DEADLY NOSOCOMIAL INFECTIONS.
Posted by bmhegde on 1
“The greatest truths are the simplest, and so are the greatest men.”
J.C and A.W. Hare.
“Every year 5,000 patients in hospitals in Britain die from an infection acquired after they were admitted. Up to 100,000 more - almost one in 10 in-patients - endure extended illness, pain and suffering caused by bugs they contract in the place where they came for a cure. The number of deaths exceeds that from road accidents, and that from drugs and HIV/AIDS combined. Our rate of infection is among the highest in the world, above that of Australia, Denmark, Norway, the Netherlands and Spain. It costs the NHS more than £1bn a year. Today, the Government will launch its latest crackdown on poor hygiene to cut the rate of hospital infections, of which the worst is MRSA (methicillin-resistant Staphylococcus aureus)” says a government report. Over the last ten years the dearth rates due to resistant hospital infections have more than doubled. The Tory health spokesman, Andrew Lansley, said: "It is a national scandal. Over the last seven years, deaths from MRSA have doubled.”
One in three people naturally has staphylococcus infections on their skin, which is not a problem in the healthy. Recently there has been a sharp growth in staphylococcus infections resistant to methicillin and other antibiotics. Today, 40 per cent of Staphylococcus aureus bloodstream infections are caused by MRSA. When these organisms get into the blood of people who are seriously ill and elderly through a wound or a needle inserted in a vein they become seriously ill because they are immune compromised. They are hard to treat because the organism is resistant to antibiotics. Yet the infections could be sharply reduced by ordinary measures such as washing hands.
The highest rates were seen in some of UK’s most prestigious hospitals. Guy's and St Thomas' NHS Trust in London had the highest MRSA rate at 0.45 cases per 1,000 bed days, followed by Addenbrooke's in Cambridge, with a rate of 0.38. "The war against hospital- acquired infection must be pursued on many different fronts, including a more robust approach to antibiotic prescribing and hospital hygiene, instituting a system of mandatory surveillance and persuading all NHS staff to take responsibility for effective infection control," said Sir John Bourn.
It is estimated that 15 per cent of cases were preventable by better hospital practices, nearly 750 deaths in the UK a year which could be prevented by adopting simple hygienic measures. “MRSA is caused by overuse of antibiotics, especially by the agriculture industry, where they are added routinely to animal feed as growth promoters. Bacteria resistant to the drugs grow and multiply, by a natural process of evolution, and the more widely the drugs are used the greater the opportunities for resistance to develop” says a report from the UK
Dr. Richard Besser, of the Centre for Disease Control of the US, in 1995, said the number of unnecessary antibiotics prescribed annually in that country for viral infections was 20 million. Dr. Besser now refers to tens of millions of unnecessary antibiotics. There were a total of 88,000 deaths in US hospitals in one year costing a total of $5 billion dollars in treatment without any success. You might wonder as to why I have only given western statistics. Indian figures are anything but reliable. Even in the west the figures given above might be far below the actual figures and many of the nosocomial deaths do not get reported correctly in the death certificate.
Doctors must be made to realize that the majority, nearly over 90%, of the upper respiratory viral diseases need no antibiotics, or worse still they will get worse with antibiotics, but these are the usual situations millions of doses of antibiotics are prescribed. The minor illness syndromes, like the viral infections in the upper respiratory tract, are the ones that cause the largest sick absenteeism in the world, especially during the winter. This brings patients to their doctors who take shelter under the cover of prescribing antibiotics to those patients thinking that their infections, mostly viral, will get better with the intervention.
The poultry industry uses large quantities of antibiotics along with hormones to keep their flock healthy while the growth hormones shorten the egg-table time of the birds; the antibiotics are given as a preventive measure to check enhanced infection due to the abnormal growth of the chicks under the influence of the growth hormone. Mastitis, a common occurrence in milch cows in any diary farm also results in large doses of powerful antibiotics being injected into the udder. The milk from such cows should be discarded at least for week to avoid the drug getting into humans. But the profit making industry would not do that for commercial reasons. All these expose every one of us to small doses of antibiotics making us resistant to their use when the need arises. It also encourages the growth of resistant germs in the environment.
The so-called “super-bugs”, the resistant germs, are seen in many hospital operating rooms as well. In the recent past several operating rooms even in British hospitals had to be closed as they could not be cleaned of those super bugs! Deadly germs have been cultured even from doctors’ neck ties and stethoscopes making it mandatory in the UK for male obstetricians to use only bow ties. Simple hand washing repeatedly, even in between patients, could help a great deal but “big” bosses in India couldn’t care less. Poor nurses in Indian hospitals can not force the medical staff to conform to the hygienic guidelines.
The worst place for any patient to be, in a hospital, is the intensive therapy unit where the seriously sick elderly are invariably admitted. (For what good scientific reasons, I don’t know) Many of them meet their maker prematurely, reminding us of the dark days in the early hospitals in the first half of the eighteenth Century when any one going to the hospital was going there en route to heaven- hospitalism. The one hundred per cent hospital mortality was brought down to just over forty per cent by Florence Nightingale only through her meticulous cleaning rituals and bed spacing with good ventilation in the wards. Elderly patients that get admitted to hospitals are immune compromised in the first place and the super bugs do not need much help to kill them. Most of them die in the hospital of nosocomial infections rather than the original disease for which they got admitted in the first place.
In the USA, a recent report puts doctors’ interventions and adverse drug reactions as the first cause of death only to be followed by cancer and heart attacks. A large chunk of this statistic comes from the deaths due to nosocomial infections. I wonder what rank we in India get if some one audits hospital deaths accurately. We can’t do better than the US anyway as they are the first rank holders there we will have to follow suit, as many doctors and most lay people in India believe that American medicine is the best to follow. Another fourteen developed country survey did show that America had the last but one place leaving the last place to Germany in overall medical care, despite the fact that America ranked first among those countries in healthy life style of the populace!
Let us learn from the American’s mistakes and take remedial steps before things get out of hand. Compared to the American population of 250 million where annually nearly 7,98,000 people die due to doctors’ interventions and adverse drug reactions, we in India could have that number in millions! Doctors are trained to keep the health of the public but in the present scenario we have become their main enemies. Let us also not forget that when doctors went on strike in Israel death and disability rates fell down significantly only to go back to the original levels when doctors came back to work. This was the experience in Los Angles County some years ago and in Saskatchewan in Canada a few decades ago! We have hard work to do in this area and miles to go, miles to go before we sleep!
“Find a need and fill it.” ………Ruth Stafford Peale.