Sunday, Aug. 22, 2010 | 2 a.m.
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Do No Harm: Hospital Care in Las Vegas, Part 2
- A hidden epidemic
- 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
See the results
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The analysis of hospital billing records on file with the state identified 2,010 cases in 2008 and 2009 in which Las Vegas hospital patients were infected with Methicillin-resistant Staphylococcus aureus, better known as MRSA, or Clostridium difficile, known as C. diff. In 239 cases, the patient died in the hospital, although the billing records do not show whether the infection contributed to each death.
We sat down last week with four people who have distinct perspectives on hospital-acquired infections:
• Christina Schofield, a registered nurse who has witnessed infection-control failures in Las Vegas hospitals.
• Julie Rich, who was infected with MRSA and nearly died after an outpatient procedure at a local hospital.
• State Sen. Shirley Breeden, D-Henderson, whose father was infected with MRSA during a hospital stay and who sponsored a bill in 2009 that requires hospitals to report certain infections. The information, however, is not made public.
• Tracy Puckett, director of infection control and critical care at University Medical Center.
The conversation highlighted the dangers posed by the bacteria, obstacles to fighting their spread and potential solutions to this hidden epidemic. It was transcribed by the Sun’s Nadine Guy and edited for clarity and length.
What is your reaction to the Sun’s findings? And what does it say about the presence of drug-resistant bacteria in local hospitals?
Puckett: I think it reflects a multisystem failure of education of patients and on the facility side and the employee side.
Breeden: The numbers are alarming. These aren’t just numbers, these are real people and lives being affected. All of us here want to do what’s right and get the information that’s really needed so we can identify the infections and determine what solutions we need.
Rich: I was shocked when I read the numbers. And those are only the ones (the Sun) dug up. Hospitals need to be more forthcoming about reporting these infections so patients can guard against them. And if the patients can’t, their families can. MRSA was never mentioned to me, even when I was released from the hospital. I only saw it on some papers. They never told anyone in my family, that I’m aware of, that I had MRSA.
Puckett: Our job is to prevent the spread of these bugs — that’s the whole point of my department of infection control. I have four staff members with the title of infection preventionists and that’s the battle we fight every day. They teach staff best practices. We get people in isolation who need to be in isolation. We make sure that there is appropriate staffing to prevent the spread of infection.
I’m happy about the state law (on reporting infections) coming into effect. The problem with reporting infections by hospital is: Does everyone do the same screening? Does everybody use the same methods to determine whether something is an infection, because it’s quite subjective? We have to find a way to make these numbers meaningful and comparable and honest, which is going to be the battle.
Breeden: The issue we’re looking at getting to is determining how many infections there are, where they stem from and how we can rectify the problems.
There is often a difference between what is said on the administrative level — hospitals talk about the methods to prevent infections — and what happens on the front lines with nurses and doctors. One thing that comes up repeatedly is health care providers don’t wash their hands the way they’re supposed to. Why is it so difficult to keep hands washed? And what other infection-control failures have you seen?
Puckett: You would think that people would do the right thing because it’s the right thing to do, but you would think that in all of life. And I don’t like to admit that health care workers don’t wash their hands, but we have people watching, and we see people who don’t. And we stop and ask them why; we get a hard time from them, so I can’t really tell you why. All I know is we are trying everything we know to encourage it and telling patients, “Please, be your best advocate. Stop people before they come in and touch you if they haven’t washed their hands.”
Schofield: Everybody has had budget cuts, and they’re cutting staff, which means you have to hurry to finish your work in eight hours. Some things that should be of the utmost importance go by the wayside. You have to get your medications given on time and you have to check this box, and half the time you check that box, you didn’t really do it. The more time they take away from the nurse being at the bedside, your priority levels change.
If you’re busy trying to change a dressing and you hear your call light going off in another room or a pump alarm or no one is answering the phone, you’re going to run out of that room and do a quick squish-squish on the hand sanitizer and you’re going to go answer the phone.
Also, there is a hospital in this city right now that has one housekeeper on night shift — in the whole hospital. How thoroughly can that housekeeper clean every empty room that gets turned over? It just doesn’t happen. If that patient was infected and the housekeeper really doesn’t have time to thoroughly clean that room, that bacteria is still in that room. When that next patient comes in, it’s still going to be on that blood pressure cuff. And if that patient comes from surgery, they’re going to have an open wound. And there you go.
Rich: The nurses on the floor have way too many patients, in my view. The nurses run around all night, and they have so much paperwork to do.
Puckett: Our staffing ratio is two critically ill patients to one nurse unless they are downgraded and could move out of the unit, then a nurse might have three patients. If there is a reason and they are sick enough, we will have a one-to-one ratio. It’s not about checking a box, it’s about taking care of patients. So my question to all health care staff is: What are you doing as a professional to help advocate for your patient?
Schofield: Nurses don’t have the ability to take care of the patients they have. Ask any nurse if she’s able to provide the kind of quality care that she would like. Everybody is focused on the paperwork, focused on checking boxes and charting medications.
Rich mentioned that during her time in the hospital, no one ever told her she was infected with MRSA. I’ve talked to many patients who have said the same thing. Is that acceptable?
Puckett: Not to me. Over time things have become more transparent. Health care workers didn’t tend to tell patients what was wrong. Now doctors and nurses are more willing to be honest.
Rich: The more people know about it, and the causes and what they can do to protect themselves, the better. And the family really needs to know. They don’t tell you in the hospital, “Your grandmother has MRSA, and you have to be very careful — and everyone who comes in this room.” There’s nothing that says that in the room, no kind of sign that lets anyone who comes in the room know that.
Puckett: There should be an isolation sign. Our isolation signs are very front and center. But because we need to protect a patient’s privacy, we can’t say that they have MRSA.
Julie Rich, would you tell your story of how you got a drug-resistant infection in a hospital?
Rich: Of course, I don’t know exactly how. I went in for an incontinence procedure — a 20-minute surgery. I went to the outpatient clinic at Sunrise Hospital. I needed to go to the restroom, it was a unisex restroom — men and women were using it. There was urine on the floor. It was really filthy. In the room where we were, there was pink sticky stuff on the floor. There I am, lying in there with an IV in my arm for hours and hours because the doctor had so many patients.
After the procedure, I’m at home trying to recuperate. A few days are going by and I’m not responsive. I just want to sleep all the time and I’m not eating. I’m vomiting. It kept getting worse and worse, so finally we went to the doctor’s office and the nurse lifted the bandages and that’s it. And I go home.
I was getting pains in my stomach so I called the doctor’s office, and they said, “Well, you were just here. You have an appointment next week, just keep that appointment.”
I said, “Something is wrong. I have a lot of pain and I can’t hold any food down.”
She said, “Just keep your appointment.”
I go to the doctor’s office. The doctor came in and he said, “Why did you bring her here? She should be in an emergency room at the hospital. She’s got a horrible infection — a hospital-induced infection.”
There was pus. I was all bent over. I couldn’t straighten up. I was in the hospital for 23 days and twice they put me in ICU. I have oxygen 24/7 now that I didn’t have, and that has affected my life a lot. It’s very costly. And I see the doctor a lot more often.
The industry should clean up its act. They should be much more sanitary than they are. And they should not overload an outpatient clinic. I don’t know if that’s what every hospital does, but that’s what the hospital that I went to did. There were way too many patients in there. I don’t know if that’s the doctor’s fault.
And the idea of having one bathroom for all those patients, to me — this is not a Third World country we’re living in.
Sen. Breeden, you sponsored a bill in the 2009 Legislature that requires hospitals to report certain infections to the Centers for Disease Control and Prevention. What role did the hospitals play in that legislative process? And what kind of compromises did you make?
Breeden: It was a struggle. Before we went before the Health and Education Committee, I asked for a meeting of all the stakeholders, the Hospital Association. We battled it out for a couple of hours because I had also asked in the bill that doctors report. To me, if we’re going to do something, let’s include all the surgical facilities, hospitals, doctors’ offices, labs. But we had to compromise, and I agreed to the compromise because I believe we needed a start. It’s a beginning. It’s just a beginning.
The stakeholders will agree somewhat because they know you’re going to move forward without them in the Senate. But then they’re talking to members of the Assembly, trying to get them to vote against your bill.
What was the sticking point for hospitals?
Breeden: I believe they’re afraid of lawsuits.
Under that law, hospitals will report the number, but the public won’t know where the infections occurred. (UMC does report its infections to the public and St. Rose Hospitals have said they will.) What are some of the reasons hospitals don’t want this reported by individual facility?
Breeden: They’ve never said this to me, but I believe they’re afraid that they will lose business. It’s money coming out of their pocket. But that’s not the issue, the issue is life and the patients. We trust them. We believe when we go in the hospital we’re going to be safe.
Schofield: It’s all about the money. Times are hard — unemployment and foreclosures, health care, health care reform. People aren’t going to the hospital as much as they used to because they don’t have insurance and business is down. I don’t deny (hospitals) need to make a profit, but when it comes to human life and human suffering, how much is a human life worth?
Are there any penalties or discipline for people who fail to wash their hands?
Puckett: I can help promote it and help monitor, which we already do. The managers would have to reprimand their own staff if we had enough evidence to do that. I would prefer to try to get them to do it.
Doctors aren’t employees of the hospital. And we don’t want to chase them away and at the same time we don’t want them infecting our patients if they are not washing their hands, so it’s kind of a fine balance.
I’ve thought about this a lot. Why isn’t everybody washing their hands every single time they go in and out of the room? I’m not defending it. But why don’t people always wear their seat belt? Or always stop at every red light? Or always go the exact speed limit? Or always eat their vegetables? Or always do everything right? Because they’re human, and everyone doesn’t always do the right thing.
But the one thing we can all do — the simplest thing and the most effective thing — is clean your hands between patients. It’s just getting people thinking that way.
What about penalties for hospitals? With the hepatitis C outbreak here — the largest hepatitis C outbreak in the history of the United States — the fine levied against it by the state was about $3,000. If money talks, does the Legislature need to increase financial penalties?
Breeden: That is an avenue that needs to be researched and investigated as well.
Puckett: I definitely agree that some financial incentives should be there. That tends to be what incentivizes people.
What can be done to hold hospitals accountable for decisions that can lead to infections?
Breeden: I believe that the Legislature needs to mandate certain requirements so hospitals have to be more accountable. I don’t know all the avenues to do that; I’m exploring it now. But it’s going to take the state to be more aggressive.
Rich: We have to have more accountability and hospitals have to be honest and report their infections.
If there are hospitals that are willing to report their infections and there are hospitals that aren’t, I think it’ll backfire on the hospitals that aren’t willing to come forth with their information. If it’s known, you’re not going to go to that hospital, so I think that they are hurting themselves in the long run.
I’m happy that we have a couple of hospitals in town that are willing to do that. We sure need a lot more of it because people are at risk and they have no idea.
In my case, I was told that it’s probably taken years off my life. It’s a very serious matter and hospitals need to be more forthcoming.