Blog dedicated primarily to randomly selected news items; comments reflecting personal perceptions

Sunday, January 25, 2015

In-Hospital Pathogens

"You could sit and call every hospital in the country, and ask them when was the last time they cleaned the sink in the [neonatal intensive care unit] and how they cleaned it, and you'd get nothing but blank stares."
"It's just totally loosey-goosey."
Darrell Horn, patient-safety investigator, Winnipeg Region Health Authority

"She kept yelling at me, 'I know my body, I know there's something wrong in my stomach and nobody wants to listen to me. And I'm going to end up dying here'."
"She died the most horrible, painful death anybody could suffer, and nobody would listen to her and reach out to her."
Kym Dyck, Kim Smith's sister-in-law
Brenda Dyck, the sister in-law of Kim Smith holds her portrait as her father, Gord Smith and brother Trevor Smith look on in her Winnipeg, Manitoba home. Kim Smith, went to hospital last year for an elective hysterectomy, the surgical wound became infected and she ended up dying in agony days later from necrotizing fasciitis - flesh eating disease.
Lyle Stafford for National Post    Brenda Dyck, the sister in-law of Kim Smith holds her portrait as her father, Gord Smith and brother Trevor Smith look on in her Winnipeg, Manitoba home.
"Nurse found her confused, half-naked, pulled her IV out, anxious. Saying she is at her end and is suicidal."
Kim Smith's hospital patient chart

"There is no question that at a national level, both our surveillance for hospital-acquired infection and our surveillance for anti-microbial resistance is not serving our needs. [And] we know, very substantially, that you can't fix what you're not measuring."
Allison McGeer, infectious-disease specialist, Mount Sinai Hospital, Toronto
Roughly 8,000 Canadians annually die from pathogens they have become infected with during a hospital stay. Infections cause many more to have a prolonged hospital stay, and their illness deleteriously impacted by the onset of an infection. Millions have been spent on combating the scourge of hospital-acquired pathogens, all of it with the intention of making hospitals safer places for patients, but the problem remains and its extent has not been properly quantified.

The rates of sepsis (blood infection) is now published by a federal agency when they occur at individual hospitals, but the value of the gathering statistics is questionable. As is the tracking of drug-resistant bacteria by government; since the data-gathering is not universal and thus of questionable practical use, according to infectious disease physicians.

Clearly Canada's health-care system needs a boost in ensuring that hospitals maintain rosters of adverse effects to be shared within and across the provincial hospital systems, to alert one another and to share best-practise hygiene protocols to combat the problems. The spotlight has, however, been turned on hospital acquired infections now with greater awareness of the problems involved than in the past, in lock-step with the rise in drug-resistant pathogens.

Kim Smith entered Winnipeg's St.Boniface Hospital to undergo elective surgery for a routine hysterectomy and ovary removal. Post-surgery she began complaining of escalating pain in her gut, intense enough to bring her to fear for her life. Finally, she wanted to end her life. It took time for medical staff to take her complaints seriously, and it was discovered an infection in her stomach had turned into necrotizing fasciitis which had eaten away at a chunk of her abdomen.

The medical staff had originally been of the opinion that her anxious state was responsible for prolonging her recovery. Until her brother Trevor Smith, sitting beside her in the hospital twelve hours after the sedative Ativan had been administered, noticed that there was a strange purple discolouring on his sister's feet. He raised an alarm, leading to his sister being taken into the operating room where "a large effluent of brown, foul-smelling liquid from the abdominal cavity" was noted.

Several abscesses were removed by the surgeons, the liquid was drained and then it was discovered that necrotizing fasciitis had expanded through the peritoneum (abdomen lining) and abdominal muscles. "What I witnessed, I was traumatized by for months and months", said Kym Dyck. "It was just a terrible, terrible, painful death. And she knew she was going to die, that's the worst thing."

After her sister-in-law's horrible death, Ms. Dyck said a doctor informed her that surgical staff had likely not disinfected her sister-in-law's stomach before the hysterectomy was undertaken. To ensure that any bacteria that came with Kim Smith into the operating room -- bacteria that most people carry around with them, on them -- stayed on the outside, proper preparation meant to prevent that bacteria from infecting the patient's interior viscera had to be ensured.

But the bacteria did intrude, leading to an infection, so that the day following her operation Kim Smith complained of pain in her abdomen. She would be unaware that surgical-wound infections arise often from bacteria that patients carry into hospital on their skin, which if able to get inside the body through incisions can cause a catastrophe such as she experienced. When she complained of pain nurses -- who presumably would have been aware of such a possibility told her she needed to walk around.

By the time doctors realized that she did indeed have a very serious infection and took her in for emergency surgery it became evident that little could be done to save her. Once begun, necrotizing fasciitis has a 70% death rate-occurrence. Her blood pressure by the following morning had sunk, more dead tissue had spread around her side to her back, and she went into cardiac arrest. Death was only minutes away.

And her sister-in-law recalls the sight of doctors and nurses desperately trying to revive her sister-in-law, fruitlessly; the sight of her sister-in-law's open abdomen as part of the treatment of the flesh-eating infection, haunting her memory.

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