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About Street roots. (Portland, OR) 1998-current | View Entire Issue (March 16, 2012)
9 Street roots March 16, 2012 EPIDEM IC, fro m page 8 enough of them, and because we don’t take enough time, (we’re) not killing germs. There is a study in Britain that came out six months ago that shows if you hire one extra housekeeper, on a Monday-to-Friday shift, you reduce the amount of hospital acquired infections by 38 percent. I was in the hospital taking care of a friend last week, at Virginia Mason. On her ward, the (nurse-to- patient-ratio seemed high). We’re supposed to have a ratio bill in this state, but it’s not being applied. (The Nurse Staffing Law, passed by the state legislature in 2008, requires hospitals to develop a nursing staff plan for each unit and shift.) The third systemic cause would be shift work: health care workers working too many hours. After a certain amount of hours you lose your cognitive ability, your rational thought. And on a shift in any health care institution, you need your cognitive ability. You need your rational thought. Yet we still are working too many hours because we don’t want to hire enough people to do the job. The fourth, health care working conditions. Health care workers are working under too much stress, under conditions that are not ergonomically suitable. One out of 10 health care workers applies for workers’ compensation every year. And when you injure a health care worker, you have a downstream negative patient effect. Bullying is huge. R.R.: W/zew you say bullying, I think, “Don’t bully people in school.” W.C.: Well, one form is being dressed down by your superior, being yelled at, being ganged up on by your peers. It’s very similar to bullying in the schoolyard. The studies show that it lowers cognitive capacity. Doctors dressing down nurses, nursing supervisors dressing down nurses, nurses dressing down licensed (practical) nurses or orderlies. There’s a pecking order in hospitals, a class system that’s very clear. But each time a health care worker gets bullied, they lose their ability to do their job. We can’t get health care workers to wash their hands when they come out of the bathroom. Systems are not being accountable through the basics of health care delivery and infection control. R.R.: But there are always those signs that say, “Employees must wash hands. ” W.C.: They don’t do it. There’s no peer pressure. There was just an article in The New York Times, where during operations, doctors have their cell phones in the OR (“As Doctors Use More Devices, Potential for Distraction Grows,” NY Times, Dec. 14, 2011). And during an operation, they’re making calls to their travel agents to book vacations. Nurses were doing the same thing. So there’s a lack of accountability. R.R.: One of the hot topics a couple years ago was MRSA (Methicillin-resistant Staphylococcus aureus) How’s MRSA tied into this? W.C.: MRSA is a bacterium, and it becomes a problem when health care workers and hospitals aren’t diligent enough to prevent transmission, either from a patient or a surface in the hospital, which has not been cleaned properly to eradicate the MRSA. Then they touch another patient who’s immuno-compromised. Most people in the hospitals are immune compromised. The germs, the bacteria, the viruses, the pathogen will spread. And they’ll spread because the basic infection control paradigms are not being rigidly enforced. So MRSA — Methicillin-resistant Staphylococcus aureus - has been killing patients for years now in hospitals. These are not easy bugs to kill. You can, if you clean properly. In America we don’t know how to clean hospitals. We’re letting the housekeeper in a room for 20 minutes or 15 minutes or 10 minutes, and then they gotta go to the next room. That’s not enough time. They’re not using the right kinds of products that actually kill them. We don’t understand survival times of these germs, these pathogens. We’re not cleaning nursing stations where they can accumulate. You know, about 100,000 people are dying every year of hospital-acquired infections and MRSA is one of them. Not the only one, but certainly one. numbers game because Europe may be counting differently than the U.S. is counting. And that’s one of the big problems we have: In 27 states in the U.S. — Washington is one of them — we have laws that say they have to report medical errors. Twenty-three states don’t have rules. But we don’t know how they’re counting, we don’t know what they’re calling a medical error or what they’re not. There’s no standardization of approach of epidemiology, which tells you events that are supposed to be reported. We don’t really have a mathematical way of comparing the numbers. R.R.: This might sound a little naïve, but hospitals are projected as this place where you go to get better. But I know so many people who are terrified to go into a hospital. W.C.: Well, we have to keep in mind the same hospital, theoretically. W.C.: Well, in terms of social approach to medicine, the U.S. is behind Brazil and a lot of other third world countries, second world countries, in how we apply the umbrella of medicine. And certainly, people of color, people of poverty, receive the lowest amount of any type of intervention than people who are more able to pay for whatever intervention they are trying to receive. And that’s true in medicine. If you go into the same hospital and you’re black and you have no insurance, you’re going to get a certain quality of care. I R.R.: Why did you Somebody has to radicalize mean, they’ll deny start researching this this ’til they’re blue the process, somebody's data? gotta get out there and shout in the face, but that’s what the data shows: W.C.: Well I from the rooftops and the that you will not get became horrified the same care as when I saw the data. I treetops that this is somebody who is untenable» Änd patients, got angry. I know so fully insured. You many people who, in especially patients of color, may get fewer tests, my own life, have poor patients — we're k illin g you may get fewer sustained a medical 134,000 Medicare patients a interventions, you error, who will never be the same. And the year in this country through may get less personal care. The metrics of more I researched it, medical error. the care become the more I realized lower for people who there was an have less money or epidemic. (Then) I are people of color. realized that the people who are in charge of fixing it are also R.R.: Earlier you mentioned someone needs the people in charge of breaking it. And to radicalize (health care). Let’s say you’re that that’s a relationship that never works. It just radical individual. What do you decide to do? never works. The Society for Actuaries, which is a W.C.: One of the things I’ve decided to do national society that actually counts money, is publish this book. It’s a conversation says — and this is a very low figure — we’re changer, because we’re saying that (medical spending $20 billion a year on medical errors. So if you take the number of hospital errors are) the leading cause of death. And nobody knows that. I mean, Americans are beds we have in this country, which are dumbed down in practically every category about 1 million, and you divide those numbers — $20 billion by 1 million — you get you can think of at this particular moment d en o m in ato r. T h e n u m b e r of c a se s th e y tr e a t a re in th e billions; n u m b e r of p eo p le $ 2 0 ,0 0 0 p e r b e d th a t w e ’re sp e n d in g on m ed ical e rro rs . E v en b efo re a p a tie n t is p u t in h isto ry , w h ich is o n e of th e re a s o n s th e e m p ire is declining. Some people see that they harm are in the millions. They’re only harming about maybe a third or more patients, according to some studies. One out of three has an adverse affect, according to Health Science, which is a journal that’s published. So you justify the epidemic in terms of the good that they do to two-thirds of the population that they don’t harm. However, when you look at the number of fatalities and the number of people they hurt, but don’t kill, it’s really becomes an epidemic of harm. in the bed. And nobody’s taking responsibility for that kind of cost. I mean, we can’t afford to insure 50 million people in this country, and there’s millions of others who are under-insured, who are making medical decisions because they can t afford it. Somebody has to radicalize the process, somebody’s got to get out there and shout from the rooftops and the treetops that this is untenable. And patients, especially patients of color, poor patients - we’re killing 134,000 Medicare patients a year in this country through medical error. as a good thing and some people don’t. But in health care it’s never a good thing. So, we want to change the conversation. We want to change how we approach this. The second thing is we’re gonna try and create a North American alliance and social movement around trying to create the change. If every state had a law, every hospital had to apply a ratios bill - like Kaiser (Permanente), in California, which is a big HMO. They’re doing it voluntarily, their rates have really come down. They’re a leader in this field. So we’re gonna introduce legislation. And we’re gonna try to get people angry. Because hospitals are literally getting away with murder. R.R.: Is there somewhere where the harm isn’t as extreme? W.C.: I think European hospitals tend to have lower medical error rates. Scandinavian hospitals have lower rates. That’s a guess on my part. I’ve seen some comparable data. But we don’t want to turn this into a R.R.: So many statistics point to how people of color, poor people, are adversely impacted in law enforcement, educational opportunities, unemployment. So how does it happen with medical errors? How would it be any different, if I were black or poor, that I might undergo more medical errors? I mean, we’re in the Rosette Royale is the assistant editor for Real Change News, Street Roots sister paper in Seattle, Wash. Reprinted from Real Change News. Non and Under Reporting: There are 27 states in the U.S. with reporting regulations and none in Canada. Accountability: Studies have shown directly to medical errors, in 115 studies included in a 2003 review, working conditions affect patient safety, the rate of even„ hands'"between patients or after leaving medication errors and the rate of recognition of such errors after they occur. low compliance rates bathrooms is not Technology: Smart technologies in health care are being designed to intervene in administration errors. But according to a recent study, 98,000 people end up in emergency rooms every year (mostly elderly) due to medication error. dangerous shortcuts. Specifically, 84 percent of MDs and 62 percent of RNs and other clinical care-providers had seen coworkers taking shortcuts that could be Cost-Benefit Analysis: The Society of Actuaries has stated that medical errors are costing $20 billion a year. Bedsores || P H O T O B Y R O BER T H A R W 1 G alone account for a cost of $3.9 billion annually. The cost per patient of medical error can be as high as $20,000 per bed (using the American Hospital Association’s data of 1 million hospital beds in the U.S.).
