July 26, 2002
2,610 Infants died of preventable hospital-acquired infections – Chicago Tribune
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.”
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
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
FAIR USE NOTICE: This may contain copyrighted (© ) material the use of which has not always been specifically authorized by the copyright owner. Such material is made available to advance understanding of ecological, political, human rights, economic, democracy, scientific, moral, ethical, and social justice issues, etc. It is believed that this constitutes a ‘fair use’ of any such copyrighted material as provided for in section 107 of the US Copyright Law. In accordance with Title 17 U.S.C. Section 107, this material is distributed without profit to those who have expressed a prior general interest in receiving similar information for research and educational purposes. For more information go to: http://www.law.cornell.edu/uscode/17/107.shtml If you wish to use copyrighted material for purposes of your own that go beyond ‘fair use’, you must obtain permission from the copyright owner.