The Wall Street Journal on August 14, 2008 perpetrated a large pile of FUD (fear uncertainty and doubt) on unsuspecting readers, in an article claiming "nearly all hospital infections are avoidable" and that "hospital infections will cause the next wave of class-action lawsuits, bigger than the litigation over asbestos." Hospital Infections: Preventable and Unacceptable (via the Hudson Institute).
On July 30, a jury awarded over $2.5 million to James Klotz and his wife Mary in a medical malpractice lawsuit against a heart surgeon, his group practice and St. Anthony's Medical Center in St. Louis, Mo. In 2004 Mr. Klotz, now 69, was rushed to the hospital with a heart attack and a pacemaker was surgically implanted. He developed a drug-resistant staph infection called methicillin-resistant Staphylococcus aureus (MRSA). It was so severe that he underwent 15 additional operations, spent 84 days in the hospital and lost his right leg, part of his left foot, a kidney and most of his hearing.
The author of this opinion piece, Betsy McCaughey, writes that central line bloodstream infections, caused by the contamination of certain devices, are preventable and that "rigorous hygiene, including clean hands, sterile drapes, and careful cleaning of the insertion site with chlorhexidine soap, can keep bacteria away.." Her's is a campaign to force a kind of "zero tolerance" of patient infections of any kind at all hospitals. Sounds good on the surface, but what she's advocating is simplistic, perhaps simpleminded.
Rob Oliver, Jr, MD, in his Plastic Surgery 101 blog, is rightfully incensed over the WSJ's questionable conclusion:
Nobody disagrees that common sense steps like hand washing and protocols for invasive intravenous (IV) access maintenance are important in limiting infections. It is both a dangerous and disingenuous idea to suggest that a goal of ZERO is attainable. It is impossible to achieve a failure rate of 0% for a system or process, particularly one with infinite numbers of variables (as with a human population of patients). Unlike a Toyota, no two models of the human assembly line are exactly alike (even identical twins gradually accumulate differences due to environmental exposure).
Ms. McCaughey, a former Lt. Governor of New York State, is at the helm of RID (the Committee to Reduce Infection Deaths), an advocacy group that certainly sounds like a worthwhile medical organization.
A few medical blogs, though, have picked up on the "zero percent" rule espoused by McCaughrey and the so-called "Never Events" policy espoused by Medicare/Medicaid. Dr. Oliver is not alone here — this topic can make physicians froth at the mouth on cue.
From the Buckeye Surgeon:
Venous thromboembolism can occur in up to 70% of patients after hip replacement if no prophylaxis is utilized. Even with the use of heparin or lovenox or coumadin, the risk still remains at around 5-10%. All scientific papers published on DVT prophylaxis talk about risk reduction. In no work of science will you read about a method of eliminating all risk of DVT after elective orthopedic procedures. As for the occurence of wound infections after bariatric surgery, only an absolute moron would advocate the stance that such occurrences are completely preventable. We have over 60 years of scientific research on surgical site infections. There are established norms and percentages for the development of wound infections after certain invasive procedures. The number isn't zero, no matter what how sterile or careful you are or how appropriately perioperative antibiotics are given. With bariatric surgery, you're dealing with patients who are obese and who often have diabetes; the two conditions most highly associated with surgical site infections. The list also condemns things like delirium and foley catheter infections and decubitus ulcers as completely preventable. In other words, when you slide a foreign body made out of rubber through your urethra into your bladder, the possibility that no bacteria will travel along the catheter to your bladder, thus setting up an infection ought to be zero….. Those sounds you hear in the background are knives being sharpened by thousands of personal injury lawyers across the country.
Regardless of one's stance on this issue, this and other physician comments here, here, and here would suggest that McCaughey, who is referred to as "Dr." in some online sources, is not articulating all sides of this important issue — and possibly ignoring basic facts about the why/how of hospital infections and related phenomena that other doctors can articulate very clearly.
So… who exactly is McCaughey? A clue can be found at Tapped:
"…[Is] this Betsy McCaughey the "Elizabeth McCaughey" who as a fellow at the Manhattan Institute wrote the legendary article, "No Exit," in The New Republic in 1993, in which she claimed to have read the entire Clinton health care plan and adduced all sorts of nightmare scenarios? Is this Betsy McCaughey the "Betsy McCaughey Ross" who, solely on the credential of having discredited the Clinton health care plan, was chosen as the Republican nominee for Lieutenant Governor of New York in 1995, becoming probably the first person ever to make news from that position by, for reasons never explained, standing up for the entirety of Governor Pataki's 1997 State of the State address? The same Betsy McCaughey who then became a Democrat, ran for governor, and divorced and sued her husband, Wilbur Ross, when he refused to bankroll her campaign?
Yes, all the same person. And her new gig, the "Committe to Reduce Infection Deaths"? A good cause, to be sure: make sure doctors wash their hands. But the actual activities are vague and the "committee" itself consists of folks like Erica Jong, Tina Brown, Sir Harold Evans, the architect Richard Meier, and various other New York socialites.