Hospital Infections Are Hard to Fight

January 20, 2011

Photo: Scanning elctron micrograph of C. difficile bacteria, courtesy Centers for Disease Control and Prevention.

Yesterday we reported on newly-released statistics on infections in Colorado's hospitals.
Today, Colorado Public Radio Health Reporter Eric Whitney talks with experts about what can be done to reduce the number of hospital-acquired infections.


WHITNEY: High school senior Sofia Stuart has a rare condition that caused her spine to start curving a few years ago. Doctors told her parents it would threaten her health as she grew, so they decided to get it corrected. The doctors told Sofia she'd have to have a six hour operation to put steel rods in her spine.

SOFIA: Oh my goodness, that's really long. And then they're like, working with my spine, which is like the second most important thing in your body. So – it was really scary.

WHITNEY: Sofia's parents were scared, too. Among the risks was the chance that she could get a serious infection during the surgery. Sofia's Mom, Darla, said her doctors brought up that possibility, but didn't dwell on it.

DARLA: the likelihood of seeing anything is minimized, it's not gonna happen, and we have a great record here. We don't have these problems here, we don't see them. So we were encouraged.

WHITNEY: Her family was encouraged, but after the surgery Sofia didn’t feel right. Her back still hurt a little, and she didn’t have much energy. But because everyone thought the risk of a surgical infection was so low, she says no one checked her for one.
Then, a couple of years later, after a car accident, Sofia's doctors discovered a slow-growing infection at the site of her surgery. And they told her she needed to get another operation to deal with it, right away.

SOFIA: the surgeon guy was like, maybe we can fit you in tomorrow? Like, he said that. And I was thinking, tomorrow? Like, I have to get this huge back surgery like tomorrow?

WHITNEY: Stories like Sofia's may be more common than people think. The CDC says that about 1.7 million people a year get infections in hospitals. It’s hard to know for sure, because hospitals aren’t required to report every infection. Whatever the number is, Dr. Connie Price thinks it can be brought down significantly.

PRICE: to get to zero infections that are caused by a health care institutions, yes, I think that is a reasonable goal.

WHITNEY: Price is one of the state's top infection control experts. She advises both the Colorado Hospital Association and the state health department on the issue. She say that while it’s possible to end infections caused by hospitals and the people who work in them, it isn’t going to be easy. 

Dr. Price takes us on a tour of the hospital where she works, Denver Health, showing some of what hospitals are doing now.

PRICE: there's a chlorhexadine alchol scrub that's used to de-contaminate the hands...(fade under)

WHITNEY: She starts with the sink where doctors and nurses wash up before surgeries. But it’s going to take more than just washing hands to prevent infections.
Operating Room Nurse Karen Moreno points to a whiteboard on the operating room door.

MORENO: it's like a pre-flight checklist that the pilots go through, and this is our verification.

WHITNEY: the checklist includes making sure that patients get a dose of antibiotics right before surgery, and checking the operating room temperature, because patients who get cold are more prone to infections.
And the precautions continue after surgery . . ..

MORENO: Now we're in the PAC-U, or the recovery room....

WHITNEY: In recovery, patients are greeted by another set of caregivers, who have their own infection control checklists to follow. Then they'll be sent to a regular hospital room, where more staff will take care of them, maybe lots more staff over several shifts, depending on how long they're in the hospital. Dr. Price says that to prevent infections, all those people have to do a lot of things right, all the time.

PRICE: how do you take a complex system, where there are a million moving parts, and get everyone to work together to make sure, 100% of each time these preventive measures are occurring? And that absolutely is the biggest challenge.

WHITNEY: The challenge includes getting patients and their loved ones to do everything right, too. Don’t visit a hospital patient if you have a cold, for instance, and keep surgical wounds clean at home.

Darla Stuart, whose daughter got an infection from her back surgery, said they did that.

DARLA: we took it really seriously, and we were thinking this would be an infection that we would introduce through the incision.

WHITNEY: But Darla's daughter's infection most likely happened during surgery. And the family says they wish they would have had better conversations with her doctors about the risks of infection. Experts say that's important – that just talking with your doctor can reduce the likelihood of an infection. They say it reminds doctors of their responsibilities, and gives them a chance to tell patients what they can do to minimize infection risk.
But Darla Stuart says when doctors told her the risk of infection was low, she trusted them and didn’t press the issue.

Sofia, who got the infection, says, if nothing else, the experience taught her to stand up for herself.

SOFIA: I'm thinking in my head, like, there's something going on, but I guess it's not that big a deal. And then I guess it was, so it's like, now I'm like able to trust myself more, because now I know that no matter what degree you have, or whatever, they're not, sometimes, very smart.

WHITNEY: The Colorado Hospital Association has a collaborative group that's constantly sharing new information and techniques for reducing hospital-acquired infections. Dr. Connie Price, who is lead faculty for that group says it's making progress, and that infection rates are going down. But she also says eliminating hospital-caused infections is going to take more research, and continued evolution in how doctors and hospitals do what they do.

Part one of our two-part series on hospital-acquired infections in Colorado is available here.

The latest state health department annual report on hospital-acquired infections is available here.

The Colorado Hospital Association's page on infection prevention is available here.

This series was produced with the assistance of CPR's Public Insight Network, learn more about it here.