Hospital-Hotel Comments


I would like to thank the many people who sent comments on my last article. MDs and RNs from every region of the US corroborated the magnitude of the hospital infection problem, and expressed their own sense of frustration in dealing with it. People sent their personal horror stories experienced in the US, Britain, Scotland, and Australia. Considering all the hype about Bird Flu, the relative silence in the media about a real epidemic growing in our hospitals is a mystery.

I discovered from my readers that in the three years since I retired the infection problem has gone from bad to horrendous. The old hard-nosed nurses and technicians, like me, are mostly gone, and there seems to be a kind of deer-in-headlights paralysis in the system. True, administration is the Green Zone of hospitals, but even they must be getting nervous. Can it be fixed? I think so.

A reader sent this. It’s about a chlorine-based disinfectant. Oh my, back to the future. A doctor thought that hospitals could no longer be disinfected. Wrong. This kills everything, but only on hard surfaces. Out with the carpets, drapes, and upholstery. I checked with my friendly Haz Mat pro and fire chief. Yes, they could do it, and Homeland Security (sic) might pay for it. So rip out the fabric, saturate the place with 10% bleach, and start over.

Sadly, I don’t think that’s about to happen. As in Iraq and Afghanistan, the people in charge will continue to spin fantasies and pretend that everything is under control when it clearly is not. A curious person could examine JCAHO, the quasi-private organization that "accredits" hospitals every three years, to see if they’re part of the problem. Look for their seal of approval in the lobby of any hospital. The present epidemic occurred on their watch, so they share the blame for it. But what is it that they do?

Here my experience fails me. My boss always made sure I was off duty when the inspection team came calling. We did have their requirements in the office, however, and I read them (five pounds of documents), and I compared them with our standard procedures (another five pounds). Evidently, the inspectors did too, or at least they wanted to verify that the documents were there. Documents matter to bureaucrats.

I gathered that the inspectors spent a great deal of time reviewing patient charts, randomly chosen, to ensure compliance with their rules. Consequently the staff had to endure an attorney’s lecture on charting every year or so. The bottom line was always the same. It didn’t matter what you did or what actually happened, what mattered was what you wrote in the chart. If there is an easier way to intimidate or terrorize a medical professional, I can’t think of it. You are creating a "legal" record that can be used against you in a court of "law." In this environment unpleasant facts are stuffed under a contaminated rug. The intellectual process of suppressing the truth becomes a habit after a while. Maybe reality will go away if we ignore it.

But this nightmare is not going to magically vanish by ignoring it. We made it happen, and we can fix it, but another five pounds of documents will not do the job. Only confronting the problem head-on and appropriately applying effective infection control procedures will work. Significantly, I have not heard from any person in hospital administration or on a hospital board of directors. Sure, maybe none of them read LRC or receive email referrals, but I doubt it. They would ask, is this guy a threat? Nope. End of story. No comment.