In For A Cure, But Out With A Deadly Disease

Sydney Morning Herald

Thursday August 24, 2006

Peter Curson; Professor Peter Curson is director of the health studies program at Macquarie University.

THE recent deaths of the Sydney teenager Jehan Nassif and two children in New Zealand from meningococcal disease show that despite the best care and intentions we remain vulnerable to infectious disease. Perhaps we rely too much on hospitals as places of high-quality, infection-free care, just as we believe vaccination and treatment guidelines offer full protection against infection. Yet why are hospitals such dangerous places? Why are there so many infections and complications?

In the US, almost 100,000 people a year die from hospital-acquired infections, and there are probably more than 2 million acquired infections in the world's hospitals every year.

In Australia probably between one in six and one in eight people entering hospital will either end up with an infection or suffer some sort of complication after surgery. There could be between 8000 and 10,000 deaths every year from these sources. If avian flu produced the same outcome it would be an epidemic.

The effect is wide-ranging: patients need longer hospital stays, re-admissions or further surgery, resulting in longer recovery and higher costs.

And the trend to shorter hospital stays often means infections or complications emerge at home and become the initial responsibility of a GP. A recent study in Pennsylvania showed hospital-acquired infections resulted in 205,000 more days being spent in hospital with $US2 billion ($2.6 billion) more in hospital fees.

It appears infections in hospitals have increased by at least 50 per cent over the past decade. A recent Australian study shows two out of three people having a coronary bypass, more than half undergoing a colectomy and 42 per cent of those receiving a hip replacement will suffer a complication or infection. Patients who acquire an infection in hospital would seem at greater risk of dying. The US study found that of those who acquired an infection, more than 15.4 per cent died, compared with 2.4 per cent of patients who avoided infection. Presumably much the same applies in Australia.

So why have hospitals become such sources of morbidity and mortality? At least four factors would seem to be responsible. First, patient susceptibility. Many people admitted to hospitals are older and sicker (many with chronic conditions), subjected to more invasive procedures and confronted by a larger array of hospital and support staff, than in the past.

Second, overuse of antibiotics has probably encouraged resistance and the emergence of drug-resistant strains. Antibiotic-resistant organisms are probably responsible for more than 70 per cent of all hospital-acquired infections. Methicillin-resistant Staphylococcus aureus has received a lot of publicity, and recent US evidence suggests this infection, once confined largely to hospital patients, is now spreading and fast becoming the most common cause of skin infection in adults.

Third, changes in health-care technology, the range of invasive procedures used in organ and tissue transplants and the regular use of catheters, ventilators and prosthetics, have produced a conducive entry environment for infections.

Finally, overcrowding, frequent patient transfer, lax hygiene and infection control practices and inadequate cleaning contribute to the increased risk of infections. Cross-infections of microorganisms from the hands of staff or on devices remains probably the most important transmission mechanism.

Often hospitals are more preoccupied with finances, reconfiguring services and meeting government targets than addressing the infection challenge. The key is to set up formal infection surveillance systems in hospitals and to fully understand the nature of infections in a changing social and technological environment.

© 2006 Sydney Morning Herald

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