July 26, 2002
2,610 Infants died of
preventable hospital-acquired infections - Chicago Tribune
FYI
President Bush would limit
health care liability
http://www.nytimes.com/2002/07/26/politics/26BUSH.html .
Clearly neither he nor
his advisers have considered The Chicago Tribune's investigative series,
Unhealthy Hospitals (excerpt below).
This Tribune series should be
required reading for members of the various research "protection" advisory
committees that are reinterpreting federal regulations to accommodate the
needs of the biomedical research industry. Efforts are under way to give
medical researchers easier access to children who are
being recruited--often against their best interest--for painful research
studies that bring them in contact with hospital-acquired infections.
These advisory panels have largely ignore the existing lethal hazards that
hospitals pose for children. Instead, they lend support for unjustifiable
experiments on the theory that healthy children may be "at risk"
of possible future illness.
The Tribune’s investigation
linked the deaths of 2,610 infants in the year 2000 to preventable
hospital-acquired infections--most were caused by Hospital staff--doctors,
nurses, and maintenance workers-- who failure to follow simple hygienic
procedures unsanitary: “The lack of hand-washing is responsible for most
germs spread in pediatric intensive care units, said Dr. William Jarvis,
chief of the CDC's hospital infections program.”
The Tribune identified 75,
000 preventable deaths "where hospital-acquired infections played a major
role. This analysis, based on the most recent national data, is the most
comprehensive of its kind and draws on thousands of hospital and
government inspection reports."
http://www.chicagotribune.com/news/specials/chi-0207220180jul22.story
INVESTIGATION: UNHEALTHY
HOSPITALS
Lax procedures put infants at
high risk
Simple actions by hospital
workers, such as diligent hand-washing, could cut the number of fatal
infections.
Second of three parts.
By Michael J. Berens Tribune
staff reporter
July 22, 2002
EXCERPT
Tamia Jones arrived two
months early, weighing less than 3 pounds. For the first three days, her
life was charted from precarious to uncertain to probable. By the fifth,
she opened brown eyes and was weaned from feeding tube to mother's milk.
On the seventh, she died.
One of the nation's most
prolific and lethal germs, pseudomonas aeruginosa, was on the loose in a
hospital nursery.
Tamia's parents say no one at
Sinai-Grace Hospital in Detroit even mentioned the infection to them. If
it was a secret, it became one that was impossible to keep.
In three months in spring
1997, on the same floor, within the same nursery unit, along the same row
of bassinets, hospital germs contributed to the deaths of three other
babies and slipped undetected into 15 more newborns at Sinai-Grace…..cut…
In the majority of cases in pediatric intensive care units, those lives
might have been saved by simple acts of washing hands or isolating
patients the moment infections were detected, according to inspection and
investigative files at the U.S. Department of Health and Human Services.
The records reveal hundreds
of examples of unsanitary conditions and unsafe practices:
His nose dripping from a
common cold, a doctor in a Los Angeles hospital in 1999 worked the
bedsides of newborn patients for half an hour without stopping to wash his
hands. Within a week, 12 critically ill children contracted infections
from pneumonia-causing staphylococcus germs. Two newborns died. A hospital
investigator traced the germ back to the doctor.
Without protection from a
mask, gloves or gown, a New York nurse took the blood pressure of a child
suffering from staphylococcus, a germ that attacks the respiratory system.
She then immediately embarked on bedside checks in another ward of at
least six other premature infants, three of whom contracted pneumonia and
died in 1998.
Hospital investigators
determined the nurse was the only common link among the infected children
[cut].
In analyzing the infection
problems inside pediatric units, the Tribune examined computerized patient
admission and billing records as well as state and federal health-care
enforcement records encompassing nearly 4 million U.S. births each year.
Infants are among the most
vulnerable patients, but they routinely are treated in ways deemed
inappropriate for adults within the nation's 5,810 registered hospitals.
Hospital investigations and CDC and Health and Human Services records
show:
- Infants riddled with
infections often are treated side by side with healthier babies in large
intensive care units, allowing germs to spread among patients. At least
1,200 hospitals use large pediatric wards as a cost-effective way to treat
the most children. But pneumonia-causing germs, for instance, can become
airborne from coughing and sneezing.
Conversely, adult patients
are usually segregated into different recovery rooms based on malady, and
they are usually cordoned off with curtains or other barriers not
typically found in pediatric wards. Adults also are more likely to be
isolated in private rooms, the CDC found.
- Harried nurses rapidly
shuttling between the beds of infected patients and other areas of the
hospital unwittingly transported germs that are believed to have led to
deadly infections in at least 500 children in 2000. Carelessness by nurses
and aides also causes life-threatening injuries to thousands more each
year. Adult patients with infections are more commonly treated by teams of
nurses prohibited from contact with other patients.
- An estimated 200 newborns
die each year because most hospitals are unwilling to pay about $5 extra
per catheter to use germ-resistant, silver alloy catheters, a federal
study found. Most ill babies are connected to catheters, which are hollow,
flexible tubes inserted into the body to allow passage of fluids. Although
the CDC and leading health-care agencies have called for nationwide
adoption of the germ-fighting catheters, many hospital officials argue
that the expense is not justified compared with the number of infections
prevented.
Premature and low-weight
newborns are the most vulnerable patients to infection. Their
underdeveloped or non-existent immune systems often coincide with serious
cardiac and respiratory ailments.
"The germs can sneak up at
you at times," said Mary Gould, infection-control supervisor for
Children's Hospital in Birmingham, Ala. "You can't be looking at all
directions at the same time.... Something could be going on behind you
[cut]...
Sanitation is particularly
important in pediatric intensive care units, where hospital-acquired
infection rates range as high as 20 percent, compared with less than 1
percent among infants born without medical complications, according to the
American Association of Critical-Care Nurses.
Infection rates in pediatric
ICUs rank higher than any hospital department because nearly all patients
are attached to respirators, intravenous pumps or other invasive devices
that can become an entry point for germs.
Deadly germs in the nursery
Sinai-Grace Hospital towers
over Detroit's northwest side. Each year the 500-bed medical center
handles 3,700 births, about 10 new lives every day.
The uncommon death of Tamia
Jones on March 21, 1997, gave no pause to the pace.
On the sixth day of Tamia's
life, a laboratory test showed she had been infected by a pseudomonas
germ. But the infection caused by the germ worked faster than the
antibiotic that was dripped into her body through an intravenous line,
hospital records obtained by the Tribune show. She died the next day.
It took more deaths of
premature babies and nearly two months before the hospital decided to
close the nursery, segregate infected patients and scrub down every piece
of equipment.
Pseudomonas is a water-based
germ that can flourish in sinks, ice machines, damp towels, on the leaves
of potted plants, even inside hand-lotion containers. The germ is
typically spread by touch and can result in lethal infections, including
in the respiratory and urinary systems. Unlike some germs that live on the
skin, pseudomonas quickly looks for pathways into the body, such as
respirator tubes.
Infectious-disease experts
said even one case of pseudomonas in a pediatric intensive care unit
should prompt immediate cleaning, isolation and enhanced testing of all
current and future patients in the ward.
Dr. Wasif Hafeez, chief of
Sinai-Grace's infectious diseases department, who was a lead investigator
on the outbreak, defended the hospital's reaction, saying the bacteria
moved so quickly the children were infected before the hospital could
identify an outbreak.
"I don't think you could find
anything that we could have done better," Hafeez said. The hospital
reacted quickly once the outbreak was identified, he said.
"I get upset when someone
says we should have been able to forecast that four children were going to
die," Hafeez said. "I got my degree in medicine. Not astrology or
palmistry."
He characterized the deaths
as the "price of modern medicine." Fragile newborns lost 15 years ago are
being kept alive with sophisticated machines and stronger medicines, which
make patients more prone to "unbelievably virulent" germs like
pseudomonas, he said.
After parents banded together
to file a lawsuit, hospital officials pointed the finger of blame at
Tamia's mother, Tracey Jones, who suffered several prenatal complications
the officials said could have been caused by a pseudomonas germ. When
Jones was brought to the hospital for an emergency Caesarean section, she
might have carried the germ into the facility, a pediatric doctor at
Sinai-Grace testified in a deposition.
There was one problem with
that theory. Doctors had taken swab tests of Jones' nose and mouth in
search of proof that pseudomonas lived on her body after Tamia's death;
the tests were negative, according to hospital records obtained by the
Tribune.
Hafeez confirmed the negative
test results.
What the hospital never
divulged to parents is that the germ was found on an employee, internal
hospital records show.
Hafeez acknowledged for the
first time to the Tribune that pseudomonas was found on the hands of a
respiratory therapist who had worked in the intensive care unit. The
therapist, he said, was ill and had undergone a colostomy; a small tube
ran from the therapist's abdomen, emptying body waste into a bag.
The moist areas of tubing or
even the bag could have been breeding spots for the germ, he said.
In addition to the strain of
pseudomonas found on the therapist's hands, hospital tests identified two
other strains in the intensive care unit, but the source of those germs
was never determined, Hafeez said.
Rebecca Walsh, an attorney
who represented the families of the dead children, said the parents were
never warned of the outbreak or that hospital officials had identified the
germ on any of their employees.
Parents would later testify
in depositions that lapses in health care were all too evident: Many
nurses and doctors did not wash hands or wear gloves while moving from
crib to crib.
On March 30, nine days after
Tamia died, another baby girl was brought into the neonatal unit. Alexis
Crooms, weighing 1 pound 12.3 ounces, showed steady improvement. She
stopped breathing 19 days later. An autopsy revealed the presence of
pseudomonas.
Despite laboratory evidence
that Tamia had died from pseudomonas, Alexis was never specifically tested
for the germ while she was alive, according to court depositions by
doctors.
While Alexis was in the
nursery, a premature infant boy arrived and was placed in the same row of
bassinets. Within 17 days, Prateep Bazel Jr. was dead. Tests done shortly
before his death revealed pseudomonas, hospital records show.
Pseudomonas can cause dozens
of different infections, making diagnosis difficult. Tamia developed
inflammation of the spinal cord and brain; Alexis was gripped by
lung-destroying pneumonia; Prateep was overwhelmed by inflammation of his
internal organs.
The fourth baby died on June
26. Once again doctors identified pseudomonas, but they were too late to
save Breanna Friday, whose intestines were attacked by an uncontrollable
infection.
The lawsuit filed by the
parents of the four infants was settled out of court in 1999 for an
undisclosed sum. [cut]
Copyright © 2002,
Chicago Tribune
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