From the November 29, 2007 Wall Street Journal
December 4, 2007
by Betsy McCaughey
Last month, health inspectors in New York City shut down Serendipity, an upscale ice cream parlor. Though the closing made headlines, it is a common occurrence for less-famous eateries charged with violations like unclean cutting boards and floors, workers who fail to clean their hands, and improper food handling that could lead to bacterial contamination.
Restaurants in New York are inspected, without prior notice, once a year. In Los Angeles, inspections are done three times a year, and restaurants must display their grade near the front door. After L.A. instituted this inspection system in 1998, the number of people sickened by food-borne illnesses fell 13%, according to the Journal of Environmental Health. Other cities are now following L.A.'s lead.
Why aren't hospitals held to the same rigorous standard? The consequences of inadequate hygiene are far deadlier in hospitals than in restaurants. The Centers for Disease Control and Prevention estimate that 2,500 people die each year after picking up a food-borne illness in a restaurant or prepared food store. Forty times that number -- 100,000 people -- die each year, according to the CDC, from infections contracted in health-care facilities.
Data recently published by the Journal of the American Medical Association show that infections from just one type of bacteria -- methicillin-resistant Staphylococcus aureus (MRSA) -- kill about twice as many people in the U.S. as previously thought. The finding is based on lab tests, not on what hospitals report. If the same methodology were used to quantify deaths from all hospital infections, the death toll would likely be much larger than 100,000.
These infections are caused largely by unclean hands, inadequately cleaned equipment and contaminated clothing that allow bacteria to spread from patient to patient. In a study released in April, Boston University researchers examining 49 operating rooms at four New England hospitals found that more than half the objects that should have been disinfected were overlooked by cleaners.
Hospitals used to routinely test surfaces for bacteria, but in 1970 the CDC and the American Hospital Association advised them to stop, saying testing was unnecessary. The CDC still adheres to that position despite a 32-fold increase in MRSA infections. CDC officials say that lab capacity should be reserved for tests on patients.
Testing surfaces is so simple and inexpensive that it's used routinely in the food industry. Is it more important to test for bacteria in meat processing plants than in operating rooms?
The organization that accredits most hospitals, the Joint Commission, usually visits a hospital every three years. The commission emphasizes hand hygiene, but that's not enough. As long as hospitals are inadequately cleaned, doctors' and nurses' hands will become recontaminated seconds after they are washed, whenever they touch a bacteria-laden surface.
Joint Commission accreditation is no guarantee that a hospital is sanitary. An April 2007 study showed that 25% of California hospitals deemed unsanitary by state investigators responding to complaints had been accredited by the Joint Commission within the previous year.
Physicians' offices are not inspected at all. Most physicians are required to take a yearly course on infection precautions, but there is no follow-up to ensure they adhere to them or maintain clean offices. Patients' privacy concerns and cost issues may stand in the way of regularly inspecting doctors' offices, but when serious hygiene infractions are suspected, state health authorities should act decisively. In many states, health departments and state medical boards are under criticism for putting a physician's livelihood ahead of patient safety.
It was serendipitous that a Nassau County, N.Y., health official noticed cases of Hepatitis C and called for an investigation of Dr. Harvey Finkelstein, a Long Island doctor. Dr. Finkelstein allegedly was reusing syringes, contrary to universal precautions, and injected patients with contaminated medications.
According to news reports, one of Dr. Finkelstein's patients is confirmed to have been infected with Hepatitis C, an incurable virus. Over a thousand other patients have been notified by health officials that they could be at risk for Hepatitis C and HIV.
The New York State Department of Health called Dr. Finkelstein's reuse of syringes a "correctable error," and is allowing him to continue to practice under observation.
"Correctable?" Not for the 53-year-old patient infected with Hepatitis C or the many other patients dreading the results of their blood tests. Restaurants are closed for far less.
Betsy McCaughey is an adjunct fellow of Hudson Institute. She is a patient advocate and founder of the Committee to Reduce Infection Deaths and former Lt. Governor of New York State.
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