Views » March 16, 2006

Are Hospitals Hazardous to Your Health?

By Terry J. Allen

Margaret Jannetti and David Cohen were victims of a lax and secretive medical system. Both underwent surgery and both died, not on the table, and not from the disease the operation was meant to correct.

Although they had little in common in life, Jannetti and Cohen shared a cause of death with the estimated 90,000 people who are infected every year by the life-threatening bacteria that cling to clothing, walls, food trays, stethoscopes, catheters and other surfaces in every hospital in the country. But the main culprit is a practice condemned in the 19th century: Hospital personnel going from patient to patient without properly washing their hands.

Cohen, an affluent New York lawyer, was a vigorous 83-year-old when he entered Mount Sinai, a prestigious New York City teaching hospital. (Cohen is a pseudonym at his family’s request.) Before laproscopic surgery to remove a colon polyp, he received broad-spectrum antibiotics. While knocking out most of the bacteria in his gut, they created a paradise for potentially fatal Clostridium difficile bacteria. Despite a dramatic nationwide increase in C. diff. infections—the great majority acquired during hospital stays—Cohen’s flourishing infection went undiagnosed and untreated until it was too late. After two months, most of it in a coma, he died of what the hospital called “natural causes.”

Margaret Jannetti, 79, a former piece worker in a Philadelphia garment factory, was the warm center of a large, working-class Italian-American family. Using present tense, Andrew Jannetti affectionately describes his short, stout mother as a “five-by-five.” After successful heart surgery at Our Lady of Lourdes Hospital in Camden, N.J., Jannetti began a precipitous slide. A month later she was dead. “We didn’t know there was an infection until the day she died,” says Andrew, recalling the doctor’s vague diagnosis of an antibiotic resistant infection. Largely because of antibiotic overuse in humans and livestock, many bacteria have mutated into strains affected by only a select few drugs—or increasingly, none at all. Because her death occurred within 90 days of surgery, Andrew was told it was automatically ascribed to “surgical complications.”

The medical profession, which pledges “First, do no harm,” did harm to Jannetti and Cohen. In addition to 90,000 killed by hospital-acquired infections, some one in 20, or 2 million patients survive but require longer, more expensive stays. In 2002, the journal Clinical Infectious Diseases put the annual U.S. price of C. diff. alone at “more than $1.1 billion in healthcare costs.”

The numbers around hospital infections are all nicely rounded because the Centers for Disease Control (CDC) estimates them; only six states require hospitals to report their rates. And only in Florida can the public meaningfully compare hospitals. Even there, the count is based on billing statistics and “Everybody knows hospitals lie about what is on billing data to get most favorable payment from insurance companies,” says Lisa McGiffert, a senior policy analyst for Consumers Union.

So Americans with no way to check infection rates must bet their lives that their hospital conforms to the safe practice standards set by the CDC.

Believing that the medical system had failed them, Jannetti and Cohen’s children turned to the legal system.

But lawyers are reluctant to sue over hospital-acquired infections. Since all hospitals are full of sick people and sick people are full of nasty communicable germs, the way to establish that a particular hospital is negligent is to show that it has an unusually high infection rate. It’s like proving that tobacco causes cancer by documenting that smokers disproportionately contract it. No reporting, no statistics. No statistics, no case.

A lawyer would also have to show that the hospital violated its own infection control protocols, but in some states both the protocol and any investigation of lapses are closed—even to a court subpoena. “You can’t determine if hospitals follow their own procedures if you can’t find out what the procedures are,” says Cohen’s son.

In death, Jannetti and Cohen, from very different socioeconomic worlds, had another critical factor in common: Neither’s life was worth a damn, or rather, the cost of a lawsuit that might inspire hospitals to clean up their acts—if not from conscience, at least from concern for the bottom line. Since both the ex-attorney and former factory worker were past their earning years, even a successful suit would garner too little compensation to tempt a trial attorney to take the case.

With hospital-acquired infections epidemic in America and litigation unlikely to spur hospitals to monitor procedures and institute vigilant infection control practices, some activists look to legislation. Spurred by a vigorous campaign by Consumers Union, numerous states are introducing legislation requiring hospitals to track and report infection rates.

“Good reporting is one of our goals,” says McGiffert. “The other is for hospitals to stop infecting people. The first line of defense is wash those hands, clean the stethoscope, clean the food tray, where you know bacteria are living.”

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• Reader Comments

  It seems that many afflications thought to have been wiped out long ago have returned with a vengeance such as syphalus, TB, and certain kinds of topically spread and airborne infections.  This is perhaps symtomatic of the whole pattern of social regression over the past two decades.  The broad public health concerns for which no expense was spared from the end ot WWII unitl turn of the new era with the onset of the “Reagan Revolution” was seen as constructing the sturdy social infrastructure needed for a stable, profitiable, and just society. Today’s outsourcers and globalizers no longer see any point in such “extravagant” concerns and have deemed sensible to return hundreds of billions of tax money for public welfare to the richest taxpayers to support financial speculation, niche markets, overseas investment, and luxury consumption. The US public takes a beating and the spread of formerly eliminated diseases with the emergence of new preventable ones is only one example of the bitter consequence of the new neo-liberal, post-Keynsean world and its priorities.  Perhaps there are actually more immediate and specifically health related explainations for the hygiene problems in contemporary US society but it surely pays to look at the social, political, and historical context in which they now exist.

  Posted by cabdriverinchicago on Mar 16, 2006 at 7:14 PM

  Syphillus, tuberculosis, and TB are bacteria. The bacteria have never been “wiped out”, and probably shouldn’t be. The diseases the bacteria cause when they overwhelm a person’s immune system have been treated successfully with antibiotics and therefore, not spread as widely.

  Strains of bacteria become resistant to antibiotics through the overuse of antibiotics, poor cleaning and sepsis protocol, and insufficient hand washing.  One thing I’ve noticed is that people often behave as if gloves were magic and are not vigilant enough about where all they are putting their hands when they are wearing gloves.

  These infections can also be spread through contact with bedding and clothes. Nurses in England are pushing to have the hospitals sanitize their uniforms so that they can cut down the risk of spreading the bacteria outside the hospitals.

  Hospitals, clinics, nursing homes, jails and prisons, should be required to culture all infections and test them before treating them with an antibiotic.

  MRSA and VRSA are nasty antibiotic resistant staph infections. Identification and proper sepsis are critical.

  Individuals would be wise to stop using antibacterial soaps and to learn how to clean——wash, rinse, dry, then use a disinfectant according to instructions, if there is a pressing reason to use a disinfectant. Harsh disinfectants can kill a pathogen’s competition and lead to anti-biotic resistant strains of bacteria flourishing. A disinfectant should be used on a dry surface that has been properly cleaned, and the soultion should be left on the surface for the proper amount of contact time. Repeated spray and wipe cleaning that does not remove dirt and bacteria allow a biofilm to develop, in which microbes can get small enough doses of disinfectants and antibiotics to develop a tolerance/resistance.

  People might also learn to wash their hands thoroughly for 17 to 21 seconds with a mild soap, rinse well, dry well. Antibacterial soaps are harsh and if used properly and frequently are likely to make a person’s hands break out in sores. They are also unnecessary and probably contribute to resistance.

  It seems like the entire medical establishment is understaffed. HMO’s were a horrible idea, and the CDC might want to get busy educating industry about using more sepsis protocols and prophylactic measures and fewer antibiotics.

  This problem is preventable, but it takes time, testing, thoroughness, training, and more staff.

  Posted by wileywitch on Mar 17, 2006 at 2:08 AM

  Thanks for the highly expert if anal retentive explaination of the spread of disease. Also thanks for the correct spelling of syphillus.  I think that your point about anti-biotic resistant strains coming from anit-bacterial soap and other surface cleansers is a good one.  I realize that stuff like TB and Syphillus have never been totally wiped out though they were reare when I was young. It seems they’re making a comeback and it seems that it could be related to all the other regression that we are making as a society. I think greater regulation of the health care profession would help.  Health care is one industry that stands in incredible need of reform. It would save many lives and much misery.  Unfortunately, the current Administration could care less!

  Posted by cabdriverinchicago on Mar 17, 2006 at 7:07 AM

  Just about every year hospitals are evaluated and number one on the list is a need for increased handwashing.

  I think part of the problem is that there are more people living longer, and our society is unhealthy.  It’s not natural for a person to wash their hands every five minutes, and to wear latex or vinyl or neoprene gloves all day. Health care people have developed allergies to latex and died from thier gloves. What’s necessary isanal.

  In fact, health care people could be written up for not being anal or compulsive enough with handwashing.

  People have been having amputations for staph infections. It can’t just be inadequate hand washing at the hospitals; but hospitals need to report it to study it.  It would help if the World Health Organization and AMA made that a requirement.

  The rise of syphillus has been attributed to a rise in sex without condoms in articles I’ve seen in the last few years. Hope that one isn’t getting to be anti-biotic resistant. Talk about a public health disaster.

  Good housekeeping really isn’t all that “anal” either. Most of what women do at home is unnecessary cosmetic work that often spreads germs. Handwashing, airing out the house, being especially careful with meat handling,  getting hot food hot, and keeping cold food cold are the most important daily things. The chemicals most people clean with are more threatening to health and nature than a messy house.

  Posted by wileywitch on Mar 17, 2006 at 5:23 PM

  The last time I checked, hospitals were the fourth leading cause of death in the United States.  And besides infection, drug administration (medicine) is the other major culprit along with gross negligence and incompetence at all levels.

  “Most of what women do at home is unnecessary cosmetic work that often spreads germs.” —an arresting accusation. Got proof or is this merely bashing the woman of the house? LOL

  If this bird flu pandemic ever gets off the ground… I seriously doubt anyone will be willing to part with any product claiming to be antiseptic - that claims to kills germs and bacteria, etc.  A hospital will be the last place in the world you will want to be. Avoid people and avoid getting sick or dying. It could come to that.

  Posted by Tim Christopher on Mar 17, 2006 at 8:53 PM

• extended discussion >>>Continued...

  Discussions with more than 5 comments are continued on our special discussion page to encourage continuity and ease of use. There are currently 14 posts.

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