My grief-stricken niece, a nurse, this week had to explain to her 7-year-old son that his daddy would not be coming home from the hospital.
That heartbreaking duty followed a stressful month.
It began one night with chest pains and shortness of breath, which was repeated a few days later. The emergency room diagnostician rushed the patient into the operating room, where extremely urgent open-heart surgery was conducted. He was not expected to live.
After several tense hours in which just about everything that can be replaced in a human heart, short of the heart itself, was replaced, the patient — himself a highly skilled surgeon — was deemed semi-stable. He wasn’t in a condition that allowed him to be moved to another hospital that was set up to perform transplants, but he was alive.
He improved and was taken to the bigger hospital. Over the following days and weeks he continued to improve. It increasingly seemed that though it would be a long slog, he would recover.
Then, Saturday, he crashed. It wasn’t his heart that went bad. He had an infection.
By Sunday it was clear that the infection would kill him, and on Monday he died. He was killed by a Pseudomonas aeruginosa infection he picked up in the hospital.
“This microorganism is one of the most frequent and severe causes of hospital-acquired infections, particularly affecting . . . intensive care unit (ICU) patients,” reports a recent study. “The majority of P. aeruginosa strains are resistant to most antibiotics currently in use.”
His case is scarcely unique. Every year about 100,000 people in this country die from infections contracted while they are in the hospital for treatment of something else.
A particularly bitter irony is that seven years ago my niece’s father was hospitalized for treatment of a serious but seldom fatal condition, Wegener's granulomatosis. While there, he got infected with one of the several bacterial infections contracted almost exclusively in hospitals. It killed him. She could be forgiven for wondering if hospitals will kill her entire family.
While SARS-CoV-2 is the Taylor Swift of pathogens and gets all the press coverage, bacterial infections are the world’s leading cause of morbidity. “[D]ue to haphazard use of antibiotics, antimicrobial resistance has become an emerging threat,” noted a study in Clinical Infectious Diseases. Patients demand antibiotics when an antibiotic will do no good, and physicians (always happy to please pharmaceutical companies which in turn are interested in the bottom line, not in curing diseases) are happy to write the prescriptions. This is compounded by patients who stop taking the antibiotics as soon as they feel better, even in cases where antibiotics are of use. In both situations, the result is bacteria that can no longer be killed by antibiotics. The ones that survive are the ones that reproduce, and next time, when it’s really needed, the antibiotic is ineffective.
So we now have “superbugs.” which are in many cases our own accidental creations. For example, Escherichia coli is a beneficial bacterium found in the guts of healthy people. But we have sparked strains that are truly dangerous, and now the name E. coli strikes fear among us. When a microbe evolves — and remember, many pathogens can go through many generations in a single day — to be immune to antibiotics, those mutations may come with other differences as well.
Nor are bacterial infections strictly a third-world problem. Just last year a widely known and respected federal judge, Laurence Silberman, died of an undiagnosed infection. This month, someone I know was hospitalized after a piece of too-thick beef jerky led to a tooth injury that led to an abscess that spread to the throat and required her hospitalization. She came closer to dying than you might imagine. Such infections spreading fatally to the lungs and heart is more common than you think. (To make things worse, in my estimation, the pathogen was not identified. She was treated with a broad-spectrum antibiotic. It may or may not have killed the bug, but it is not likely that it killed all of it, or all the other bacteria in her system, leaving the survivors to grow into stronger populations.)
Though when she entered the hospital, I was mainly concerned that while there she might catch something worse.
In one respect it should be no surprise that you can get sick as a result of a hospital visit. As Willy Sutton famously said he robbed banks because that’s where the money is, hospitals are where the sickness is. So people already weakened by illness or injury can get exposed to opportunistic microbes. It has a lot to do with how diligent the hospital is in its sanitation practices, though that’s not the entire answer.
It is a big problem but one that gets little attention. It won’t enrich those drug companies that buy all those ads on television (half of which by volume are devoted to ways the advertised drugs can kill you; the tension between medicine and the legal profession is palpable). It won’t make big money for pharmaceutical companies whose representatives stalk the hallways of regulatory agencies. There’s no increase in profits there for the companies that provide junkets for physicians and hospital administrators.
(I think it is important always to remember that the medical industry is not especially interested in your recovery, not anymore. It is interested in your being sick until you and your insurance company are out of money. There are good doctors who care about patients, but the same cannot be said of medicine as an industry.)
“The risk for hospital-acquired infections is dependent on the infection control practices at the facility, the patient's immune status, and the prevalence of the various pathogens within the community,” says a book, Hospital-Acquired Infections, available online from the National Institutes of Health. “The impact of hospital-acquired infections is seen not just at an individual patient level, but also at the community level as they have been linked to multidrug-resistant infections. Identifying patients with risk factors for hospital-acquired infections and multidrug-resistant infections is very important in the prevention and minimization of these infections.”
If you can make it through the very sterile text (far more sterile than most hospitals), you’ll find things that might make your hair stand on end. “Hospital-acquired Pneumonia is defined as ‘pneumonia that occurs 48 hours or more after admission to the hospital and did not appear to be incubating at the time of admission’.” There isn’t just a thing called “hospital-acquired pneumonia,” but it is common enough that there’s a term to describe it.
“While hospitalizations play a major role in the management of acute illnesses, and they also enhance the risk of susceptible patients for multiple nosocomial [hospital-introduced] and often antimicrobial-resistant pathogens. These pathogens can be acquired from other patients, hospital staff, or the hospital facility. The risk is higher among patients in ICU. A point prevalence study that included 231,459 patients across 947 hospitals concluded that about 19.5% of patients in ICU had at least one HAI.” Yes, you read that correctly: One in five hospital patients catch another disease while in the hospital!
Let’s continue. “[I]n 2011, an estimated 648,000 hospitalized patients suffered from 721,800 infections. The dominant infections (in descending order) include Pneumonia (21.8%), surgical site infections (21.8%), gastrointestinal infections (17.1%), urinary tract infections or UTIs (12.9%), and primary bloodstream infection (9.9%, and include Catheter-associated bloodstream infections). Among the pathogens causing HAI, Clostridioides difficile (12.1%) is the leading pathogen and is closely followed by Staphylococcus aureus (10.7%), Klebsiella (9.9%), and Escherichia coli (9.3%). Skin and surgical site infections are usually caused by Staphylococcus aureus and sometimes include Methicillin-resistant staphylococcus aureus (MRSA).”
One study concluded that doing something about it would be useful. “The SENIC study (Study on Efficacy of Nosocomial Infection Control) pointed out the possibility of reducing infections by a third by combining infection tracking and infection control programs.” Lo, and behold, they were right: “The implementation of robust infection surveillance and prevention practices has resulted in some success in the prevention of HAI.”
Surely this is difficult to accomplish? Well, no. “Universal standard (infection control) measures, such as handwashing with soap and water or using alcohol-based disinfectant before and after each patient visit, are vital in reducing rates of transmission of MDR pathogens. In a study, the use of gloves and gowns did not prevent contamination and conclusively did not seem enough to prevent the spread of infections.” [Emphasis mine.]
Why haven’t you heard about this before? It doesn’t get much coverage, and when it does it is typically festooned in terms like “flesh-eating bacteria,” in articles put together by reporters and editors who lack the skills needed for manual labor. (Hospital-spread “flesh-eating bacteria” are, by the way, a real thing.)
There is little you can do to protect yourself other than maintaining a healthy way of living, but there is more than nothing.
It is a real problem. No one goes to the hospital to be cured of one thing and welcomes getting killed by something else instead.