Hospital Infection Problem Persists - NY Times

[sfpcjock]

http://www.nytimes.com/2010/04/14/us/14infect.html?src=tptw">Hospital Infection Problem Persists

By KEVIN SACK
Published: April 13, 2010

The nagging and largely solvable problem of hospital-acquired infections remains as resistant to cure as the germs that contribute to an estimated 100,000 deaths a year, according to an annual government study issued Tuesday.

Despite a renewed focus on prevention and threats of governmental sanctions, hospitals continue to see increased rates of post-operative bloodstream infections and catheter-associated urinary tract infections, the Agency for Healthcare Research and Quality reported. The rates increased by 8 percent for bloodstream infections and 4 percent for urinary tract infections over the year before.

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[global1]

1. With The Potential For 30 Million More People Getting Health Insurance......

that means that hospitals should become busier places and the consequences of a hospital acquired infection will be much greater. It will be incumbent for hospitals to do everything in their power to minimize or eliminate hospital acquired infections. This article mentions that in fiscal year 2015 that hospitals will be penalized if they have a high infection rate. That is the stick that hopefully gets them to take this seriously and do everything they can for infection control/prevention.

[tiptoe]

29. "...do everything they can for infection control/prevention." Anyone can take care, like Kaiser

voluntarily began doing for its health plan members in 2009 as part of standard medical checkups (while other health plans "pass the buck" until/unless medically necessary), to test Vitamin D status for discovery of need for boosting innate immune systems of its members, if necessary, through supplementation.

Kaiser probably didn't initiate this policy for the benefit of its health plan members out of the "goodness of its corporate heart", but likely because of a study for Western Europe showing a 19-1 ROI from estimated savings in the cost of the burden of disease through elevation of vitamin D status for preventing incidence of a multitude of diseases -- cancers (colon, breast, ovarian, kidney, Non-Hodgkins lymphoma...), Type I diabetes, MS, heart attacks, fractures, falls...

The CDC -- with researchers tied to influenza industry $$$ interests -- address only adaptive immunity, as if the human innate immune system were merely an afterthought. Kaiser, through medical research over the last 12 years, has learned differently and makes investment in vitamin d status testing and likely supplementation for boosting of its members' innate immune systems to optimal levels...in order to save $$$ in its end-to-end health system operations.

Vitamin D's active metabolite, a secosteroid hormone, calcitriol,: Anti-viral, anti-fungal, and, now hypothesized, broad-spectrum anti-biotic.

The Vitamin D Newsletter June/July 2006
Is Vitamin D An Antibiotic?

Antimicrobial Peptides

Dr. Liu and colleagues at UCLA, publishing in this March's edition of the prestigious journal Science, showed that vitamin D might be, in effect, a potent antibiotic. Vitamin D increases the body's production of naturally occurring antibiotics: antimicrobial peptides. Antimicrobial peptides are produced in numerous cells in the human body where they directly and rapidly destroy the cell walls of viruses and bacteria, including tuberculosis. Furthermore, Liu showed that adding vitamin D to African American serum (African Americans have higher rates of TB) dramatically increased production of these naturally occurring antibiotics.   (Liu PT, Stenger S, Li H, Wenzel L, Tan BH, Krutzik SR, Ochoa MT, Schauber J, Wu K, Meinken C, Kamen DL, Wagner M, Bals R, Steinmeyer A, Zugel U, Gallo RL, Eisenberg D, Hewison M, Hollis BW, Adams JS, Bloom BR, Modlin RLToll-like receptor triggering of a vitamin D-mediated human antimicrobial response. Science, 2006 Mar 24;311(5768):1770–3).

Plenty of you have e-mailed me that pharmacological doses (high doses) of vitamin D (1,000–2,000 units/kg per day for three days), taken at the first sign of influenza, effectively reduces the severity of symptoms. However, has anyone ever studied giving 100,000, 200,000, or 300,000 units a day for several days to see if vitamin D induces antimicrobial peptides to help fight other life-threatening infections? (By the way, doses up to 600,000 units as a single dose are routinely used in Europe as "Stoss" therapy to prevent vitamin D deficiency and have repeatedly been shown to be safe for short-term administration.) No, you say, studies of "Stoss" therapy in serious infections have never been studied or reported in reputable journals. Well, maybe such treatment has been studied—and reported in the best journals—by way of the weirdest medical invention ever patented in the USA.
...
Actually, if I had a serious infection, I wouldn't hesitate to take 200,000 units of vitamin D a day for 3 days ...
[i.e. 2000 IU D3 per kg of author's body weight]
...

John Cannell, MD

(Link to Vitamin D material below.)

[bemildred]

2. So, what this is saying, is going to the hospital is likely to make you really sick, if not dead. nt

[trotsky]

3. Oh, absolutely.

You'd be far better off just staying at home and using leeches. :eyes:

[bemildred]

4. What this says is that sometimes that is true.

Deal with it.

[trotsky]

5. LOL

No, it doesn't, but you go right on with your crusade.

[bemildred]

6. Denial is not just a river in Egypt.

If you get medical care for some non-life-threatening illness and wind up dead or very sick you are worse off, and that happens a lot, and that is what the OP says, among other things.

[trotsky]

7. And an understanding of statistics and risk is seriously lacking in America today.

Among other things.

[bemildred]

8. I have degrees in Math and Computer Science, I understand statistics just fine. nt

[trotsky]

9. Clearly you don't.

Your quote: "going to the hospital is likely to make you really sick, if not dead"

Define "likely," and show your statistical reasoning to justify the use of that word. A good start would be to look at the total number of hospitalizations and compare it to 100,000 deaths from resistant infections. I'm really curious to see how "likely" can be applied to that ratio. Thanks.

[bemildred]

10. It happened to my brother twice, one year apart.

Septicemia from a PIC line. They pulled him through both times too, but we had to "encourage" them a bit. He is not the only one either. If my views about hospital care seem a bit jaundiced to you, it's not for no reason.

[trotsky]

12. I am sorry for your brother, but that is an anecdote, not statistics.

Are you backing away from your "likely" claim?

[bemildred]

13. "Likely" is not a statistical claim.

It is an informal term for something like "with a substantial probability", and the OP does indeed say that this sort of thing happens "a lot". It is you that is confused about statistics.

[trotsky]

16. OK then, define "substantial probability" and show how the numbers back that up.

I don't know why you are changing terms and moving goalposts. Well actually, I do know why, I just want you to admit it instead of getting angrier at me.

[bemildred]

18. It is not a statistical term.

You can find the meaning of "substantial" and "probability" in any dictionary.

[bemildred]

19. PS: if you go look up "probability" you will sooner or later run into "likely" or "likelihood". nt

[trotsky]

20. So you give up then, huh?

Too bad.

[HuckleB]

31. Here.

Let me buy you a beer. You deserve one.

:toast: :beer:

[trotsky]

36. LOL

Gonna take a lot more than one this time. :crazy:

[bemildred]

14. Doesn't 100,000 deaths a year seem like "a lot" to you?

Or is that just the breaks?

[trotsky]

15. Of course it does, and it is terribly nasty of you to insinuate I don't care about human life.

I guess you're just mad that you can't back up what you claimed. No reason to take it out on me.

[bemildred]

17. Yeah, we sure would not want to be nasty would we?

You are just Mary Poppins and everyone picks on you.

[trotsky]

21. All I did was ask you to back up what you said.

You have steadfastly refused, and in fact, gotten increasingly more angry and combative as it becomes more obvious that you simply misspoke, but for whatever reason, cannot admit it.

[bemildred]

22. All I did was point out a seemingly minor deficiency in your English skills.

And an apparent misperception as to what statistics is.

[trotsky]

23. I'm going to try and pull this back from your personal attack spiral one last time.

You said, and I quote once again: "going to the hospital is likely to make you really sick, if not dead"

All I've wanted to know is, how likely? Since you have steadfastly refused to take a look at the numbers, and instead just ratcheted up your attacks on me, I'll do just a tiny bit of math for you.

According to the CDC, there were just under 35 million inpatient hospital discharges in 2006. A fair comparison would look at the number of incidents of resistant bacteria deaths from that year, but let's go nuts and use this latest number: 100,000.

So roughly, your chances of dying from a resistant infection when being hospitalized is less than 0.3%. (If you really want to go nuts, you could add in the outpatient visits and ER care to push your chances even LOWER.)

Please put aside your viciousness for just a moment and answer this question: Is that "likely?"

What definition of "likely" are YOU using?

Plain and simple, I don't like it when people engage in unwarranted fearmongering. That's what your initial post did. I await your next attack.

[bemildred]

24. I assume you know that not every such infection leads to death?

One would hope that only a small number would.

The OP talks about "hospitals with high rates of infections", why don't you take it up with them? Argue with them about what "high rates" means and whether it means "too likely to occur".

And do continue your struggle to withdraw from this discussion, I can support you fully in that.

[trotsky]

25. So you admit that you didn't know the numbers at all?

And therefore your claim that it was "likely" was all bullshit?

At last. An admission. Thank you.

[bemildred]

26. Well, I must say I envy your vivid imagination.

[trotsky]

27. Sure, I'll take that as your concession.

Peace to you.

[bemildred]

28. Dang, here I thought it was more "viciousness". nt

[bemildred]

11. Very expensive too ... nt

[HuckleB]

30. And I'm the reincarnation of Paracelsus.

:rofl:

[bemildred]

32. Whom is it you want to insult?

http://en.wikipedia.org/wiki/Paracelsus

[HuckleB]

33. Oh, my goodness.

It keep getting better!

:rofl:

[bemildred]

34. Well, heck, have some more.

:rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl::rofl:

[bemildred]

35. There are no statistics involved here.

No sampling methodology, no hypothesis, no population being studied. What we have is a statement that 100,000 people die every year in the USA because of infections they picked up in the hospital. That is a fact, or a factoid, or a result of data collection, or a reporting procedure, but it is not a statistic, and it means that you can die because you went into the hospital. It does not mean one ought not go into the hospital, but it is something that one ought to keep in mind when considering that question.

[Celebration]

37. Yup

The terminology in all this is irrelevant. There are people with minor problems that go into hospitals, and come out with major problems. Not everyone, and not most, but enough of them that it makes you think twice. I think hospitals should all be required to publish their internal statistics on infection rates.

[trotsky]

38. "Not most" means it's not likely.

Thank you for agreeing with me.

[bemildred]

39. This reminds me of Semmelweis.

Especially the posters insulting everyone that brings it up and torturing English and Math and what other people say to do it. People are dying and being injured, and the attitude is "La de da de da, how dare you question us?" Half as many people are killed driving but nobody insults you for saying you need to be careful about driving, it can be dangerous to drive.
:puke:

http://en.wikipedia.org/wiki/Ignaz_Semmelweis

[trotsky]

40. It's called being concerned about accuracy.

It is just as irresponsible to run around screaming that people are "likely" to get a deadly infection from a hospital visit as it is to scream that Obama is gonna set up death panels. Exaggerating in order to make a point is harmful to debate and dialog. We're better than the Teabaggers, aren't we? (Side note: It's also irresponsible to accuse others of not caring that people die.)

[bemildred]

41. Stick with that line of "debate", it's a real winner. nt

[trotsky]

42. Do you care about using accurate facts?

Or do you want to continue down the path of attacking someone who actually AGREES with the notion that resistant infections are a problem, but who thinks that misrepresenting/exaggerating/misstating the problem hurts more than helps the fight against them?

Your choice here.