elcam medical safety

Safety is in the details

Infections in the ICU-Part 1

elcam medical safety

The “scourge of hospital-acquired infections” is how a recent article in The Wall Street Journal phrased it. In this piece entitled “Designing a Hospital to Better Fight Infection,” the author profiles a research project in Chicago and the team of scientists that is mapping “where hospital germs linger and what causes them to take root.” While the data is still being reviewed, certain features of the hospital have been identified as having an affect on the types of bacteria patients and visitors come in contact with while in the buildings.

Ventilation, furnishings and fixtures are among the bacteria-affecting components cited as having an impact on a hospital visitor’s health. The article cites an annual survey by the Centers for Disease Control and Prevention illustrating that hospitals have stepped up to the plate when it comes to taking measures to reduce infections. Yet it goes on to reveal that “on any given day, about 1 in 25 patients is fighting an infection contracted during hospital care,” and that, it says, results in 75,000 US deaths annually. While human lives can never be measured in dollar amounts, it may be prudent to mention that the monetary cost of this reality is a staggering $36 billion a year.

“Some of the hospital pathogens live both in the humans and in very expensive pieces of medical equipment that are hard to clean,” the author cites Dr. Julie Segre as saying. The senior scientist at the National Human Genome Research Institute adds: “That is why we worry.”

Recently, the superbug CRE (carbapenem-resistant Enterobacteriaceae) has received considerable press coverage in healthcare and mainstream news outlets alike, as occurrences of these antibiotic-resistant bacteria have been found in several hospitals across the US.

As a recent USA Today article titled “Deadly bacteria on medical scopes trigger infections” relates, a concerning pattern of hospital illnesses linked to CRE began to emerge in 2012. CRE is, as the author points out, “perhaps the most feared of superbugs,” which are difficult to treat because they resist “even the ‘last defense’ antibiotics.” Commonly introduced into hospital operating rooms via specialized duodenoscope endoscopes, which, as most of you know are inserted into patients’ throats during procedures to treat digestive disorders, CRE kills up to 40% of the patients infected with it.

CNN has reported on the subject as well, offering that these recently evolved “superbug family” bacteria include Klebsiella and E. coli, naturally found in peoples’ intestines but deadly when they spread to other areas of the body. The piece goes on to say that only a few antibiotics help fight against the infection, and some of those, unfortunately, can cause kidney damage.

This is a significant healthcare challenge, and so far not much has been offered in the way of guidance for dealing with the issue from the FDA or anyone else.

While this infection is not introduced into the patient in the intensive care unit—and the name of this blog is, after all, “Infections the ICU,” those infected during surgery do, of course, come into the ICU following the procedure. Once there, they enter the care of the ICU nurses and physicians. For that reason, we felt this superbug was worth mentioning in this blog series on the different types of infections ICU clinicians regularly deal with.

Of course, more pertinent to the ICU clinician is the central-line associated bloodstream infections, or CLABSIs, which, according to InfectionControlDaily.com, cost healthcare institutions an estimated $9.8 billion annually to treat. In the scope of healthcare-associated infections (HAIs), this puts CLABSIs into the top five most expensive to treat.

We’ll focus more on these infections next time in Part Two of this series. See you then.

Ilana Engel-Regev, MD

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