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.