Jennifer Manganello had beaten a staph infection. She won out over a nasty bug called Klebsiella, too, as she lay in the intensive-care unit, suffering from complications of a seven-year-old spine procedure and was breathing with a ventilator.
But the 22-year-old, who had been partly paralyzed since the spine operation when she was 15, was attacked by two more infections as the weeks passed at Hartford Hospital in Connecticut. She finally died, one of the 99,000 Americans killed by a hospital-acquired infection in 2005.
Jennifer’s mother, Susan Manganello, was horrified by the toll that hospital care took on her daughter’s body. “Whatever antibiotic they gave her burned the entire side of her arm. It was like a huge, huge burn,” Manganello, a former transplant nurse, said in a telephone interview. “They kept it wrapped. When they took it down in front of me one day, I actually gagged. And I am a nurse. It was very deep and very nasty. She died with that. It never got healed.”
Doctors used to shrug off cases like Jennifer’s. Infections, they argued, are an unfortunate but inevitable side effect of long-term hospital stays. Germs are everywhere, they are invisible, and they can cause infections in so many ways when patients have multiple tubes inserted in veins, arteries, and other parts of their bodies. People carrying all sorts of microbes go in and out of hospitals all the time, and nurses are busy. It’s impossible to control all the exposures.
Public-health groups disagree, and they have become increasingly vocal about hospital-acquired infections. The influential Institute of Medicine made headlines when it issued a report in 1999 estimating that as many as 98,000 Americans die annually from preventable medical errors, mostly infections, at a cost of up to $29 billion a year. But the report changed little. “Hospital stays for methicillin-resistant Staphylococcus aureus infection have more than tripled since 2000 and have increased nearly tenfold since 1995,” the Health and Human Services Department reported in 2009. “One decade later, we can’t say whether we are any better off today than when the IOM first sounded the alarm about medical errors in 1999,” Arthur Levin, director of the Center for Medical Consumers and a member of the IOM’s Committee on Quality of Health Care in America, said at the time. Health and Human Services estimated that 1.7 million people acquired infections in the hospital, and that 99,000 of them died, in 2002.
But bit by bit, a combination of patient outcry, government reports, state requirements to report infection rates, and—finally—federal government action, including the 2010 health care reform law, is starting to move the needle. A few projects by big hospital groups demonstrate that hospitals can begin, perhaps for the first time in human history, to become safe places for sick people.
“SHE KILLED MY DAUGHTER”
Germs are sneaky. They stick to stuff, and they generate spores that can hide and grow long after the parent microbes have been cleaned away. They evolve in the flash of an eye to resist antibiotics, coming up with tricks that allow them to pump out toxic drugs or grow thick membranes as defenses. No red light flashes when a nurse transfers a few dozen methicillin-resistant Staphylococcus aureus bacteria onto a bandage he is changing. But the tiny batch of MRSA microbes can quickly multiply and make their way into a patient’s bloodstream, causing an impossible-to-trace lethal infection.
“One simple little medical error can cause a calamity and kill somebody,” Manganello said. “And that nurse who did that doesn’t even know she killed my daughter.”
Experts do, in fact, know how to prevent infections. “Wash your hands, wash your hands, wash your hands,” Julie Gerberding, former director of the Centers for Disease Control and Prevention, has intoned for years. Plain, old-fashioned hygiene really does work—keeping surfaces clean, keeping fecal matter away from open wounds, putting clean dressings over punctures made by catheters, and following sterile procedures in the operating room. So why is it so hard to make people follow such simple precautions?
“Creating a culture of safety requires changes that physicians may perceive as threats to their autonomy and authority. Fear of malpractice liability, moreover, may create an unwillingness to discuss or even admit to errors,” wrote Lucian Leape of the Harvard School of Public Health and Donald Berwick, who just stepped down as head of the Centers for Medicare and Medicaid Services, in a 2005 review of the Institute of Medicine findings.
“We don’t want to throw a bunch of antibiotics at people who don’t need them.” —Pharmacist Kevin Roshak
So step No. 1 was to require hospitals to get a handle on how bad things were in their own institutions, and then publicly fess up. The Health and Human Services Department’s 2009 Action Plan to Prevent Healthcare-Associated Infections lays it out. “The first thing you do is surveillance and know what the rates of infection are in your particular institution,” says Don Wright, deputy assistant secretary for health care quality at HHS. “No hospital wants a bad report card.”