Staph infections, MRSA, and other nosocomial ("hospital") infection issues

The recent spate of publicity generated by NFL football players suffering  staph infections has created public awareness of the possibility that a patient can leave the hospital sicker than he or she was when they entered, as a result of infection.  Tom Brady, Kellen Winslow and Peyton Manning have all suffered widely reported infections this fall, and in recent years Brandon Noble of the Redskins and Jeff Novak of the Jaguars suffered career-ending methicillin-resistant Staph  (MRSA) infections.   A 2005 survey of the NFL identified at least 60  such MRSA infections, a very serious condition in which normally easily treated skin infections become resistant to anti-bacterial medications.  Jeff Hageman of the Centers for Disease Control pointed out that the Staphylococcus aureus bacteria  is the most common source of skin infections and results in 12 to 14 million doctor visits per year.  Authorities are becoming concerned that more and more of these "common" infections are becoming very difficult-to-treat MRSA infections, and in truth, the primary cause is not "malpractice" by health professionals.

Winslow, for example, brought attention to the fact that the Browns have allegedly suffered 5 or 6 MRSA infections in recent years.  This reminded league authorities of the 2003 MRSA outbreak in the Los Angeles Rams' locker room.  After suffering eight cases of MRSA, the Rams asked the Centers for Disease Control to investigate their sanitary procedures.  The CDC found that in a warm and humid bacteria-friendly environment, there were many unsanitary practices, including players sharing towels on the practice field and failing to shower before entering the whirlpool;  trainers did not always wash their hands at appropriate times.  In addition, the roster of players was taking antimicrobial drugs at ten times the rate of the general public.  Together, these circumstances created a perfect environment to multiply and share organisms and to immunize them from the effect of standard medications.  MRSA was found even on the ultrasound equipment and in the cold pools in the locker room, according to the team's trainer.  With proper procedures, the team eliminated its mini-epidemic.

A hospital can be similar to a locker room, in the sense of population density, invasive procedures and wounds, and "sharing" of treatment equipment, supplies, facilities and personnel.  More dangerously, the hospital also brings into close contact a population of ill and resistance-weakened patients.  While one might expect that [new] hospital infection rates would be lower in large, university or tertiary care centers where procedures would theoretically be in accord with the highest standards, in fact the opposite has been true.  Because they bring the sickest of patients together, tertiary care centers have historically reported nosocomial infection rates 2 or 3 percent higher than the rates reported at small, rural institutions (often reported at around 2-4 percent). 

As a result, it can be fairly easy for a health institution to "prove" that a particular nosocomial infection was not "caused" by hospital employees, particularly where recent media reports have documented the fact that one in four London commuters carried fecal bacteria on his hands, and MRSA-infected patients are arriving at the ER with unrelated problems and no related symptoms, but carrying the difficult-to-treat bacteria.  Infected patients are normally not allowed access to internal hospital investigations into the cause of infection or other bad outcomes and complications, due to a legal privilege that maintains the secrecy of these investigations--even from patients and family.  Further, a patient cannot prove that his or her infection was caused by negligent practices simply by showing that the institution has a less-than-stellar history with infection rates: each case must be proved on its own merits and without reference to prior incidents.  This remains true, despite a recent Johns Hopkins study in which the rate of ICU infections was reduced to virtually zero at two Michigan hospitals, merely by a studied effort to reinforce hand-washing standards.

Some of this may change in the future.  In any event it will become more interesting.  Medicare has recently adopted new rules that would deny compensation to hospitals for treating some infection complications which Medicare has deemed to be caused by the institution.  Medicare apparently relies primarily upon the institution's rate of infection to make this determination, and it is likely that many patients experiencing a poor result and seeing that Medicare has rejected the hospital's billing, will be seeking legal counsel.  If current trends continue, the logic that a poor record reflects inadequate procedures will likely be deemed adequate to deny public funding, but inadequate to warrant individual compensation.