injuries. Now we're able to perform surgery to repair the damage. Where 20-30 years ago there would be no hope for these patients we now have technology to save ever more of them.
But the consequences of these type maladies are that the body's systems, particularly the immune system, become compromised and are not able to fend off infection. The first line of defense after the body's natural immune system are antibiotics which have largely filled that void. The consequences of that development results in the rise of the superbugs.
So it is not as easy as simply saying the hospitals are filthy germ infested ratholes. They aren't. A significant contributor to this problem is the fact that medical technology to resuscitate patients who used to be hopeless has consequences and infection happens to be a big one.
I knew someone from California who cut themselves pretty badly in Nevada, they stapled the cut on the arm at an area hospital. Back in California at Kaiser Hospital they said
they never saw staples anywhere except a head wound.
Isn't easier for a doctor with a bad rep to get work in Nevada?
brain? seems like you think germs have rights?
1).
It's difficult for us to acknowledge the revulsion and outright negligence for the safety of American citizens and the disrespect to our national sovereignty demonstrated by this administration, it's devotees who march in lockstep, and the racial special interests who wait to be rewarded with amnesty for delivering hordes of illegal aliens to the voting booth.
No need to discuss the SPP, NAFTA, CAFTA, ALCA, or the unrestricted dangerous approval to the Mexican government by opening our highways to Mexican trucks and their drivers. Our subversive politicians increasingly places our lives at risk, reducing Americans to mere easy prey for illegals aliens and their behavior (drunk driving murders by illegals are just a cultural configuration according to Geraldo Rivera).
Americans have to admit without guilt, the diseases illegals are bringing into our nation and inflicting upon us. For example, one city in Virginia had to close all of its public schools in order to sterilize them. As with this issue, true numbers of those affected were not revealed. One student's death was reported. The germ had spread to his kidneys, liver, lungs and muscles around his heart.
The reason for the school closings, and the number of sickened students is blamed on the out-break of a staph infection that is endemic to Mexico. This infection is a particularly strong strain that is resistant to treatment. This staph infection is typically found in hospitals. It destroys bone and skin tissue. The infection is one that seems easily spread.
More than 90,000 Americans get these potentially deadly infections each year from drug-resistant staph super bugs. Deaths tied to these infections may exceed those caused by AIDS. One form of the staph germ has spread beyond its traditional hospital setting. The overall incidence rate was about 32 invasive infections per 100,000 people.
That's an astounding figure, said an editorial in JAMA, which published the study. Most drug-resistant staph cases are mild skin infections. But this study focused on invasive infections - those that enter the bloodstream or destroy flesh and can turn deadly. They found that only one-quarter involved hospitalized patients. More than half were in the health care system - people who had recent surgery or were on kidney dialysis.
Open wounds and exposure to medical equipment and the cleaning of the facilities left to a third world workforce are major ways the bug spreads. In recent years, the resistant germ has become common in hospitals and it has been spreading through prisons, and poor neighborhoods. The new study offers the broadest look yet at the pervasiveness of the most severe infections caused by the bug, called Methicillin-Resistant Staphylococcus Aureus, or MRSA.
2).
These bacteria are carried by people. It lives on the skin or inside the nose. The newer threat, the extremely resistant Clostridium difficile is not even in discussions.
The overuse of antibiotics in raising livestock for meat consumption, and increasing numbers of an illegal alien culture that abuses antibiotics is contributing to outbreaks of bacterial infections.
Researcher estimates are extrapolated from 2005 surveillance data from nine illegal alien saturated regions considered representative of the country. There were 5,287 invasive infections reported in people living in the regions, which translated to an estimated 94,360 cases nationally.
Most cases were life-threatening bloodstream infections. About 10 percent involved so-called flesh-eating disease, according to the study led by researchers at the federal Centers for Disease Control and Prevention.
There were 988 reported deaths among infected people in the study, for a rate of 6.3 per 100,000. That translates to 18,650 deaths annually. Researchers will not admit if MRSA was the cause in all cases.
If these deaths all were related to staph infections, the total would exceed other known causes of death including AIDS - which killed an estimated 17,011 Americans in 2005.
This underscores the need for extreme prevention measures. It includes curbing the overuse of antibiotics (which is prevalent in Mexico, and the underground pharmacies for illegal aliens in this country), improving hand-washing and other hygiene procedures among illegal alien hospital workers.
Some hospitals are now isolating new patients until they are screened for MRSA. The bacteria don't respond to penicillin-related antibiotics once commonly used to treat them, because of reasons mentioned. They can be treated with other drugs but health officials worry that their overuse could cause the germ to become resistant to those as well.
The Egyptians used copper thousands of years ago to treat infections. Stainless steel is nearly everywhere you look in hospitals. MSRA remains fully active for days on stainless steel. On copper, the bugs can only live for 30 minutes.
3).
A survey earlier this year suggested that MRSA
infections, including noninvasive mild forms, affect 46 out of every 1,000 U.S. hospital and nursing home patients - or as many as 5 percent. These patients are vulnerable because of open wounds and invasive medical equipment that can help the germ spread.
Dr. Buddy Creech, an infectious disease specialist at Vanderbilt University, said the JAMA study emphasizes the broad scope of the drug-resistant staph epidemic, and highlights the need for a vaccine, which he called the holy grail of staphylococcal research.
The regions studied were all metropolitan areas with large illegal alien populations.
Ellis Island was established for a reason. Today, imprudent, pacify the world college apologist inclined politicians, and naive liberals welcome disease carriers from around the world to live freely amongst us without second thought.
These same numb skulls would rather you be at risk, or killed by diseases that millions of illegal aliens are bringing into the country - some that were eradicated in America decades ago - rather than protect us, or admit the truth.
All for fear of being labeled racist.
Im not sure why the hospitals in Nevada seem to be behind the curve with the infections that patients can pick up while they are hospitalized.
When my father was hospitalized at the Sentara Norfolk General Heart Hospital in Virginia, his nursing staff were zealous with the prevention of any infection, and were specifically concerned with eliminating the exposure to MRSA. Before my family and I could go in and see him, we were educated on the importance of washing, gowning and gloving up properly, and on the consequences if one of these infections was passed on to any patient with a compromised immune system, with the focus again on MRSA as well.
My condolences go out to all of the people here that have suffered the consequences of an overtaxed underfunded healthcare system. And no, I am not in any way implying that illegal aliens are to be faulted as it seems that the LVRJ blogs always have the regulars that steer them in that direction.
Basic quality healthcare is everyones right as a human being and should never be denied due to a line on a birth certificate.
mred: Surgeons use staples all the time to repair wounds. Ever had a hysterectomy? I think you're oversimplifying the situation. There are community standards which do differ from place to place. You have to be careful to diffrentiate between personal preference of a particular treater and what is the standard. But I understand the point you're trying to make.
fretsward: You haven't even made a determination whether the MRSA you reference was of the hospital acquired or community acquired nature. MRSA exists and can be on your skin any given time of the day. Most people have the bacteria on them at one time or another but in rare cases does it develop an infection.
fretsward: I agree with you that infection control is one BIG reason to be more vigilant on who is entering our country. We've also seen a big rise in tuberculosis and other disease which we thought were conquered.
Comment removed by moderator. Post in all caps.
My father spent 70 days in the hospital with an enterococcus faecalis infection which vegetated to his heart valve. I was at the hospital twice a day, questioned his caregivers diligently and he survived. Unfortunately people get sick and die. That's why hospitals want to get you out as quick as possible. I had no problem looking at his chart and his caregivers were very open and honest because I cared. What's your point?
And I worked in the semiconductor manufacturing industry in a clean room manufacturing computer chips at Micron Technology. They aren't concerned about bacteria but particulate matter. It's a completely different scenario.
I'm sorry you lost a family member in a tragic situation. But don't project your grief and ignorance on those who work very hard to help people. It's unfair and petty.
Comment removed by moderator. Post in all caps.
Dude get a clue'I'm not attacking health care workers,rounding doctors yes and the hospital yes cause they knew and kept it a secret and an investigation by the state is on going.I was at the hospital ALL the time and called when I was'nt. She was infected'they knew it they hid it they transferred her, it killed her.Here's what's petty;your attitude that people should get out of the hospital quickly or risk dying.here's what's ignorant;your ability to research or you would know there are cleanroom companies that specialize in hospital infection reductions and when they show up infection rates drop to zero,documented.Here a thought, Medicare/cade pay for cleanroom companies everybody wins.Hospitals are off the hook financially and can focus on care, cleanroom companies do their thing Medicare/cade saves billions in prevention thousands of lives are saved people don't have to fear getting infected, I'd have my mom your dad would not have been at risk.Hospitals are keeping people in the dark instead of ask for our help-HERE'S MY POINT -I HAD NO CLUE MY MOM WAS FIGHTING TWO FIGHTS AND THEY NEVER REVEALED IT TIL IT WAS TOO LATE.She won one battle ,what she went in with- we both lost the other THAT'S MY POINT.
And just when we thought MRSA or C. diff was bad enough, European plastic surgery patients are carrying a new class of superbugs resistant to nearly all antibiotics from South Asia to Britain. These superbugs have world health professionals nervous that they could spread worldwide.
Hospital infections that were already difficult to treat have become even more impervious to drugs thanks to a recently discovered gene that can jump across different species of bacteria.
The NDM-1 gene was first identified by Cardiff University's Timothy Walsh in two types of bacteria - Klebsiella pneumoniae and Escherichia coli - in a Swedish patient admitted to hospital in India.
Worryingly, the new NDM-1 bacteria are resistant even to carbapenems, a group of antibiotics often reserved as a last resort for emergency treatment for multi-drug resistant bugs.
In the new study, led by Walsh, researchers set out to determine how common the NDM-1 producing bacteria were in South Asia and Britain, where several cases had turned up.
Checking hospital patients with suspect symptoms, they found 44 cases - 1.5 percent of those screened - in Chennai, and 26 (eight percent) in Haryana, both in India.
They likewise found the superbug in Bangladesh and Pakistan, as well 37 cases in Britain, where several patients had recently traveled to India or Pakistan for cosmetic surgery.
India also provides cosmetic surgery for many Europeans and Americans, and it is not likely, but when NDM-1 will spread worldwide.
NDM-1 was mostly found in E. coli, a common source of community-acquired urinary tract infections, and K. pneumoniae, and was impervious to all antibiotics except two, tigecycline and colistin.
In some cases, even these drugs did not beat back the infection. Crucially, the NDM-1 gene was found on DNA structures (plasmids), that can be easily copied and transferred between bacteria, giving the bug an alarming potential to spread and diversify.
Unscreened air travel and migration allow bacterial plasmids and clones to be transported rapidly between countries and continents, without detection.
The emergence of these new drug-resistant strains could become a serious global public health problem as the major threat shifts toward a broad class of bacteria - including those armed with the NDM-1 gene - known as Gram-negative.
There are few new anti-Gram-negative antibiotics in development. Currently, none are effective against NDM-1.
NDM-1 is New Delhi metallo-beta-lactamase-1.
The University of Calgary in Canada said patients who have medical procedures performed in India should be screened for multi-resistant bacteria before they receive any type of care in their home country.
Dude "getting out of the hospital early" is not my phrase, it's what any doctor worth his salt will tell you. People die in hospitals. And yes, there are cleanroom companies that may specialize in hospitals but that wasn't the context of your post. I just happened to be at the doctor with my father today and he lamented the quality of the journalism in this piece. His largest criticism was that the data used was not properly filtered to determine whether these infections were hospital or community acquired. That information is not always distinguishable from a simple analysis of billing records. Which goes back to my original comment as to the veracity and validity of Mr. Allen's work. And yes, this series was a BIG waiting room conversation topic in the office. Fortunately most of the people there have a healthy dose of skepticisim about the press and the medical community so I think they'll be ok.
Let me say this. The best thing anybody can do is become more informed about your health. And like you said, be fastidious in hand-washing and question your caregivers. Go to the doctor with your family members if you are responsible for them and learn what chronic conditions they may have. Get the phone number of the hospitalists treating your family while they're inpatients and don't hesitate to call for an update. Ask the nursing staff when the physicians round and make sure you're there when they are. If you don't get the answers you want be strident in moving up the chain of command to the charge nurse, the on duty nursing supervisor and if necessary the Risk Manager until you do. Similar to the words of Smokey Bear, "Only you can prevent your next infection."
And lastly he said that the reason physicians and hospitals are loathe to speak with the press is a general lack of journalistic integrity.
Nice try ,I did all that , I told the charge nurse that , I followed every thing they did, we looked up everything they were saying and doing. we questioned and listened and helped where we could. I have a master's degree , I can research and study and be a student and learn and listen. I wanted to help just like any family member would. And they said "trust us" I did until I figuered out they hid some pretty important details that led to death. Now I don't trust anymore and I'm going to do my best to make sure no one else does either. It does'nt matter what you say cause you belive them. "keep drinking the coolaid and "trust us" oh by the way the four weeks of antibiotics you've been on, we forgot to tell you you're infected and when your organs fail you die a really painful horrible death as your family watches, will be sure to tell them"sorry for your loss" Were done her see you at the health dept meeting, you do your thing ,I'll do mine
By the way ,mr.Allen's facts were verified by independent's in the north who ,to their dismay, hoped to prove him wrong as they are his competition.
I live in southern california. I do not know about the rest of the U. S. , but I do know that we have some very dirty hospitals here. I have seen the medical staff lay clean and sterile things on chairs and the tops of dirty sheets hampers. I have heard that they pick things up from the floor and use it. I saw that in a nursing home.They throw clean and dirty sheets on the chair where visitors sit and they put instruments and other things that should be kept sterile on the top of the very dirty linen hamper. I could see the dirt that is how dirty it was. I actually put on some gloves and cleaned the hamper myself it was so disgusting. But it looked good after I was done with it. I also cleaned the chair. I am far from being a clean freak. However The dirt in the medical facilities did freak me out because it was a hospital and it is supposed to be a very sterile environment. I was in 3 different hospitals and all of the hampers were all dirty. I also saw the nurses using a dirty sink for 2 people. They set the wash clothes in the very dirty sink that they used to clean a woman's private area. I saw that everywhere hospitals and nursing homes alike. It seems that this is just an infection waiting to happen. I saw that also. There was one hospital that was always mopping in the emergency room and the stairs. This was a refreshing change. However the other problems still existed. I very rarely saw anyone moping only once in two hospitals that I was at. I had spent a lot of time there. I was a visitor of these hospitals. They should have some sterile tables that pull out for the clean items and maybe there should be a clean big drawer to keep clean sheets in. Dirty things should be kept very separate from the clean. Clean stuff should never be tossed on a chair where the visitors sit. Visitors can bring in a bug and patients can spread disease to the visitors. The procedures that require a sterile environment should be done properly. Sterile basins should be used for everyone. Everyone has there own. We need much stricter rules in the medical environment and we need someone who inspects hospitals and all medical facilities to make sure that they are kept clean and safe. That means there has to be clean tables or somewhere clean where these items can be put. That alone may help cross contamination of instruments etc Something has to change or else we will continue to lose precious loved ones. Hospitals need to save lives not take them.