Friday, March 20, 2009
Imagine being in a hospital for an operation, and becoming infected with potently deadly bacteria. It happens more often that you might imagine. In fact, one out of every 20 hospital patients contracts an infection. Hospitals are taking a variety of measures to reduce these incidents. But it's a constant battle. KPBS Health Reporter Kenny Goldberg has the story.
(Photo: Technicians grow and identify bacteria in the lab at Scripps Hospital.
Intensive care units are ground zero for inspection control in hospitals.
"The ICUs are the area where the patient is the most vulnerable," says Myers, "And we also see the scariest multi-drug resistant organisms; so the patients have the least amount of defense, and we have our nastiest bugs. So this is where infection control makes the biggest difference for a hospital."
Myers says ironically, the things that keep patients alive like ventilators and catheters make them more vulnerable to infections.
"One of the patients' normal barriers is there skin and their respiratory system," Myers says. "And here in the ICU we actually create artificial holes in the skin to put medicines in, and we also then actually puts them on ventilators, which gets past most of their respiratory defense system. And because of that vulnerability, we can see some negative patient outcomes if we're not on top of our game."
Being on top of their game means being constantly vigilant.
Myers and his team track infections on a daily basis. They look at the types of bacteria that are cropping up, and what kind of trends are occurring.
(Photo: Bacteria growing in the Scripps Hospital lab. Kenny Goldberg/KPBS)
Upstairs in the lab, technicians process samples of patients' blood, urine, and spinal fluid.
Scripps scientist Dan Keays says it takes about a day to grow and identify most bacteria.
"And then we do other definitive tests," Keays says, "To see just exactly what strain that is, if it's a particularly virulent strain, or if it's a normal type of strain. And we subject those organisms to different levels and different concentrations of antibiotics, and see which gives it the best response."
Antibiotic-resistant staph infections can break out. So can a potentially deadly strain of infectious diarrhea.
Myers and his staff urge doctors, nurses, and other hospital workers to take steps to make sure pathogens don't spread.
(Photo: Frank Myers checks to see if medical equipment has been properly cleaned. Kenny Goldberg/KPBS )
Of course, hand washing is fundamental. So is the use of alcohol-based hand gels. And other protocols have recently been added.
"Can you sit up all the way for me," says a doctor, "So I can listen to your back? Go ahead and take some ice deep breaths through the mouth"
The stethoscope this doctor is using could potentially spread bacteria. That's why all equipment that comes in contact with patients must be cleaned. Even things like blood pressure monitors should be wiped down.
That doesn't always happen.
Frank Myers periodically goes to patient rooms and dusts equipment with a residue that's invisible to the naked eye.
"We'll come back in a week, and see whether it's clean," Myers says, "And that's simply done by using this ultraviolet light. And you can see here, that we've got white residue right on there, so we can quickly tell, gee, that item's not been cleaned since we last deployed it."
Even if hospitals practice perfect hygiene, they're not closed systems. Patients who are already carrying an infection are admitted from other places.
Dr. Gonzalo Ballon-Landa is a specialist in infectious diseases. He says many patients in long-term care facilities have harmful bacteria growing in their bodies.
"And whenever they develop a little fever, then they're going to get some more antibiotics," says Ballon-Landa. "Every time they get more antibiotics, the antibiotic causes a selection for a more resistant organism".
Frank Myers says it's a never-ending challenge.
"Patients' own flora and fauna will in many cases cause infections," Myers points out. "We have to have a goal of zero, though. It's one worthy of striving for. It is truly achievable, based on everything we know at this point? Probably not."
Things are improving. For example, hospitals have seen a big decline in the antibiotic-resistant staph infection known as MRSA . Some facilities have eliminated ventilator-associated pneumonia.
Even so, federal health officials estimate up to 100,000 Americans die each year from hospital acquired infections.
Kenny Goldberg, KPBS News.