Hospital Infections: Does Hospital Ownership Matter?
Private hospitals tend to have private rooms and lots and lots of plumbing. These features help control infections and make hospitals safer for patients. Because governments can shut down private hospitals that fail cleanliness standards, private hospitals also spend a lot on maintenance and housekeeping. Government hospitals tend to do things differently.
Clostridium difficile is a spore-forming toxin producing bacillus that lives in the gut. It is shed in feces. Alcohol hand rubs are not effective in controlling it. It can kill. New strains seem to be more dangerous, and deaths are on the rise.
CDC recommended control measures include hand washing with soap and water, placing patients in private rooms, using gloves and gowns when entering an infected patient's room, using disposable patient-care items, and meticulous environmental disinfection using bleach. [link]
C. difficile control is difficult in old or overcrowded hospitals. Isolation is difficult when private rooms are a pipe dream. Hand washing is impossible when a shortage of beds leaves patients warehoused in wards and stacked in hallways that lack sinks and soaps.
In England, The East Kent Hospital NHS Trust's self assessment on a C. difficile outbreak notes that "The infection control team were keen to isolate patients but the scarcity of side rooms made this difficult…both before and during the outbreak…some patients were not isolated…it took 4 months to establish an isolation ward." [link]. The Trust goes on to note that "…there is a relative shortage of isolation rooms in the Trust and in particular a need for negative pressure isolation facilities for TB patients." Infection control policies were "largely out of date," and staff was both lacking and untrained.
The report says that in January 2006, Maidstone Hospital was only cleaned between 7:30 and midday. An audit, also in 2006, found that 98% of its commodes were soiled. Cleaning standards have reportedly improved and cleaning is now available for 24 hours.
Canadians have similar problems with C. difficile. According to Valiquette et al. in a 2004 edition of the CMAJ, part of the problem with controlling C. difficile in Canada is due to "The aging infrastructure of hospitals and our willingness to tolerate hospital rooms with 4 patients and a single bathroom, less than 3 feet between beds and progressively fewer resources assigned to housekeeping all facilitate the spread of this disease, as does our inability to achieve acceptable levels of hand hygiene among hospital staff." [link]
In the US, the government-run Veterans Administration hospitals also have sanitation problems. In 1997, an outside consultant reported housekeeping problems at the Kansas City VA Medical Center. By 2002, things were so bad that clinicians felt compelled to clean their own areas. Management embarked on a hand washing campaign. This had limited success, as a review found that many soap dispensers were empty and that, as one clinician noted, "sinks should actually work." [link] In Dallas in 2004, "Most patient rooms and bathrooms we inspected were unclean…the rooms had foul odors, suggesting that they had not been thoroughly cleaned over a significant period." [link]
Let’s alert Commonwealth about these findings. I’m sure they will want to send out a press release immediately.
This illustrates a point John Goodman has made at this blog many times. When providers compete on price, they also compete on quality. But if they do not compete on price, they do not compete on quality either.
Sometimes, Death Is Good….. For A Vicious Unicellular Microorganism
There are a variety of different types of foreign bacterial infections one can get from many different sources, yet some are more common than others. If they are not beneficial for your physiology, they all should die in order to restore your health.
Bacteria are a simple life form, yet are incredibly productive and efficient. As with other life forms, it exists to reproduce, and does so about every hour, and evolves and adapts to its environment as needed. To do this, it fully utilizes all available resources and energy to develop the protein that is essential for its survival, and bacteria have the ability to adapt as needed to assure this happens.
It needs exactly 7 genes to produce the essential ribosomes for this to occur. Any more or less genes than 7, the bacteria is not maximizing its efficiency to survive and reproduce. Amazing.
Strept infections are caused by what are called gram positive bacteria, and are unique that these bacteria grow in pairs. Staph bacterial invasions are gram positive as well, yet it is the MRSA, Methicillin Resistant Staff Aureous microbes of this type often are very difficult to treat normally when a patient suffers from their damage from being invaded by these bacteria. Another difficult situation is when a patient is infected by VRE, Vancomycin Resistant Enterococci, as well.
These MRSA and VRE pathogenic or disease causing bacteria are the ones that are the most clinically concerning for the health care provider. At times, such bacteria invade a resident of a medical institution. If so, they are called nosocomial infections, and such infections are not limited to resistant strains of bacteria.
Group A strep infections can cause diseases such as strep throat and pneumonia. Since there are several types of bacteria, a diagnostic test called a culture and sensitivity is usually performed to assure the correct antibiotic is selected for treatment, as the bacteria are identified with this method.
Typically, fluid from the area suspected of being infected is obtained from the patient suspected to have an infection and smeared on what is called a petrie dish. And then these dishes are incubated for 2 to 3 days. Gram positive bacteria stain during this process a dark violet or blue. Gram negative bacteria would be pink in color, and are capable of harm as well to a human being.
When the culture is complete, technology offers recommendations on the appropriate class or brand of antibiotic for this bacteria present in another person- presuming the bacteria will not be resistant to the antibiotic recommended, as this happens on occasion.
Usually, classes of antibiotics that are used to treat gram positive strep infections that are not VRE or MRSA are cephalosporins, macrolides, or general penicillins. If the microbe that is causing the infection is resistant to the antibiotic from such classes that are administered to the infected patient, particularly with methicillin and vancomycin, which is the case with VRE and MRSA bacteria, then there are other more aggressive antibiotics that will be chosen for this patient.
Such brands and types of antibiotics for MRSA and VRE bacteria include Zyvox, which has both IV and oral dosage options. There are also other antibiotics, such as Cubicin. However these antibiotics for antibiotic resistant bacteria are given usually due to infections that have progressed to a more serious nature within a patient infected in such a way.
Progressive medical conditions include sepsis, or blood infection, osteomyelitis, or bone infection, or Pneumonia, which is a serious lung infection. A hospital stay is normally required with such patients, as the last antibiotics mentioned for MRSA and VRE bacterial infections are given by IV administration initially for several days, if not several weeks.
There are numerous classes and types of antibiotics available, yet bacterial resistance to most of these antibiotics constantly remains serious concern for the health care provider, and the infected patient, with MRSA at the top of the list of concerns for the health care providers.
Dan Abshear
http://www.cdc.gov/ncidod/dhqp/ar_mrsa_spotlight_2006.html