00Doc:
Is this real in your view? Please comment with your usual clarity
and candor.
Thanks.
MikeV

From the New York Times.

June 6, 2005
Coming Clean
By BETSY MCCAUGHEY
INFECTIONS that have been nearly eradicated in some other countries
are raging through hospitals here in the United States. The major
reason? Poor hygiene. In fact, hygiene is so inadequate in most
American hospitals that one out of every 20 patients contracts an
infection during a hospital stay. Hospital infections kill an
estimated 103,000 people in the United States a year, as many as
AIDS, breast cancer and auto accidents combined.

   And the danger is worsening as many hospital infections can no
longer be cured with common antibiotics. One of the deadliest germs
is a staph bacteria called M.R.S.A., short for methicillin-resistant
Staphylococcus aureus, which lives harmlessly on the skin but causes
havoc when it enters the body. Patients who do survive M.R.S.A.
often spend months in the hospital and endure several operations to
cut out infected tissue. In 1974, 2 percent of staph infections were
from M.R.S.A. By 1995, that number had soared to 22 percent. Today,
experts estimate that more than 60 percent of staph infections are
M.R.S.A.

Hospitals in Denmark, Finland and the Netherlands once faced similar
rates, but brought them down to below 1 percent. How? Through the
rigorous enforcement of rules on hand washing, the meticulous
cleaning of equipment and hospital rooms, the use of gowns and
disposable aprons to prevent doctors and nurses from spreading germs
on clothing and the testing of incoming patients to identify and
isolate those carrying the germ.

Too few hospitals in the United States are using these precautions,
though where they are used they are highly effective. In a pilot
program, the veterans hospital in Pittsburgh reduced M.R.S.A. 85
percent, and the University of Virginia Medical Center eradicated
it. Unfortunately most hospitals have not shown the will to defeat
infections.

More than half the time, doctors and other caregivers break the most
fundamental rule of hygiene by failing to clean their hands before
treating a patient. Gloves are not the answer because pulling them
on with dirty hands contaminates the gloves.

Nearly three-quarters of patients' rooms are contaminated with
M.R.S.A., which, according to experts, can be found on everything
from cabinets to bedside tables. Once patients and caregivers touch
these surfaces, their hands become vectors for disease. Ordinary
cleaning solutions can kill these bugs, but surfaces need to be
drenched in disinfectant for several minutes, not just sprayed and
wiped quickly.

Frequently, stethoscopes, blood-pressure monitors and other
equipment are contaminated with live bacteria. Yet doctors and
nurses almost never clean the stethoscope before listening to a
patient's chest.

Astoundingly, most hospitals in the United States don't routinely
test patients for staph bacteria. Studies show that 70 percent to 90
percent of patients carrying M.R.S.A. are never identified.

Clothing is frequently a conveyor belt for infections. When doctors
and nurses lean over a patient with M.R.S.A., their coats and
uniforms pick up bacteria 65 percent of the time, and carry it to
other patients.

Contaminated clothing is believed to be the culprit at New York
City's Mount Sinai Hospital, which has recently struggled to control
another type of infection called Clostridium difficile. This common
and seldom life-threatening infection is often caused by fecal
material from one patient entering another patient's mouth. Doctors
at the hospital suspect that this infection spread because clinical
nursing assistants wear the same clothes while doing two jobs:
emptying bed pans and delivering food trays.

Hospital infections can be stopped, but most hospital administrators
have not made prevention a top priority. The Centers for Disease
Control and Prevention are also to blame. While the C.D.C. has made
some efforts to curb hospital infections, they have failed to ask
hospitals to follow the rigorous precautions that are working in
other countries and in those American hospitals where they have been
tried.

In 2003, a task force for the Society of Healthcare Epidemiologists
of America chastised the C.D.C. for this failure, but the C.D.C. has
still not acted. Every year of delay is costing thousands of lives.

Many hospital administrators say they can't afford to take the
necessary precautions, but they can't afford not to. Infections
erode hospital profits because rarely are hospitals fully paid for
the added weeks or months that patients must spend in the hospital
when they get an infection. Studies show that when hospitals invest
in these proven precautions, they are rewarded with as much as
tenfold financial return. These infections add about $30 billion
annually to the nation's health costs. This tab will increase
rapidly as more infections become drug-resistant.

In February, the Centers for Disease Control and Prevention declared
that it will not support the growing demand to make hospital
infection rates public. That's a shame because if you need to be
hospitalized, you should be able to find out which hospitals in your
area have the worst infection problems. This secrecy may allow some
hospitals to save face, but it won't save lives or money.

Betsy McCaughey, a former lieutenant governor of New York, is the
founder of the Committee to Reduce Infection Deaths