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An Acquired Distaste

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An Acquired Distaste

By Jock Hoffman, CRICO

Related to: Ambulatory, Emergency Medicine, Primary Care, Nursing, Obstetrics, Other Specialties, Surgery

Ever since 1865—when the first promoter of sanitary hand washing, Ignaz Semmelweis, was committed to an insane asylum after denouncing non-compliant obstetricians as murderers—infection control practices have fallen short of the ideal. In the ensuing years, our understanding of the causes of nosocomial infections has improved, but compliance with recommended, effective prevention techniques remains inconsistent. Apparently, we’ve spent more time wringing our hands than washing them, and that may well lead the patient population into court for compensation.

The CDC estimates that, annually, nearly 2,000,000 patients in the United States acquire infections while hospitalized, leading to (or contributing to) 99,000 deaths. Even though awareness of hospital acquired infections is fully raised, guidelines abound, and recommendations are neatly packaged and cleverly promoted, patients continue to suffer. Improved prevention techniques are often offset by adaptable organisms that demand newer drugs or more complex precautions.

But amidst the parry and thrust of infections and deterrents, tolerance among patients is being supplanted by intolerance, increased activism, and regulatory intervention aimed at eliminating them altogether. And if that isn’t enough to motivate better hand washing and central line technique, the financial impact of hospital acquired infections might. Since October 2008, the federal government no longer reimburses hospitals for several types of nosocomial infections. This policy, along with increased media attention around MRSA and other infection outbreaks, may well lead patients to be more motivated to sue the hospitals or clinics where they acquired their infections.

Analysis of nosocomial infection-related malpractice cases in the CRICO/RMF Comparative Benchmarking System (CBS) shows that, from 2004-through April 2009, the average incurred loss is $210,000. For similar cases closed over the same time period, the average indemnity payment was $414,000. One quarter of the asserted cases involved a high severity injury, including deaths (16 percent of all cases). Likewise, 15 percent of the patients in the closed cases analyzed died.

In an era of increased transparency and public data, patients who once tolerated nosocomial infections as a known risk of treatment may now seek compensation for what they have been led to believe is a preventable injury. Clearly, the human cost of hospital acquired infections is a compelling reason to adopt the best preventive practices, and the direct and indirect costs associated with patients who suffer nosocomial infections offer further motivation for innovative solutions and vigilant implementation. Anything less might have Ignaz Semmelweis spinning in his grave.

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May 1, 2009
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