Hospital Acquired Infections

 Hospital Acquired Infections

Numerous posts in this blog and other sources show the multi-faceted aspect of patient dangers following hospital admissions. While the risks associated with hospitals vary across the country, it seems one of the most hazardous locations for picking up a nosocomial infection might be in U.S.-Mexico border towns.

Before going into details about this situation, here is a bit of history connected with the term nosocomial, which provides some insights into how long the issue has been recognized as a problem.   The first use documented by the Oxford English Dictionary was in an 1853 compendium of medical words by Robley Dunglison titled Medical Lexicon, A New Dictionary of Medical Science, containing a concise account of the various subjects and terms (9th edition).  The term probably was formed from two Greek words, Greek nosos (disease) and komos (someone who takes care of the sick.

Etymologically, you would think the word would apply to any kind of disease a patient gets while being cared for by a doctor. However, the accepted connotation now uses the the term as a synonym for any illness contracted in a hospital.

Moving on to more pertinent information, a survey titled, “Antimicrobial resistancein eight US hospitals along the US-Mexico border, 2000-2006” appeared in Epidemiology and Infection, December 17, 2013 (Epub ahead of print). The authors collected microbiology data for “select healthcare and community pathogens including three Gram-negative Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and three Gram-positive (Staphylococcus aureus, Enterococcus, Streptococcus pneumoniae) pathogens and 10 antimicrobial-pathogen combinations.”

The data came from eight United States hospitals in three states bordering Mexico. For specific single pathogens, resistance to oxacillin and quinolone was highest. “Six of the 10 antimicrobial-pathogen combinations studied had a significantly increasing trend in resistance over the study period.” The conclusion of the report was a recommendation for further study of contributing factors in the hospital and community—infectioncontrol practices and antimicrobial use.

An optimist might speculate that things have improved in hospital infection control. A large survey hospitals published in Infection Control and Hospital Epidemiology: The Official Journal of the Society of Hospital Epidemiologists of America, January 2013 (Epub 2012 Nov 27) reporting on Healthcare-associated infections (HAIs) suggests an optimist most likely would be wrong.
The article title is “Antimicrobial-resistantpathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010.” According to the results: “Overall, 2,039 hospitals reported 1 or more HAIs. 1,749 (86%) were general acute care hospitals, and 1,143 (56%) had fewer than 200 beds. There were 69,475 HAIs and 81,139 pathogens reported. [Emphasis mine]. Eight pathogen groups accounted for about 80% of reported pathogens: Staphylococcus aureus (16%), Enterococcus spp. (14%), Escherichia coli (12%), coagulase-negative staphylococci (11%), Candida spp. (9%), Klebsiella pneumoniae (and Klebsiella oxytoca; 8%), Pseudomonas aeruginosa (8%), and Enterobacter spp. (5%).”
You can look at these figures from either a wine glass is half full or a wine glass is half empty point of view. According to an annual survey conducted by the AmericanHospital Association there are 5, 273 hospitals in the U.S. So, stretching statistics a bit over years and evening out the number of infections across all hospitals, there might be a 39% chance that the hospital you visit will have had at least one HAI. Or, on the positive view, a 61% chance your hospital escaped an HAI.

On the other hand, all these reports and odds assume all the hospitals are reporting nosocomial infections accurately. Anyone care to bet on that? If so, then as the song says, “I’ve Got Some Ocean Front Property in Arizona,” are you interested?