A story in today's Washington Post, on the first page of the Metro section, titled "Bug Puts Hospitals On Edge, On Guard" entirely misses the central facts about what is going on with regard to increasing virulence of bacterium in hospital settings. To head folks off from running down the wrong path in search of solutions for MSRA and other pathogens, I want to share my research into these issues. This is a long paper, but it is a complex tale of woe that must be understood if the population is going to be protected from harm, up to and including totally preventable death.
This is a tragic and unsettling story about the number of avoidable deaths being caused by medical doctors because of their generally careless attitude about the spread of infection, and because of the shoddy practices that flow directly from this widely prevalent physician mind-set. The disturbing truths about the huge dimensions and frightening implications of the present patterns of nosocomial infection have been obscured and shrewdly concealed from public notice by the purposeful, well-organized, and self-protective actions of the American medical guild. The latest development in this cover-up is reflected in the referenced Washington Post story written by Susan Levine entitled "Bug Puts Hospitals On Edge, On Guard: ‘Nasty’ Bacterium Resists Antibiotics, Forces New Actions." What Ms. Levine has not grasped is the fact that the planned "new actions" in Virginia and elsewhere ignore the real problems while blaming patients, not doctors, for the evolving presence and increasing virulence of methicilin resistant Staphylococcus aureus (MRSA) in American hospitals.
On November 30, 1999 the Institute of Medicine (IOM) issued a report entitled: "To Err is Human: Building a Safer Health System?" which documents the incidence of as many as 98,000 deaths each year among hospitalized Americans, and concludes that these patients are dying because of "unintended" physician errors. This is an interesting choice of words in that an intended error would appear to be a logical impossibility.
In her July 2000 Commentary in JAMA Johns Hopkins School of Hygiene and Public Health’s Barbara Starfield, MD summed the deaths attributable each year to all physician errors, concluding that medical errors are now the third leading cause of death for residents of the United States, behind only heart disease and cancer.
The public and compelling evidence that doctors and those they are directly responsible to supervise are causing the deaths of their patients at an annual rate exceeded only by heart disease and cancer has changed nothing. Physicians stand accused of responsibility for close to one-tenth of the deaths from all causes that occur annually in America, but the reality is studiously ignored.
Selecting a category of iatrogenic disease that fully merits Webster’s definition of "not focusing the mind on the matter," what follows is a presentation of facts about the truly horrific scale on which Americans are dying from nosocomial infections, including MSRA, that are regularly occurring in hospitalized patients chiefly because of inattentive practices by undisciplined physicians and the medical personnel who work under their direct supervision. Deaths caused by nosocomial infections constitute at least forty percent of the total deaths that Barbara Starfield has added up and reported.
The whole sad story really begins with the "secret language" tactic evident in the choice of an obscurantist word like "nosocomial" to describe these infections. The word "nosocomial" is derived from two Greek words : nosos, meaning "disease"; and komeion, meaning, "to take care of." In realistic terms, the word "nosocomial" means "doctor caused." The use of this adjective in the contemporary American context is freighted with the irony that, today, these hospital-acquired infections constitute rampant disease which is manifestly not being adequately "taken care of" by the attending physicians. The federal Centers for Disease Control and Prevention (CDC) has estimated that the incidence of nosocomial infection extends to more than two million individuals annually, nearly six percent of all the patients who are hospitalized during a given year. An estimated ninety-eight thousand patient deaths result each year from infections which the patient did not have, and which were not incubating, at the time of admission to the hospital, but which were acquired during what proved to be their final hospital stay. CDC’s estimates are extrapolated from voluntary reports made by only 257 hospitals, out of nearly 7,000 acute-care hospitals in the US. The hospitals doing the best job in infection control are the ones most likely to submit voluntary reports on nosocomial infection rates. These two facts strongly hint that recent federal estimates are far below the actual incidence of nosocomial illness and death.
The CDC has reported that at least half of the two million nosocomial infections, and half of the ninety-eight thousand deaths estimated by the IOM to result annually from these infections, could be prevented if physicians and the hospital staff under their supervision would follow the handwashing and related policies on asepsis which have been established as standard procedure in each acute-care hospital in the nation. This finding by a federal public health agency means that at least forty-nine thousand American lives could be saved each year by the straightforward means of assuring that MDs and the staff they are responsible for simply adhere to their own published, formally adopted procedures and protocols for washing their own hands and sterilizing the equipment they use. In view of the persistence of the irresponsible behavior patterns, it appears that physicians consider such adherence to be more than society can expect of them. And besides, if a patient acquires an infection while in the hospital, the doctors can always take care of it with antibiotics, right? Wrong.
This IOM estimate that at least ninety-eight thousand people die each year from nosocomial infections means that an average of two hundred and forty-five people are dying each and every day of each and every year from this single dimension of iatrogenic disease. This means that an average of ten people die of a nosocomial infection every hour of every day. It means that over 7,350 die each month, over twice as many as perished in the terrorist attacks on September 11, 2001. Imagine that one domestic airliner, carrying 245 passengers, crashed each and every day of the year in the United States, with every passenger being killed, no survivors. Under such circumstances, who in this society would ever again purchase an airline ticket? Yet little if anything has been done to eliminate or even to reduce the incidence of avoidable deaths from nosocomial infection.
These deaths from hospital-acquired infections constitute five times the current annual deaths in the United States caused by the AIDS virus, yet the society rarely if ever hears about the deaths that result from nosocomial infection. Such is the power of the American medical guild to bury its mistakes, and to suppress all evidence of its incompetence and of its abuses of trust, that information about these deaths is entirely absent from periodic federal reports of all other causes of death in the nation. The AMA has had a conscious political strategy aimed at prohibiting any surveillance or reporting role with respect to nosocomial infections to be undertaken outside the confines of the physician-dominated Centers for Disease Control. The National Center for Health Statistics (NCHS), an affiliated agency of the CDC, does not include a category for nosocomial infection in its routine reporting on the overall incidence of morbidity and mortality in the United States, despite the fact that these physician-caused infections are certainly a leading cause of illness and death in America. The National Nosocomial Infection Surveillance System (NNISS), administered by the CDC, confirms that reporting by hospitals under NNISS is entirely voluntary, with about four percent of hospitals complying and ninety-six percent of hospitals refusing to submit reports on nosocomial infections to NNISS.
The medical guild’s position that the American public should not be openly informed about the incidence of nosocomial infection is based upon the following reasoning:
"Comparisons of the rates of nosocomial infection between or among hospitals would be unfair and misleading because data collection would not be consistent across all hospitals, and because differences in patient mix involving morbidity or complexity of treatment would be difficult to factor into the reporting; and,
These comparisons would tend to increase risk for patients in that a patient might choose a hospital reporting a low rate of nosocomial infections despite the fact that the hospital selected might not be the optimal choice from the viewpoint of being best equipped to treat that patient’s medical condition."
These are the specious reasons that have led to the present situation of no surveillance of and no reporting about nosocomial infections by the NCHS; and of a very minimal, entirely voluntary effort taking place under hands-off coaxing by the CDC, an effort which the CDC admits reaches less than four percent of the acute-care hospitals in the United States.
The reasons for secrecy propounded by the AMA can be seen to be entirely bogus ones. Comparison of infection rates between hospitals can simply be dropped as an issue. The NNIS should require all acute-care hospitals to report their nosocomial infection data regularly and completely, under the guarantee that reporting on the findings will be done on an aggregated basis, by hospital region, by state, or on some similar broad-scale basis. The problem of nosocomial infections can be effectively worked on from this broad population-based perspective without publicly identifying individual hospitals. The system in place now is best described as cunning. A case involving the University of Iowa hospital clearly illustrates the lengths to which the medical profession will go to protect data on the incidence of nosocomial infections. One University faculty physician in the Iowa case testified in open court that doctors and nurses on the hospital staff are fully prepared to lie about the incidence of nosocomial infections because it seems to them to be the right thing to do. His judgment was that the public does not have either a right or a need to know about the incidence of nosocomial infections, including the number of deaths that are continuously resulting from these infections.
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