Germ Police Patrol Hospitals

Published July 1, 2007

SAN ANTONIO–Like her counterparts at hospitals everywhere, Patti Grota knows it takes more than just rules and guidelines to make sure overworked doctors, nurses, and health workers keep their hands clean and avoid spreading infections among sick patients.

She patrols the wards to see how well people use hand sanitizer between patients and explains to them how they fell short. Report cards go to supervisors. Everyone sits through germ-fighting classes each year.

Then there are the bribes.

“We try to approach it almost from a marketing standpoint,” said Grota, deputy chief of infection control at the South Texas Veterans Health Care System, which operates hospitals in eight cities throughout south Texas. “We give them a little pin, tokens if they’re doing a good job. The medical staff, we actually give them what we call a hand-hygiene gift bag.”

Legislation Advances

Senate Bill 288, which has passed both the [Texas] House and Senate and is headed to the governor, would provide even tougher incentives, making certain hospital-acquired infection rates are public information. Under the bill, sponsored by state Sen. Jane Nelson (R-Lewisville), patients could go online and compare how well hospitals fared in infection control.

“I think it will save lives in the long run,” said Thomas J. DeChant of Austin, whose father, Thomas DeChant, died of Legionnaires’ disease at a San Antonio hospital and whose family lobbied for the bill.

“I also think it will make hospitals become more diligent in working to keep their infection rates down,” DeChant said. “It’s going to possibly isolate where (in the hospital) these infections are coming from, and they’ll be able to nip it that way, too. The public will get to know that. They’ll be able to say, this hospital’s rate is way too high so I’m going to go to this other hospital that’s a little cleaner.”

It’s been a long struggle. About 1840, Hungarian obstetrician Ignaz Semmelweis acted on a hunch and ordered his medical students to wash their hands with chlorinated lime before examining mothers-to-be.

The maternal death rate dropped from 12 percent to 1 percent within two years. His findings triggered such a backlash from colleagues that he resigned and eventually died, of a hospital-acquired infection, in a mental hospital after suffering a nervous breakdown.

Infection Takes Toll

Today, infection control is a complex science, and an obsession in good hospitals. Still, an estimated 2 million people a year, one in every 20 patients, contract an infection through a health procedure, resulting in 90,000 deaths and costing $4.5 billion, according to the Centers for Disease Control and Prevention.

At least 14 other states have passed laws requiring public reporting by hospitals.

“I think everyone agrees it’s the right thing to do,” said Amanda Engler, a spokeswoman for the Texas Hospital Association, which supported the bill.

“The problem is there’s a right way to do it and a wrong way to do it. And we wanted to make sure we did this the right way so that it’s good data, usable data, it will mean something for consumers, and it will be useful for the hospitals to do benchmarking and really be able to see where they stand and where they need to make improvements.”

Initially, hospitals must report infections that occur during certain types of surgery, bloodstream infections associated with central intravenous lines, and infections that are more common to pediatric hospitals. Even small hospitals that perform few surgeries will have special rules. And the bill would allow more types of infections to be added, said Lisa McGiffert, a health policy analyst with Consumers Union’s regional office in Austin.

“Is it everything I would ever want?” McGiffert said. “No. But it’s got all the elements we feel are important in the bill.”

Don Finley ([email protected]) is medical editor of the San Antonio Express-News, where this story originally appeared on May 10. Copyright 2007 San Antonio Express-News, reprinted with permission.