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If you’ve ever had the sneaking suspicion hospitals aren’t doing all they can to prevent infections, you may be right. According to three studies published in the American Journal of Medical Quality, most hospital-acquired, or nosocomial infections, arise as a result of hospital procedures, not from the level of patients’ illness. Inadequate hand-washing and insufficient donning of sterile clothing by busy healthcare workers are believed to be major contributing factors.

The Veterans Affairs hospital in Pittsburgh, PA thought more could be done and began an experimental program six years ago, utilizing simple sanitation and isolation techniques to cut the infection rate by 78% in their surgical care unit. The plan was simple and cost-effective, slashing hospital expenses by $900,000 overall.

Richard P. Shannon, who headed a similar program at Allegheny General Hospital in Pittsburgh to reduce the number of catheter infections, concurs. Shannon showed that the average infection cost the hospital $27,000, and that health insurance reimbursements for weeks of treatment could not keep pace with actual expenses. Basic hand sanitation was a major emphasis of his program.

Such programs could be crucial for Texas healthcare systems, a state that is already overburdened with less-than-adequate numbers of qualified physicians, a flood of rural residents rushing to the larger cities of Dallas, Austin, and Houston to seek care otherwise unavailable or inaccessible to the uninsured, and 25% of its population going without any kind of health insurance whatsoever. Lawmakers in Texas are already pushing for change, and in May, the state House passed Bill SB288, requiring hospitals in Texas to publicly disclose certain infection rates developed by patients in the course of treatment.

Veterans Affairs’ methods are rudimentary enough: test all incoming patients for drug-resistant bacterial infections and isolate those with positive results, being sure healthcare workers don sterile gloves and gowns before entering those areas; equip every room with separate stethoscopes, and every room and corridor with hand sanitizer dispensers; discard blood pressure cuffs after each use. Total cost of the program? Around $500,000 per year, including test kits, salaries for three workers, and the $175-per-patient expense of gloves, gowns, and hand sanitizer. The program was so successful that the hospital began phasing it in at each of their 140 acute-care centers in March, and several European countries have all but eliminated certain resistant infections through similar regimens.

The Centers for Disease Control projected that 1.7 million patients in this country will contract a hospital-acquired infection this year, and that tens of billions of dollars will be spent treating them. Ninety-nine thousand will die from these infections, killing seven times as many people as HIV, and more than diabetes and Alzheimer’s disease. Tragically, many of these fatal infections will result from relatively routine procedures.

The primary problem is not just infections, but rather drug-resistant infections. Hospitals are perfect environments for these super bugs to develop — decreased immune systems, open surgical wounds, plenty of victims in close proximity, and a plethora of antibiotics in which to mutate in response. The most prominent one of them, methicillin-resistant staphylococcus aureus (MRSA), accounts for 63% of hospital staphylococcus infections, up from 22% in 1998. That’s a dramatic jump in less than ten years. MRSA can be asymptomatic, making it difficult to recognize and, once recognized, difficult to treat.

Simple screenings would identify most cases of MRSA, but only one-quarter of hospitals methodologically screen for bacterial colonies. Terri Gerigk Wolf, director of the Veterans Affairs Pittsburgh Healthcare Systems, believes a certain element of denial is in place. “People don’t believe it’s in their institution, and that if it is, that it’s too big to do anything about…But we have shown you can do something about it.”

State legislatures other than Texas’ are also stepping in. Eighteen states now require hospitals to publish infection rates; New Jersey and Illinois are the first to require hospitals to test all intensive-care patients for MRSA. In Pennsylvania, Governor Edward G. Rendell signed a bill requiring MRSA screening of certain high-risk patients, though he did not win efforts to test all patients for drug-resistant infections.

Critics, such as Dr. John A. Jernigan, question the necessity of such programs, believing improving hygienic and surgical practices alone may yield similar results. It’s “a legitimate scientific debate,” said Jernigan, about whether hospitals should take the time and expense of screening every patient. Other critics wonder if isolating infected patients will result in lower quality care. Statistically, patients in isolation are seen half as often, and suffer more falls, bed sores, and stress. Understaffed hospitals may also be an issue; blaming healthcare workers who are already overburdened, while simple enough, might not be a real solution. Hiring more staff, so that workers have more time to do all “the little things” that make such a difference, could have dramatic results.

The American Hospital Association recommends trying methods other than universal screening, and testing all incoming patients only when those methods are unsuccessful. But, to the former lieutenant governor of New York, Betsy McCaughey, that is simply unacceptable. The agency “is largely to blame,” she said for failure to contain these infections. “…their lax guidelines have given hospitals an excuse to do too little.”

Sad, but perhaps true, is an age-old adage: “An ounce of prevention is worth a pound of cure.” In other words, try not getting sick…so you won’t end up getting even sicker.

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