FROM HOSPITALISM TO NOSOCOMIAL INFECTIONS

12 May

Surgeons no longer fear the old hospital  fevers, but few patients  realize that nosocomial infections are still a very significant threat. Probably  few patients   know   that   nosocomial   infection   simply   means   hospital- acquired  infection.  Although  it is difficult to assess the morbidity  and mortality   directly   due  to   nosocomial   infections,   according   to   the National Nosocomial   Infections  Surveillance  System,  the  overall  in- fection  rate  is highest  in large  teaching  hospitals  and  lowest in non- teaching   hospitals.   Based  on  a  representative   sample  of  American hospitals, investigators  calculated that five to six percent of hospitalized patients  developed nosocomial  infections, which cause or contribute to many thousands of deaths each year. The true incidence of nosocomial infections  was presumably  much  higher,  because many  cases were not

properly  reported.  In  response  to  calls for  cost-containment, hospital infection-control departments are often neglected, because they use resources,  but  do not  generate  revenue.  In all hospitals,  the incidence of nosocomial  infections  was highest  in the  surgery  department,  fol- lowed by the medicine and  gynecology wards.  Semmelweis and  Lister would be dismayed to find that the most common and most preventable cause of nosocomial infections is a general neglect of hand washing, the most  fundamental aspect  of  infection  control,  by  many  doctors  and healthcare   professionals.   Many   healthcare   practitioners  think   that hand  washing  is a nineteenth  century  technique  that  has  been super- seded by modern  methods,  such as the use of disposable gloves, despite the fact that  bacteria  can contaminate gloves as well as hands.  A 1999 report  by  the  Institute   of  Medicine  found  that  medical  mistakes  in hospitals  killed an estimated 44,000 to 98,000 patients  a year. Theoreti- cally, operating  teams keep track of everything used during surgery and make sure that anything that went into the patient  was taken out before the  conclusion  of  the  operation. Surgeons  acknowledge  that  leaving objects inside a patient  occurs occasionally  and  that  it is a dangerous error that  can lead to severe infections, organ damage,  and even death. Researchers estimate that sponges or instruments  are left behind at least

1,500 times a year in the United  States; the total  number  of operations

exceeds 28 million. Objects left behind after surgery include sponges and various   instruments,  like  clamps,   retractors,  or   electrodes.   These mistakes  have  caused  deaths,  sepsis, further  surgeries,  and  prolonged hospital  stays.

Although  there is no doubt that nosocomial  infections significantly add to morbidity  and mortality  rates and increase the costs of hospital care, it is difficult to determine  the actual  risk assumed when a patient enters  a  hospital.   The  proportion of  extremely  sick  and  vulnerable patients   found   in  today’s  hospitals—transplant  patients,   premature infants,  elderly patients  with multiple  disorders,  cancer  patients,  burn victims,  AIDS   patients—has   dramatically   increased.   Such  patients would  not  have  lived long  enough  to  contract   hospital  infections  in the not so distant  past.

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