Germs and flu are up; infection control is down

Even as the threat from drug-resistant germs continues to rise and a novel swine flu virus sweeps the country, U.S. hospitals are cutting back on staff and resources to battle potentially deadly patient infections.

More than 40 percent of nearly 2,000 hospital infection workers responding to a professional association survey reported being hit by budget cuts in the past 18 months, mostly because of the troubled economy.

The result has been layoffs, reduced hours, hiring freezes and diminished ability to detect, track and manage infections that can cost money — and endanger lives, said Kathy Warye, executive director for the Washington, D.C.-based Association for Professionals in Infection Control and Epidemiology.

“If we’re cutting monitoring and surveillance and infection prevention staff, we’re cutting the muscle out of this aspect of patient safety,” said Warye, whose group conducted the survey. APIC is a group of more than 12,000 infection control and prevention staffers at acute care hospitals and other health care centers around the U.S.

The reductions are short-sighted, experts said. Every new hospital infection adds an average of $15,275 in additional costs to a patient's care, according to RID, the New York-based Committee to Reduce Infection Deaths.

Thirty-nine percent of infection control staffers who responded said they’d had layoffs or reduced hours in their departments and 35 percent had seen hiring freezes. Nearly a quarter said they’d reduced surveillance, meaning they weren’t able to look as carefully or as often for evidence of infections.

That includes detection and treatment of so-called superbugs such as methicillin-resistant staphylococcus aureus, or MRSA, and Clostridium difficile, known as C. diff, plus emerging threats from new infections.

‘More MRSA, more C. diff’
“There’s more MRSA, there’s more C. diff, we’re seeing more of the Acinetobacter,” said Suzanne Cistulli, director of infection control at O’Connor Hospital in San Jose, Calif., where she’s the sole full-time staff in her department.

Acinetobacter is a group of bacteria increasingly responsible for infections in intensive care units and healthcare settings, and increasingly resistant to most front-line antibiotics.

But hospital advocates note that infection control isn’t the only casualty of a lingering downturn. According to an American Hospital Association survey, nearly half of hospitals nationwide have cut staff and more than 40 percent expected to post losses in the first quarter of 2009, up from about a quarter a year ago.

“Hospitals are walking a tightrope, trying to balance the growing needs of their communities with today’s economic challenges,” Rich Umbdenstock, AHA president and chief executive said in an April statement.

Still, the loss of infection prevention is troubling at a time when dangerous infections are becoming more common and more virulent, said Lisa McGiffert, director of the Stop Hospital Infections program for Consumers Union, a nonprofit patient advocacy group. Hospital-associated infections cause nearly 100,000 deaths a year in the U.S. and cost around $20 billion to $30 billion, according to estimates.

“Cuts in staffing in this area reflect poor management,” said McGiffert. “It puts patients in danger.”

Just this week, researchers reported that the incidence of MRSA infections among children admitted to pediatric hospitals in the United States more than tripled between 2002 and 2007. Researchers at the Children’s Hospital of Philadelphia and the University of Pennsylvania found cases of MRSA jumped from 6.7 per 1,000 admissions in 2002 to 21.1 cases per 1,000 admissions in 2007, according to a study released online Monday in the journal Clinical Infectious Diseases.

More than half of the cases of staph infections in kids were drug-resistant, according to the scientists, who analyzed records from nearly 2 million patients admitted to 33 U.S. children’s hospitals. The median age of the kids with staph was 3 years, and 360 of the nearly 30,000 infected kids died.

Cutting infection budgets is also worrisome during a spring when infection workers have been swamped with the fallout from an epidemic of the previously unknown H1N1 swine flu virus, which has sickened more than 13,000 people in all 50 states and contributed to at least 27 deaths.

Swine flu drew long lines for the ER
At Cistulli’s hospital, more than 200 people a day flocked to the emergency department for flu screening at the peak of the outbreak. She worked 15-hour days for two weeks straight and saw the worst of her fears of coping with a potential pandemic come true.

“We had people lined up out the door, literally,” she said.

The cuts in staffing and resources are hard to understand, infection experts said, because they come just as hospital infections have gained increasing attention from politicians and the public. The federal stimulus plan, for instance, includes $50 million aimed at reducing health-care associated infections, with most going to state prevention efforts.

At least 30 states have passed laws requiring reporting of hospital infections and another six have created committees to study public reporting. While they support the transparency of reporting infections, many of the staffers responding to the APIC survey said the new mandates added to an already over-burdened workload.

The answer is for hospitals to make infection control a priority, even in difficult economic times, said McGiffert.

"These are very fundamental things," she said.

But Cistulli said that message is a hard sell, even when the math makes sense.

“If you prevent infections, you’re going to save dollars on the bottom line,” she said.

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