Bacon's Rebellion

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Who’s Treating the Infectious Diseases?

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by

James A. Bacon
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Click for larger image. Graphic credit: Virginia Business

I apologize for being obsessive on the subject of hospital-acquired infections recently (see here and here) but I just heard a story today of someone who went into Duke University hospital for a routine colonoscopy and contracted a case of flesh-eating bacteria. This was Duke! Supposedly one of the top hospitals in the country!!

Virginia Business magazine has published data on the volume of infectious diseases treated at Virginia’s larger hospitals in 2015. The data comes from the Virginia Health Information Foundation.

Note: The data does not necessarily reflect infectious diseases acquired in the hospital. Here’s how VHIF describes the data set:

These diseases can be transmitted from human to human, from animal to human, by direct or indirect contact; e.g., fevers of unknown origin, sexually transmitted diseases (including HIV infection), herpes, central nervous system (CNS) infections, measles, rubella, mumps, hepatitis, rabies, and rickettsial infections (such as Rocky Mountain spotted fever). Bacterial infections such as streptococcal and chlamydial infections also fall under this classification, as well as those of spirochetal, protozoal, helminthic and mycotic causes.

The total is not quite 38,000. That strikes me as a remarkably low number for all infectious diseases. Perhaps most of these diseases are treated by primary care doctors. The million-dollar question: How many of these cases, if any, were contracted in a hospital setting?

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10 responses to “Who’s Treating the Infectious Diseases?”

  1. LarrytheG Avatar
    LarrytheG

    Virginia Healthcare-Associated Infections Report

    http://www.vdh.virginia.gov/content/uploads/sites/13/2016/10/2015ConsumerReport.pdf

  2. V N Avatar
    V N

    You realize most of these are fudged? If they can hide it, they will. Its like asking criminals to tell what they did wrong to a hanging judge.

  3. LarrytheG Avatar
    LarrytheG

    took a while to dig this up – they do not self-identify as a “foundation”: but simply as: VIRGINIA HEALTH INFORMATION and they deal in a wide variety of data for health care and this particular data comes from a database they have created called 2015 SERVICE LINE REPORT

    http://www.vhi.org/serviceline_compare.asp

    digging around more on their website -you find this:

    “PATIENT SAFETY ORGANIZATION SERVICES
    Seven years ago Virginia Health Information (VHI) expanded its work to include services as a Virginia Patient Safety Organization. VHI now supports provider efforts to improve patient safety in 10 states through multiple contracts. ”

    now “Patient Safety Organization” is a key phrase as it is a US govt-created entity (from WiKi ” Patient safety organization”

    “On July 29, 2005, the United States Congress established guidelines for Patient Safety Organizations under the Patient Safety Quality Act of 2005. The focus of the legislation is to provide incentives for clinicians to participate in voluntary initiatives to improve the outcomes of patient care, provide information about the underlying causes of errors in the delivery of health care, and to disseminate this information in order to speed the pace of improvement.”

    If you GOOGLE ” Voluntary Patient Safety Event Reporting (Incident Reporting) – you’ll get a better idea how it works –

    it basically encourages voluntary reporting in exchange for some level of protection from that data being used against them later by others.

    I vaguely remember there was a big debate when the legislation was considered as to how to obtain enough good data voluntarily if the providers feared the data could be later used against them and so a compromise was reached in hopes that providers would more freely provide the data if they were protected from retribution. That does not protect them from other sources of information and actions , just that this particular data cannot be used for that purpose. So if someone dies from a mistake, the provider can still be sued by accessing other information like patient charts and other patient-specific data.

    The system was never set up to be used as a primary way for hospitals and health care providers to be evaluated by Consumers on their performance even though by providing the data providers and the public can compare compare peers and know which might be having more issues.. and in turn need to improve. The idea of improving was the motivation for collecting the data.

    you can find way more than you’ll ever want to know by starting out Googling ” Patient safety organization” and then following other references and links but the bottom line is that this was born was 2005 legislation in Congress.

  4. Steve Haner Avatar
    Steve Haner

    In all fairness Jim, the hospitals recognize the issue and are a lot more worried about it than you are. The feds and insurers are applying major pressure because ending such infections is probably one of the best cost-cutting measures you could imagine. I’m no expert but a big part of the problem is overuse of antibiotics for minor complaints, which have caused the evolution of more resistant bugs. (Try telling a mom that her kid’s cold or ear infection doesn’t need antibiotics). Then once these new bugs get into the hospital setting they can be hard to eradicate. My mother caught one of the most common infections in her nursing home near the end of her life, and we were furious, but in that setting and in her weakness it was not that surprising. I think if you looked at the stats compared to 10, 20, 50 years ago the progress would be remarkable.

    I went into the hospital in 2014 with a deadly infection contracted outside of it, and the docs and nurses and massive amounts of drugs saved my life. So I do not doubt their skill or commitment or concern on this.

    1. James A. Bacon Avatar
      James A. Bacon

      I’m sure hospitals are making infections a top priority. The question is what progress have they made? The simple fact is, we don’t know.

      Also, I think the evidence would show that infections are more likely to occur in hospital settings than outpatient settings such as ambulatory surgery settings. Here’s where the rubber meets the public-policy road: Virginia’s COPN law tilts the playing field in favor of hospitals and against independent, free-standing surgery centers. In other words, public policy has the unintended consequence of herding patients into a physical setting where they are more likely to contract an infectious disease.

      1. Steve Haner Avatar
        Steve Haner

        Now you are making an assumption that the surgery centers are safer, and I’m not sure the data shows that. If a person has an issue in one of those, their next stop is the hospital. Having the outpatient centers around means that only the more serious surgeries go first to the hospital, those needing a stay to recover, and that might tend to bump up the infection rates. This stuff is high level statistics. But I’m glad you revealed that you have a ideological ax to grind and you aren’t just worried about sick people! That said, I’m all for reporting and openness.

  5. Reed Fawell 3rd Avatar
    Reed Fawell 3rd

    This is complicated subject, with many variables and special exceptions to general rules. But study after study has shown that many of these “chronic” problems can often be dramatically reduced simply by strictly enforced procedures such as mandating proper scrubbing by surgeons before operations, given the fact that studies show that failure to properly scrub easily becomes chronic with individual surgeons and groups of surgeons lacking the” proper professional care and attitude” within institutions. The harm reeked by this carelessness often bred of hubris has been enormous.

    Hence high anomalies such as apparently shown here by Inova Fairfax Hospital and UVA Medical Center, if chronic, deserve immediate and serous independent investigation. Unfortunately transparency and cooperation in these matters are far too frequently difficult to obtain in far too many institutions.

    1. James A. Bacon Avatar
      James A. Bacon

      I totally agree with Reed’s statement here, with one caution. First, while big hospitals like Inova Fairfax and UVa Medical treat the highest number of infectious that may simply reflect the fact that they treat more patients overall; the number doesn’t tell us the percentage of patients with infections. Second, we don’t know what percentage of these patients acquired the infections in the hospital. The reason I re-published this data is simply to reinforce the notion that the numbers are large. We’re talking about thousands of patients. Clearly, we need more transparency about this issue.

      1. Reed Fawell 3rd Avatar
        Reed Fawell 3rd

        We don’t disagree here. The studies I refer to focused SOLELY on infections transmitted to patients during surgery, including those cases where the source of those infections correlated with the chronic failure of surgical staff to scrub, based on statistical analysis used.

        There are, of course, other potential sources of infections within operating rooms, and hospitals generally, that are “caught” by patients solely by reason of their being treated in hospitals, or that particular hospital, including cases that result of a failure to take proper precautions against infections (incl. plagues and exotics), that otherwise typically infest hospitals. Reuse of improperly cleaned paraphernalia and hospital spaces are a common cause of patient infections in hospitals and doctors offices, like improperly cleaned reused needles use to be. Now too highly resistant strains creates exponential threats.

        Indeed hospitals always have been at constant war with old and newly emergent infections, including plagues. Some hospitals fight these wars far better than others, while victories and defeats ebb and flow over time, absent great vigilance, supervision, and allocation of resources. Some hospitals confront far more dangerous enemies than others hospitals, if only by reason of the kinds of incoming patients they treat, as you suggest.

        Hence the need of constant transparency and monitoring, including from competent outside independent sources.

  6. LarrytheG Avatar
    LarrytheG

    and that’s exactly what Congress did in 2005:

    “On July 29, 2005, the United States Congress established guidelines for Patient Safety Organizations under the Patient Safety Quality Act of 2005. ”

    and it’s exactly what Virginia could do if the feckless gnomes in the GA could tear themselves away from totally useless ideological foolishness like trying to spend tax dollars on private schools.

    there is no “transparency” in a free market without using the police power of government dictating top-down what institutions and business must do that they’d not do unless forced by govt.

    What Transparency we have right now – is the result of govt …

    that’s a reality.

    Is that what we are advocating for with these calls for “more transparency”?

    let’s be clear about what we are saying we want…

    I’m amused by those who keep saying “get the govt out of our lives” and “govt should be small and unobtrusive” and ” let’s get rid of these job killing regulations” … on one day .. and then the next day.. without honestly admitting what they really want – call for “more transparency” so we can “hold these institutions “accountable” “.

    so which is it?

    do we want the power of govt to force institutions to be more transparent?

    would we want the same thing for non-govt entities like doctors and other health-care providers?

    I keep getting whiplash here on these issues!

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