Lately there has been a lot of scare about MRSA, methicillin resistant staphylococcus acquired by bed riden hospital patients and the elderly in nursing care facilities.These and other types of infections acquired in clinical settings are called Nosocomial Infections. There are several that contribute to hospital setting morbidity and mortality annually.
Some 2.5 million infections in hospitals occur in this setting. It is actually considered the 4th largest killer in the U.S after AIDS, cancer and accidents. This problem may actually be costing the US taxpayer some 30 $billion dollars annually. Studies indicate that one in twenty patients gets infected in the hospital.
Why has this persisted in the era of greatest medical findings and technolgy, drug therapy? Bio-medical scientist and clinical pharmacologist believe that in the era previously, so many antiobiotics may have been given as a "knee-jerk" response to every cough, cold, or sneeze and that over several generations the "bugs" (bacteria, viruses) have out smarted some of antiobiotics by creating in their own DNA codes to resist them.
How health workers handle sanitation is another area. Do doctors and others wash their hands after seeing one patient and going to the next room? do spills on clothing, ties or lab jackets transmit the "bug" room to room? Are the air flows in rooms with communicable disase functioning such in a TB ward? Are colonoscopes, brochoscopes, and other surgical equipment autoclaved and if so at the correct temperature?
Another curiosity are Iatrogenic Effects". These are health worker induced(normally accidental) occurences that cause morbidity and mortality. Dosing of drugs is perhaps one of the biggest areas that is of concern. Writing correct medical records for change of shift is another. This is a vulnerable time where important lab that is in transit may be missed.
Usually at the beginning of July in teaching hospitals new Interns fresh out of medical school ready to "take on the world" and invade the ERs of America get started. There is a wide range of teaching competencies from medical school to medical school. While some schools teach very hands on some prefer being more academic but less hands on. They all get to blend in a residency program together.During this time morbidity and mortality rates do go up. those who were once Interns now hold down even more repsonsibility by becoming a Supervising resident who is now in charge of 2 or 3 or more interns. This can be a heavy responsibility.things do get misplaced.
The Journal of the American Medical Association has regularly attributed very conservativelly an annual mortality of 300,000 due to Iatrogenic causes. But ,other observers report it as high as 700,000.
It may be the "practice of medicine" which is to heal the sick that may have more benefit in prevention and sanitation as a major method of treatment. Physicians are not to blame, but rather poorly designed logistics that could help double check what is going on better . The president's campaign to put medical records online especially prescirptions will help pave the way for other measures to come, but much more needs to be done to prevent both Nosocomial Infections and Iatrogenic Effects.
Dr. Marcus Wells is a previous Clinical Associate at the NIH at the National Heart, Lung, & Blood Institute. He has served with the US Health & Human Serives, US Public Health Service and the US Commissioned Corp. Dr. Wells also holds a Master's degree from Emory University.
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