Long before Ebola created anxiety about the preparedness of U.S. hospitals to handle serious contagious diseases, infections contracted in hospitals were a leading killer in America, and remain so.
Although Colorado compares well to other states, hospitals here have run into problems with their infection-prevention efforts, The Denver Post found.
Inspectors cited one hospital for potentially reusing an intravenous bag and reusing oxygen tubing. Others were rapped for unsafe practices during a blood transfusion and poor communication after a staph infection outbreak.
The issue of infections in hospitals took on new urgency last week after a Texas hospital botched the treatment and isolation of the first U.S. Ebola case, which resulted in two nurses contracting the disease.
"We have a good medical system. We have the knowledge, the equipment to contain Ebola and other infections," said University of Denver professor Phil Danielson, a specialist in infectious diseases. "But the risk of spreading them is always going to be there. It is never zero. There is always the human factor."
In 2011, there were about 722,000 hospital-acquired infections nationally, according to the Centers for Disease Control and Prevention. About 75,000 of these patients died, the CDC reports.
"On any given day," the CDC says, "about 1 in every 25 hospital patients has at least one health-care-associated infection."
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Infection rates associated with health care at Colorado's hospitals and dialysis centers were lower than or equal to rates for hospitals across the nation in all but one of 15 categories measured between August 2012 and July 2013, according to data collected and reported to the Colorado Department of Public Health and Environment.
Overall, Colorado hospitals and dialysis centers reported 1,108 health-care-associated infections during that time frame. Deaths associated with those infections were not included in the health department's report. Outpatient-surgery figures also were not included.
The only area in which Colorado had a worse rate of surgical-site infections than the national average was in patients who underwent breast surgery.
Some data conflict. Numbers from the Centers for Medicare & Medicaid Services, or CMS, this year showed that Colorado ranked seventh-highest in the country for the percentage of facilities facing potential fines for hospital-acquired conditions. That includes infections in patients with catheters in major veins and their bladders as well as eight other patient problems, including blood clots, bed sores and accidental falls.
Sixteen of 46 Colorado hospitals in the data faced potential fines. Final data haven't been released.
Texas Health Presbyterian Hospital in Dallas, where the Ebola patient was treated, faced a potential fine, according to the preliminary data. Hospital officials didn't respond to a request for more information.
CMS records of hospital inspections from 2011 to 2013 found problems at Colorado hospitals.
At Sterling Regional MedCenter in June 2012, inspectors found a half-used intravenous solution bag dangling from a pole available — improperly — for use for another patient, reuse of sections of oxygen tubing by more than one patient and nebulizers that were not adequately disinfected.
"The incidents were addressed immediately, and the corrective actions were reported to the appropriate agencies," said Sara Quale, a public relations director for Sterling's parent company, Banner Health. "We are confident that processes put in place following these findings have resolved this concern."
After a June 2013 outbreak of MRSA infections hit patients at North Suburban Medical Center in Thornton, the hospital's top leaders failed to ensure that medical staffers were told of the outbreak or given recommendations that would prevent such outbreaks in the future, an inspector found.
"The state inspection report noted we could improve how we communicate with our physicians regarding infectious-disease trends in the area," said Dan Welch, director of marketing for North Suburban. "We adjusted our processes to accomplish that objective and a follow-up review with state inspectors in January 2014 found that we were in compliance."
At Englewood's Swedish Medical Center in September 2012, an inspector saw a registered nurse with no gloves administering a blood transfusion to a patient — a breach in the hospital's protocol.
The nurse got flustered while the inspector was reviewing her and made a one-time mistake, said Nicole Williams, the assistant vice president of marketing and public relations for Swedish.
"This isn't a rampant issue and in no way, shape or form would reflect on our abilities to handle an infectious patient," Williams said.
Inspections also found unsafe food preparation at several Colorado hospitals and operating-room temperatures at one facility that were high enough to promote infections.
Colorado's health department is one of 10 state health departments in the country participating in the CDC's Emerging Infections Program, which allows for extra monitoring and research of hospital-acquired infections.
Of the 50 or more Colorado hospitals reporting to the CDC for 2012, the most recent year for which data is available, the state composite score was "significantly better" than the national infection rate in two high-risk areas, central-line-associated bloodstream infections and catheter-associated urinary-tract infections.
The public reporting of hospital-acquired infections in Colorado was enabled by a 2006 state law, but that law also gave hospitals protection from disclosure in specific patient cases. The law designates all patient information compiled for the reports, and any related materials, as confidential, not subject to disclosure.
"It means you can't find out from hospitals anything regarding an infection," said Denver medical malpractice attorney Daniel Sloane, who represented a man whose spinal fusion resulted in a surgical-site infection.
Sloane said a recorded conversation the man had with his physician about the infection could not be used in court because of the absolute privilege the law grants hospitals.
Nationally, infections directly related to surgical procedures are projected to cost consumers and health-care payers from $3 billion to $10 billion, studies suggest.
The watchdog group Committee to Reduce Infection Deaths, or RID, reports there are 2 million patient-contracted infections each year in the United States, with 103,000 resulting in death.
RID estimates that all hospital infections could add an estimated $30.5 billion to hospital costs each year.
There are signs of improvement. Tracking by the CDC showed that from 2008 to 2012, infections stemming from surgical sites declined by 20 percent. Infections due to central lines placed in the veins of necks or chests of patients declined by 40 percent during the period. Yet catheter-associated urinary-tract infections have risen by about 3 percent.
Dr. Anthony Harris, an infectious-disease physician at the University of Maryland School of Medicine, is also president-elect of the Society for Healthcare Epidemiology of America.
"The public is afraid about Ebola. But if you ask the public about what epidemiologists do, they would have no idea," Harris said. "That's exactly the problem this country has at this time."
Hospital epidemiologists and infection-prevention specialists work to drive down infection rates by monitoring, intervening in specific cases, training, education and forming policies and protocols, he said. There are too few of them. They aren't given enough time or resources. And they're up against antibiotic-resistant super bugs bred in hospitals.
In other words, he said, the country chronically ignores proven methods to prevent and control infections.
Health care workers often pay the price. They are exposed to a wide range of workplace hazards, from needle sticks and back injuries to exposure to violence and contagions.
Cases among heath care workers of nonfatal occupational injury and illness are among the highest of any industry sector, the CDC reports.
The two nurses who treated the first Ebola fatality in the U.S., Thomas Eric Duncan, reported following hospital procedures and CDC guidelines, which have been something of a moving target with regard to protective equipment. travel restrictions, warning symptoms and so on.
"I'm sure (Texas) health care workers think that they followed all the procedures correctly, but it is so easy to make a wrong move — the inadvertent rubbing of an eye or touching a lip without even knowing it," said Danielson, who teaches courses in infectious diseases at DU and has trained law enforcement in containment of bioterrorism agents, including Ebola.
Danielson said the CDC's missteps have been harder to understand.
"The CDC has amazing resources and immense talent," Danielson said, "but I am somewhat dismayed by the breakdown in common sense."
At Presbyterian/St. Luke's Hospital in Denver, chief medical officer Steve Quach was leaving nothing to chance or the CDC, as his staff practices in pairs and refines, over and over, the protocol for health care workers' donning and doffing of protective clothing and equipment.
"I do believe with the proper precautions, Ebola patients can be taken care of safely without health care workers being infected," Quach said. "But there are more bodily secretions with this disease than health workers expect."
When one staff member asked whether he has to scrub his eyeglasses with bleach afterward, Quach wryly tells him he could always incinerate them instead.
Three Denver-area hospitals Friday were designated by the state to handle Ebola cases if they surface in Colorado. They are Denver Health, University of Colorado Hospital and Children's Hospital Colorado. More hospitals could be added to the list.
Electa Draper: 303-954-1276 or edraper@denverpost.com
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