With the current focus at federal and state government levels on addressing the problems and costs confronting our hospitals, it is important not to ignore the small actions that are guaranteed to deliver big results.
One major pressure point for stressed hospital systems is the burden of nosocomial, or hospital-acquired, infections from bacteria such as golden staph. These infections, which are increasingly resistant to antibiotics, mean longer lengths of stay, higher health costs, poorer patient outcomes and, too often, unnecessary deaths. Canberra Hospital's director of infectious diseases, Professor Peter Collignon, a recognised expert in this area, says doctors are not doing enough to reduce the rate of complications caused by potentially deadly hospital infections.
As many as one in five people who undergo surgery in Australia will develop an infection that requires further treatment, and half of these infections are preventable. Every year at least 600,000 patients contract an infection and hospital-acquired infections cause significantly more deaths than road accidents. The rates of infection are the same in public and private hospitals, and they cost the health-care budget hundreds of millions of dollars a year.
In Victoria in 2006, 126 patients who contracted infections after a hip or knee replacement cost the state an extra $5million, or $40,000 each. Five per cent of these patients died and on average they stayed an extra 27 days in the hospital. Another Australian study showed that a wound infection after coronary artery bypass graft could add an extra $31,000 to the cost of this procedure.
The cure is simple. It's about timely hand washing and aseptic techniques. Basic infection control practices need to be followed by everyone in the hospital: doctors, nurses, physiotherapists, students, cleaners and administrators. It requires sufficient sterile equipment, clothing and gloves to be available always and adequate personnel in infection control. Ideally, all patients should be tested for latent infections on admittance and discharge. The cornerstone of successful hospital infection control is surveillance and the national reporting of results because hospital acquired infections are an indicator of quality clinical care.
The key principle is nothing new. In 1847, Viennese obstetrician Ignac Semmelweis deduced that by not washing their hands consistently or well enough, doctors were to blame for childbed fever which resulted in the deaths of 20 per cent of the mothers who had babies in his hospital. Every health-care worker knows this story, but too many are unable to translate its importance into their own practice.
Doctors readily acknowledge that hand washing is important in the control of infections, and this is shown by their rigorous attention to scrubbing-in before surgery and their scrupulous maintenance of sterility in the operating theatre. But outside the operating theatre it is a different story. About half of clinical staff fail to wash their hands each time they look at a new patient, change a patient's dressing or pick up a patient's chart. Doctors offer excuses such as the pressure of work, the detrimental effects of hand-washing agents on the skin, and the more important needs of the patient as reasons for not washing their hands . There is little emphasis on infection control in medical school and poor hand-washing practices may be learnt from teachers and peers at the bedside.
It was announced last August that the Medicare program in the United States would no longer pay for the extra costs of treating preventable infections that occur in hospitals, a move that is sure to focus attention on addressing this issue. And results from Scandinavia and the US show that it is possible to quickly reduce hospital infection rates to as low as 1 per cent.
The interventions involve little more than the ready availability at each patient's bedside of alcohol rinses or gels, gowns, disposable gloves, needed dressings and syringes, and a "big brother is watching" approach ongoing observation, verbal reminders and monitoring of each other's behaviour by health-care professionals and the infection-control team.
Collignon makes the case for requiring all hospitals to collect data about golden staph infections, to identify preventable factors and then to change clinical practices and protocols to reduce these life-threatening infections.
This could be implemented immediately. The small costs will quickly realise substantial benefits for hospitals and patients.
Dr Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy, University of Sydney/Australian National University.