In the ongoing war of humans vs. disease-causing bacteria, the bugs are gaining the upper hand. Deadly and unrelenting, they’re becoming more and more difficult to kill.
You might think of hospitals as sterile safety zones in that battle. But in truth, they are ground zero for the invasion.
Though infections are just one measure of a hospital’s safety record, they’re an important one. Every year an estimated 648,000 people in the U.S. develop infections during a hospital stay, and about 75,000 die, according to the Centers for Disease Control and Prevention (CDC). That’s more than twice the number of people who die each year in car crashes. And many of those illnesses and deaths can be traced back to the use of antibiotics, the very drugs that are supposed to fight the infections.
Terry Otey appears to be one casualty in that ongoing battle. Three years ago, a few weeks after an overnight stay for back surgery at Providence Regional Medical Center in Everett, Wash., he went to the emergency room vomiting, dizzy, and with excruciating back pain. Bacteria known as MRSA (methicillin-resistant staphylococcus aureus) had taken hold in his surgical incision and quickly spread to his heart. He died in the hospital about three months later, following a cascade of serious health problems. “He just wanted to ease his back pain enough to play golf,” says his sister, Deborah Bussell.
Kellie Pearson, 49, a farmer in northern California, says she encountered a different kind of bug after having heart surgery last April. Her doctors prescribed an antibiotic in the hopes that it would prevent a postsurgical infection. Instead the drug killed off healthy bacteria in her body, and another germ, C. diff (clostridium difficile), swooped in, causing diarrhea so severe that she had to stay in the hospital an additional five days until doctors could rein in the potentially deadly infection.
She recovered but soon realized that she wasn’t the only patient suffering. “When I was able to walk down the hall in the hospital,” she says, “I was horrified to see room after room with C. diff caution signs on their doors warning that the patients inside, like me, had been infected.”
people die each year as a result of hospital infections
people die each year as a result of hospital infections
‘Be your own advocate’
KELLIE PEARSON recovered from a life-threatening case of C. diff caused by antibiotics she got in the hospital. But shortly after, she says, her doctor wanted to prescribe a broad-spectrum antibiotic to prevent infection in her incision. “I was shocked because that could trigger the C. diff all over again,” she says. Her takeaway: “You have to be your own advocate.”
‘I am a fighter’
BARBARA THOM, 61, says it was plenty scary undergoing surgery for a benign brain tumor at Sacred Heart Hospital in Eau Claire, Wis., in 2010. But the worst was still to come. Two different bacteria invaded her incision site and wreaked havoc despite treatment with multiple antibiotics. Ultimately, to control the infections, doctors had to replace part of her skull with surgical mesh and put her on high doses of antibiotics that, five years later, she still must take every day. “I’m a fighter, so I’m going to keep doing whatever it takes,” Thom says, though she worries that the drugs will eventually stop working. “It’s the unknown that scares me.”
Hospitals That Rate Well
To earn our very top rating in preventing MRSA or C. diff, a hospital has to report zero infections—an admittedly high bar. Still, 322 hospitals across the country were able to achieve that level in our MRSA ratings, and 357 accomplished it for C. diff, showing that it is possible. (Experts say some hospitals might game the system. Read more about how hospitals fudge the numbers, and help us identify those that may not accurately report infections.)
More hospitals were able to earn either of our two highest ratings—indicating that they reported either zero infections or did much better than predicted compared with similar hospitals: 623 hospitals received high marks for MRSA, and 917 did so for C. diff.
Hospitals really begin to distinguish themselves when they earn high ratings against both infections: 105 hospitals succeeded in that. Even better, some hospitals excel against not only MRSA and C. diff but also other infections that the CDC tracks and that are in our Ratings. Those include surgical-site infections and infections linked to urinary catheters or central-line catheters, large tubes that provide medication and nutrition.
“Hospitals that do well against infections across the board have figured ] something out and deserve special mention,” Peter says. Only 9 hospitals in the country—those featured in the “Highest-Rated in Infection Prevention” chart—earned that high honor.
And Hospitals That Don’t
You won’t find any familiar, big-name hospitals on that top-performing list. In fact, several high-profile hospitals got lower ratings against MRSA, C. diff, including the Cleveland Clinic in Cleveland, Johns Hopkins Hospital in Baltimore, Mount Sinai Hospital in New York City, and Ronald Reagan University of California Los Angeles Medical Center.
Those are all large teaching hospitals in urban areas, which in our analysis did not do as well as nonteaching hospitals of similar sizes in similar settings. That could be because teaching hospitals may do a better job of reporting infections. Or, as a representative for Ronald Reagan UCLA Medical Center told us, they may see sicker patients or have more patients undergoing complex procedures.
Although the CDC adjusts the data to account for some of those factors, teaching hospitals tend to perform worse. For example, only 6 percent of teaching hospitals received one of our two top scores against C. diff, compared with 14 percent of similar nonteaching hospitals.
“Yes, teaching hospitals face special challenges. But they are also supposed to be places where we identify best practices and put them to work,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. “Obviously, that is not happening as well as it should.”
Larger hospitals also tended to do worse in our Ratings. That could be because patients in smaller hospitals are less likely to be exposed to infections. But some larger hospitals managed to do a good job avoiding infections. Case in point: Harlem Hospital Center in New York City earned high ratings against MRSA and C. diff. Or consider Northwest Texas Healthcare System in Amarillo, Texas. It made it onto our list of top hospitals in the prevention of all of the infections included in our Ratings.
What Safe Hospitals Do
Good hospitals focus on the basics:
USE ANTIBIOTICS WISELY. Almost half of hospital patients are prescribed at least one antibiotic, Srinivasan says, but “up to half the time the drug is inappropriate.” To combat antibiotic misuse, many good hospitals have “antibiotic stewardship” programs, often headed by a pharmacist trained in infectious disease, to make sure that patients get the right drug, at the right time, in the right dose.
Such programs often monitor the use of broad-spectrum antibiotics. Doctors at some hospitals use three times more of those all-purpose bug killers than others. Reducing broad-spectrum prescriptions by 30 percent would “cut hospital rates of C. diff by more than 25 percent, plus reduce antibiotic resistance,” says Clifford McDonald, M.D., a CDC epidemiologist
KEEP IT CLEAN. C. diff and MRSA can live on surfaces for days and can be passed from person to person on hospital equipment or the hands of health care workers. To prevent that, hospitals must be kept scrupulously clean. “Infection control is all about the basics, starting with hand hygiene,” says Christine Candio, president and CEO of highly rated St. Luke’s Hospital in Chesterfield, Mo. She reminds patients, “it’s your right to ask” staff to wash up. In fact, fastidious hand washing slashes rates of C. diff, MRSA, and other infections. St. Luke’s also “prioritizes cleanliness,” in some cases exceeding infection-control guidelines—cleaning the rooms of C. diff patients twice daily, for example, and replacing curtains between patients.
How to wash your hands
Fighting Bad Bacteria With Good Ones
Antibiotics kill off not only bad bacteria that make you sick but also good bacteria that help keep you healthy. So replenishing the good bugs in your digestive tract seems to make sense. That’s the idea behind two growing trends: probiotics and fecal transplants.
There’s some evidence that probiotics might shorten a bout of diarrhea caused by antibiotics. And an analysis of 23 clinical trials found that taking probiotics with antibiotics can greatly cut the risk of diarrhea caused by C. diff.
Probiotics may be worth a try if you’re on antibiotics for more than a few days, taking two antibiotics at once, or you’re switched from one drug to another. People older than 65 and those who take an acid-blocking drug such as Nexium or Prilosec are at higher risk for C. diff; check with your doctor to see whether probiotics will help you.
Research suggests that the most effective probiotics are combinations of L. acidophilus, L. casei, L. rhamnosus, and S. boulardii. To reduce the risk of diarrhea caused by C. diff, the most effective dose is thought to be more than 10 billion colony forming units, or CFU, daily.
You don’t have to take a pill to get those good bacteria. Yogurts we
tested several years ago contained an average of 90 billion to 500
billion CFU per serving. Probiotic supplements contained less, from
just fewer than 1 billion to 20 billion CFU per capsule. Read more about probiotics and yogurt.)
Probiotics should be avoided by people with compromised immune systems or serious medical conditions because of a rare risk of bloodstream infections
For C. diff infections that keep coming back, a “fecal microbiota transplant” is nothing short of a miracle. In the procedure, a doctor places stool from a healthy donor into an infected person’s colon, usually using colonoscopy. The idea is to repopulate the colon with good bacteria to fight off C. diff. Research shows that it works about 90 percent of the time. In 2013 the Food and Drug Administration decided to allow doctors to perform the procedure in C. diff patients with diarrhea and other symptoms even after being treated with antibiotics.
Some recent reports suggesting that fecal transplants may have other benefits—including weight loss. As a result, a cottage industry of “poo practitioners” has emerged. Some people are even going the DIY route.
“That’s a terrible idea,” says Christina Surawicz, M.D., a gastroenterologist and professor at the University of Washington School of Medicine. For example, there have been reports of people developing autoimmune disorders after the procedure and even suddenly gaining weight.
Instead, if you have C. diff, look for an infectious disease doctor or gastroenterologist with experience in the procedure. The stool can come from a friend or family member, or doctors can buy frozen specimens from screened donors. Check with your insurance company to see whether it will cover fecal transplants to treat C. diff.
Yogurts we tested several years ago contained an average of 90 billion to 500 billion CFU per serving.
If you’ve been in the hospital, “assume you’ve been exposed to potentially dangerous bacteria,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. Here’s what to do when you get home to keep yourself and your family safe:
WATCH FOR WARNING SIGNS. Those include fever, diarrhea, worsening pain, or an incision site that becomes warm, red, and swollen. People at particular risk include adults 65 and older as well as infants, anyone on antibiotics, and people with a compromised immune system.
PRACTICE GOOD HYGIENE. If you or someone you live with is diagnosed with a hospital-acquired infection after being discharged from the hospital, take extra precautions to make sure that it doesn’t spread:
Clean frequently touched surfaces with 1 part bleach mixed with 10 parts water. Reserve a bathroom for the infected person. If that’s not possible, use the bleach solution to disinfect surfaces between uses.
Don’t share toiletries or towels; use paper towels rather than cloth hand towels.
IN THE HOSPITAL
CONSIDER MRSA TESTING. A nasal swab can detect low levels of MRSA and allow medical staff to take precautions, such as having you wash with a special soap before you are admitted.
INSIST ON CLEANLINESS. Ask to have your room cleaned if it looks dirty.
Bring bleach wipes for bed rails, doorknobs, and the TV remote.
Bring bleach wipes for bed rails, doorknobs, and the TV remote. Insist that everyone who enters your room wash his or her hands. Keep your own hands clean, washing regularly with soap and water.
QUESTION ANTIBIOTICS. Make sure that any anti-biotics prescribed to you in the hospital are needed and appropriate for your infection.
WATCH OUT FOR HEARTBURN DRUGS. Medications such as Nexium or Prilosec increase the risk of C. diff by reducing stomach acid that normally helps keep the bug in check. So ask whether the drug is needed and, if so, request the lowest dose for the shortest possible time.
Ask every day whether catheters, ventilators, or other tubes can be removed. The risk of infection increases the longer they are left in place.
Say no to razors. If you need to be shaved, use an electric hair remover, not a razor, because any nick can provide an opening for infection.
How to Say No to Antibiotics
On any given day in the hospital, half of patients are given an antibiotic and 25 percent get two or more, according to the CDC. But up to half of the time, doctors don’t use the drugs right. “It can feel awkward to talk to your doctor about antibiotics,” says Conan MacDougall, Pharm.D., a team leader for antibiotic stewardship at the University of California at San Francisco. But asking a few simple questions can “encourage physicians to be more thoughtful about prescribing,” MacDougall says.
What is this drug for?
If your doctor suspects a bacterial infection, ask whether you can be tested for it; results can confirm the infection and determine the type of bug, which can dictate the type of antibiotic that works best.
What type is it?
If a narrower-spectrum drug such as penicillin will work against your infection, that’s usually a better choice than a broad-spectrum drug.
How long should I take it?
Ask your doctor to prescribe the drug for the shortest time possible. (Be sure to take it for that duration.) Ask for the type and dose to be re-evaluated when test results are in. A common error, MacDougall says, is not switching from a broad-spectrum drug to a targeted one once the bug is identified.
What about side effects?
Most antibiotics are well tolerated; but in addition to C. diff, antibiotics can trigger serious allergic reactions, including rashes, swelling of the face and throat, and breathing problems. Some antibiotics have been linked to torn tendons and permanent nerve damage.