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Hidden Harm in Healing: Patients, Loved Ones Seek Greater Accountability From Health-Care Facilities

Posted on: Sunday, 29 January 2006, 12:00 CST

By Elizabeth Suh, The Akron Beacon Journal, Ohio

Jan. 29--When Mary Pashley, a 75-year-old resident of Coventry Township, went into The Cleveland Clinic for open heart surgery in September, she thought she knew the risks.

But doctors had never brought up one of the biggest dangers -- infection acquired during hospital stays.

And less than three months after surgery to repair a deteriorating heart, Pashley was dead.

The culprit was a bloodstream infection from a bacterium called methicillin-resistant Staphylococcus aureus (MRSA). It's one of the most problematic infections to fight because the bacterium is resistant to many drugs.

Pashley, a former realtor and performer for water-ski shows, underwent surgery at The Cleveland Clinic on Sept. 27. She had been anticipating a 10-day hospital stay. Eight days later, she went into septic shock from MRSA.

For the rest of her life, in the Clinic and in rehab facilities, she battled the infection. When she died on Dec. 14, after suffering several strokes, her death certificate listed sepsis as the cause.

That day, as she took her last labored breaths after life support was removed, her husband Dick was there, stroking her hair.

"Carelessness got her infected," Dick Pashley says. "What can be done to stop this kind of thing?"

Infections widespread

Each year, about 2 million patients -- one in every 20 -- gets infected during a hospital stay, and, according to the U.S. Centers for Disease Control and Prevention, 90,000 of those patients die from the infections.

Most common are urinary tract infections, pneumonia, Clostridium difficile (C. diff) infections and staph infections, including the particularly dangerous MRSA.

Information about the number of infections at a particular hospital is not available to the public because most states, including Ohio, do not require hospitals to report them. (C. diff is a new exception; starting this month, the Ohio Department of Health began requiring hospitals to report infections from the potentially deadly intestinal infection.)

Hospital infections usually are spread between patients through contact by health-care workers, according to the CDC.

At area hospitals, spokesmen say health care workers do their best to prevent infections and managers reinforce the importance of hygiene practices, especially hand washing.

Elizabeth Winter, of WRH Health System, formerly Wadsworth-Rittman Hospital, says managers observed a 100 percent compliance rate for proper hand washing at the last formal check in 2004. Managers specifically watched, while working, for hand washing during various times over a six-month period.

Innovative software

One of the most innovative examples of an infection control program came to Akron General Medical Center in July when it became the second hospital in the state to begin using a software program called MedMined.

MedMined constantly collects data from inside the hospital, including results from tests for infection, to help spot any trends as they are developing.

"That's been very exciting, because (MedMined) can pick up things before a human can pick it up," says Diane Salisbury, Akron General's director of infection control. "And it can pick up things that maybe a human can never pick up."

In the first three weeks of MedMined's use, as a result of information from the program, Salisbury says, the hospital staff introduced a new mouth-care kit for patients in the intensive care unit. The number of lab tests that showed bacterial growth -- and possible infection -- dropped by 80 percent.

The hospital now has a baseline for its infection rates in 2005, she says, and it plans to reduce those numbers by about 40 percent in 2006 by improving practices.

Patrick Hymel, MedMined's chief medical officer, says hospitals that use MedMined have seen infection rates drop an average of 13 percent in the first year and continue to improve with time.

That's because the software allows the hospital's infection control professionals to reallocate time from digging through data to analyzing it and improving practices, he says.

Accountability sought

But Dick Pashley and his son's fiancee, Maureen Sloan, a 50-year-old resident of Fairlawn and an area nurse, say they saw inconsistencies in hygiene practices at the hospitals that took care of Mary Pashley.

For days, a line that fed into her heart was not taped to her body to minimize the portal for bacteria, Sloan says. And sometimes health-care workers did not wear gloves while handling the line.

Al Gareri, a 76-year-old resident of Coventry Township and a close friend of the Pashleys, has his own infection story.

He suspects that a lack of cleanliness contributed to an infection, possibly MRSA, he got last year after the second of two ear surgeries at an area hospital. He doesn't want the hospital to be identified while he remains in the facility's care.

For the past six months, he and his wife, Glenna, have been homebodies while he fought the infection with five daily IV drug treatments. On Tuesday, doctors relieved him of his drugs, saying the infection finally seems to have cleared.

Both families want greater accountability from hospitals.

"(The Clinic) did all the right things to save her life," Dick Pashley says of his wife. "But that all doesn't make any difference since they infected her."

Pashley, who is the executor of his wife's estate, is willing to waive patient privacy rights and permit The Cleveland Clinic to speak about his wife's case.

However, Christina Thompson, a Clinic spokeswoman, cites patient privacy as the reason why the hospital can't comment.

"We express our deepest sympathy to the Pashley family," she says in a statement on behalf of the Clinic. "Cleveland Clinic is committed to patient safety and has a rigorous quality management process."

Hospital precautions

After noting an increase in the number and severity of C. diff infections in 2004, some area hospitals began taking added precautions.

Aultman Hospital in Canton, for example, began requiring two cleanings per room after use by a patient with a C. diff infection.

And, says Akron General's Salisbury, in the past year many in the health-care community have come to realize that alcohol-based sanitizers such as Purell are not as effective as hand-washing in eliminating organisms like C. diff, which must be washed away.

Ginnie Abell, Summa Health System's director of infection control and clinical safety, advises hospital visitors to be cautious -- washing their hands before and after contact with a patient -- but not overly fearful.

"You only want organisms to feel isolated," she says. "You don't want patients to feel isolated."

Hospitals deal with infection control every day, and there are always difficulties: human error, elderly patients who need strong antibiotics and are very susceptible to infection, determining where an infection came from.

"Everybody tries," Salisbury says. "Nobody wants to do something that would harm a patient, but I guess there's always room for improvement."

Elizabeth Suh can be reached at 330-996-3748 or esuh@thebeaconjournal.com.

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Copyright (c) 2006, The Akron Beacon Journal, Ohio

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Source: Akron Beacon Journal (Akron, Ohio)

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