Bugs could leave them needing a longer stay or extra treatment
UP TO one in seven hospital patients in Singapore picks up an infection on the ward, doctors say. The bugs leave them needing extra treatment or longer stays, and sometimes even prove fatal. They also hurt patients financially. About half of those with severe infections catch “antimicrobial- resistant” strains that have the power to resist multiple drugs, a recently published study shows. It means they could end up paying around $150 to $200 a day for medication, or thousands of dollars more for their treatment. “Antimicrobial infections are becoming ever more important,” said the study’s principal author, Dr Hsu Li Yang. His research quoted international figures showing that between 5 per cent and 15 per cent of hospital patients catch infections during their stay.
According to the World Health Organisation, those in South-east Asia are at the upper end of the range. Dr Hsu’s study was carried out at the Singapore General Hospital and Tan Tock Seng Hospital. It found 675 patients with blood infected by hospital-acquired bugs between January 2007 and July 2009. One in six of them died. Patients who caught the drug-resistant infections were no more likely to die than those with the other types. However, they ended up staying in hospital for about six days longer, and paid far more for their treatment. Their median bill was $8,639 higher than if they had been infected by a normal bug. In some cases, they might need to be on antibiotics for as long as six weeks, said Dr Hsu, director of the Centre for Infectious Disease Epidemiology and Research at the Saw Swee Hock School of Public Health.
By contrast, those who catch non-drug-resistant infections face a lighter financial burden, with medication costing around $10 to $15 a day. The study looked only at gram-negative bacteria, which account for more than two-thirds of hospital-acquired infections. It did not include the superbug that causes the most harm on the wards – Methicillin-resistant Staphylococcus aureus, more commonly known as MRSA. Some of its results were published last month in the journal of the Singapore Academy of Medicine. Dr Hsu, a consultant at the National University Hospital, said he became interested in the bugs because he sees so many of them in the course of his work. He started researching this subject about eight years ago and has published a number of papers, including one on how hospital-acquired MRSA adds to health-care costs. It found that those who catch the superbug end up staying in hospital 25 days longer than other patients and paying about $20,000 more.
People get infected in different ways. For example, bugs can move into the body on the outside of canulas and catheters which are inserted into the patient to drain fluid or for intravenous feeds. Dr Hsu said most infections are caused by poor hand hygiene, with health-care workers carrying them from one patient to another. They can also be passed by visitors and patients themselves. The bugs can survive for several days on surfaces such as beds and cupboards. These therefore need to be cleaned properly to avoid infecting the next patient. “Preventing such infections will result in substantial improvements in patient outcomes and health-care delivery,” said Dr Hsu.
Hospitals here have been trying to tackle the problem by encouraging staff to wash their hands and placing alcohol cleaners on the wards and in long corridors for employees, visitors and patients to use. To curb the increase in multi- drug-resistant bugs, public hospitals have also set up antimicrobial stewardship programmes. These aim to avoid using too many antibiotics, which is thought to be the prime reason for bugs becoming resistant.
Bugs now more resistant to antibiotics
HOSPITALS in Scandinavia and Australia appear to have fewer hospital-acquired infections than those in the United States and Asia. But all hospitals harbour bacteria that can be passed on to susceptible patients. Those that are a hive of bugs would see as many as one in six or seven patients, or around 15 per cent, picking up a bug and getting more sick while being warded. The rate of hospital-acquired infection in “cleaner” hospitals is about one in 20 patients, or about 5 per cent. Dr Hsu Li Yang, director of the Centre for Infectious Disease Epidemiology and Research at the Saw Swee Hock School of Public Health, said most hospitals with lower rates of infection usually have fewer patients in a room.
Another possibility, he added, was the lower use of antibiotics at these hospitals. This reduces the ability of the bugs to gain immunity against the drugs. A study of 55 hospitals in 14 countries by the World Health Organisation (WHO) a decade ago found the highest frequency of hospital-acquired infections in Eastern Mediterranean and South-east Asian countries. Such infections led to higher costs, largely because patients stayed an average of eight days longer, it found.
Over the past decade, hospital bugs have become increasingly resistant to common antibiotics. Such resistance “is becoming more dangerous and urgent”, said WHO, which declared a war against the increasing resistance of germs to drugs last year with the slogan “No action today, no cure tomorrow”. One Dutch hospital initiated a search-and-destroy policy against the superbug Methicillin- resistant Staphylococcus aureus (MRSA). It had one full-time infection control doctor and all patients identified with the superbug were housed in isolation rooms. This cost the hospital ¤215,599 a year between 2001 and 2006. But it concluded that the practice “saves money and lives” as it cut hospital-acquired MRSA by 36 cases a year and saved 10 lives. Treating these people would have cost the hospital almost double what it spent.