Not just a problem in developing countries

Publié le par hort

Irradiés de Toulouse

Infections nosocomiales (ou hospitalières)
Comment éviter les infections nosocomiales

Vegas hepatitis exposure list incomplete

Health officials used an incomplete patient list to notify people exposed to hepatitis and HIV at a Las Vegas clinic, an epidemiologist testified Thursday."We know of patients who had been there whose names were not on the list," Southern Nevada Health District epidemiologist Brian Labus told a state legislative committee on health care.
The public hearing was the first investigating the spread of hepatitis C from unsafe practices at the Endoscopy Center of Southern Nevada. An outbreak of six cases of acute hepatitis C was made public last week. The surgical center and five other affiliated clinics have been closed.Nearly 40,000 patients who received treatment at the center from March 2004 to mid-January have received letters telling them they are at risk for exposure and urging to be tested for hepatitis B and C, and HIV.
Labus said the patient list was provided by the center and based on financial records. He did not explain why some patient names would not have appeared. Health officials believe the clinic spread the virus by reusing syringes and vials of medication. Health District chief Lawrence Sands said it was a well-known violation of common safety standards. The clinic's records show the practice of using single-patient vials of medication to treat more than one patient has been in use since March 2004, when the clinic underwent a renovation and expanded operation, Labus said. Inspectors could not be certain the practice wasn't in place before March 2004, he said.
The clinic's majority owner, Dipak Desai, and member of the governor's commission on health care, has refused to answer questions about the allegations. He took out a full-page ad in Sunday's Las Vegas Review-Journal insisting that needles had not been reused and that the chances of contracting an infection at the center in most of the last four years were "extremely low."

Beware Of Hospital Infections
March 15, 2005
 About two million infections are acquired in U.S. hospitals each year, killing about 90,000 patients. There is a growing movement to require hospitals to disclose the number of infections that are acquired during surgery and other routine procedures. The Early Show medical correspondent Dr. Emily Senay reports on the growing problem.

On Christmas Eve 2002, 16-year-old Raymond Wagner III shattered his left elbow in a sledding accident. He had surgery later that night to repair his bones. "They said everything went well," Raymond Wagner says. "The next morning, I woke up; it was Christmas; it was my birthday; went home, opened presents, and I had a fever, but the doctors kept on telling me that it was a fever from the trauma of the surgery."

But the fever persisted for days, and his condition worsened. Back in the hospital, he was diagnosed with osteomyelitis, a serious bacterial infection of the bone. Raymond Wagner was treated unsuccessfully for months afterward. Antibiotics didn't work to kill the infection. And he had to have more surgeries to stop it from spreading. "It was a harrowing experience for all of us," his father, Ray Wagner Jr., says, "There was concern on the part of some of the medical team that this infection might migrate into other organs in his body, which would have proved fatal." His son's persistent illness had all the hallmarks of a hospital-acquired infection.

Dr. Tim Wilkin of Weill-Cornell Medical College says the types of bacteria in a hospital are different from bacteria out in the world in general. "They can be quite different," he says. "They can be resistant to antibiotics, which makes them more difficult to treat. What it means is that they have to use stronger, more expensive, antibiotics to treat the infection, and can often require antibiotics for a longer period of time." The Wagners finally moved Raymond to another hospital, where doctors were able to cure him.

Raymond Wagner says, "They put a broviac tube in me, which is a tube that goes in your chest directly into your heart. And that fed antibiotics through me for half the summer." Today, Raymond Wagner III is back in fighting form: both he and his father are now dedicated to raising awareness of hospital infections. Ray Wagner Jr. says, "I didn't know that I should ask: Is he more likely to acquire an infection in this hospital or that hospital or that hospital? And it occurred to me that as a consumer, as a patient, as a father, that I might need to know this - that I should've known this." The Wagners lobbied for a new law that took effect in August, requiring Missouri hospitals to publicly report rates of hospital-acquired infections.

Hospital-acquired infections are a major problem all over the U.S., but opinions differ on the best way to disclose hospital infection rates. Dr. Don Nielsen, senior vice president for Quality Leadership for the American Hospital Association, believes hospitals can adequately provide this information on a voluntary basis. "No physician, myself included, wants to see a patient have an infection," Dr. Nielsen tells The Early Show co-anchor Harry Smith. "Hospitals are committed to ensuring the safety, and most certainly, preventing infections from occurring with regard to patients."

Lisa McGiffert, campaign director for the Consumers Union, believes that legislation is required to force hospitals to fully disclose infection rates. She says, "People want to be informed of the health care that they're getting and they want information based on quality. Hospital infections kill more people than homicides and car accidents combined every year. And the tragedy is that most of them can be prevented." Though Dr. Nielsen says he is not opposed to having some sort of public record that people could examine, he notes it is important for the documents to be accurate and reliable. The problem is that you can't make comparisons between hospitals when it comes to reporting information publicly.

He explains, "They have different ways of measuring the same thing, which leads to confusion among the general public when they are tring to make this comparison, and that's the reason that the Hospitals of America have joined together to form the National Hospital Quality Alliance, and we are publicly reporting data now on a number of conditions, and we will be reporting information with regard to infections in this coming year."

McGiffert says it is thanks to the people who want to know this information that states are now looking into whether or not to require its release by legislation. She says, "The public has played a role in bringing this agenda to all of the legislators. Over 30 states are considering this bill. These are mandatory reporting systems, and the one he's talking about is voluntary. It is important for people to have full information about every hospital in their community, and this information can be made comparable. There are ways you can adjust the data so that you can compare hospital to hospital."

Dr. Nielsen says he does not disagree with the notion that the patient has a right to be able to examine this information. He says, "We think patients deserve the right to have accurate, reliable information. The CDC has recently come out now with a report recommending the type of information that should be the starter set."

Publié dans health-sante

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