Nurses are on an understandable rampage about lax infection controls at Texas Health Presbyterian Hospital, which has now left two nurses fighting for their lives after having been infected by a dying Ebola patient. Writes the New York Times,
[N]urses at the Texas hospital complained that the protective gear the hospital issued left their necks exposed — and they were told to wrap their necks with medical tape.
“They were learning infection control on the fly,” said DeAnn McEwen, chief of infection control for the union. …
This hospital, which also misdiagnosed the patient and then “issued contradictory statements" about the misdiagnosis, is considered “one of the finest hospitals in Texas.” And, “Its supporters question whether any hospital would have performed much better under similar circumstances.”
Good point, actually.
- “On any given day, approximately one in 25 U.S. patients has at least one infection contracted during the course of their hospital care….”
- In 2011, “about 721,800 infections occurred in 648,000 hospital patients.”
- “About 75,000 patients with healthcare-associated infections died during their hospitalizations.”
And that wasn’t exactly news, either. Back in 2011, for example, another study found that medical errors occur in one-third of hospital admissions (as much as 10 times more frequently than previously estimated), and included among the chief medical errors are, “hospital-acquired infections, which often result from poor sanitation.” As lead researcher Dr. David C. Classen, an associate professor of medicine at the University of Utah, put it, “The more you look for errors, the more you find.” And that same year, another study found that the single most expensive cause of harm is infection after surgery, with more than 252,000 infections costing $3.36 billion a year.
Finally, some in the media are starting to pick up on this. USA Today just wrote a large overview of the 2014 study, noting,
"There is very little discipline in a lot of hospitals around infection control," says Leah Binder, president of the Leapfrog Group, a consortium of corporations and other health care purchasers that tracks hospital quality. "If an Ebola patient walks into a hospital that has a high rate of infection for other (illnesses) … they are going to be woefully unprepared for an infection with so little room for error."
Dr. Daniel Varga, the chief clinical officer for Texas Health Resources, is testifying before the U.S. House Energy and Commerce Committee today. He says in his written statement, “We did not correctly diagnose [Thomas Eric Duncan's] symptoms as those of Ebola. We are deeply sorry.” (We assume that apology was on advice by his new PR firm, Burson-Marsteller, because who doesn't need top quality PR at a time like this?)
However, that brings us to another huge problem in hospitals: misdiagnosis. In 2013, Johns Hopkins researchers reviewed National Practitioner Data Bank data from the past 25 years and found that “diagnostic errors [i.e., diagnoses that are missed, wrong or delayed] – not surgical mistakes or medication overdoses – accounted for the largest fraction of claims, the most severe patient harm, and the highest total of penalty payouts.” Lead researcher Dr. David E. Newman-Toker explained, “This is more evidence that diagnostic errors could easily be the biggest patient safety and medical malpractice problem in the United States…. There’s a lot more harm associated with diagnostic errors than we imagined.”
Notes the New York Times, “If [Texas Health Presbyterian Hospital] has served as a canary in a coal mine for the country’s Ebola response, the results have not inspired confidence. ……
If only Ebola was the only problem.