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The Latest, Greatest Tools for Health Care Reform: Soap, and Fewer Drugs

Mary Catherine O'Connor | Wednesday January 13th, 2010 | 0 Comments

In recent history, hospitals have become increasingly successful at making people sick—or worse. Studies show that each year, 100,000 Americans die from medical mistakes, and that healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. But, as NPR’s health blog recently reported, two recent reports show that following some pretty basic practices can prevent infections and save lives.

These low-tech answers include bathing patients before surgery and swabbing their noses with antibiotic ointment. One of the studies found that “when doctors clean the area on the patient’s body where surgery will be performed with chlorexidine, an antiseptic, their patients get 40 percent fewer infections than those cleaned with iodine, another antiseptic.”

Getting in the habit of hand-washing (and in doing so, taking their own advice) will also go a long way toward enabling health care providers to better heal patients. In fact, NPR reports that Peter Pronovost, a Johns Hopkins professor, earned a 2008 MacArthur Fellowship just for devising a simple five-point, pre-surgery to-to list that includes, believe it or not, washing one’s hands. (Perhaps I’ve watched too many episodes of MASH, but I thought that step was pretty well ingrained in surgeons’ minds…)

But there’s another act to which health care providers have become–perhaps wrongly—habituated: dosing patients with antibiotics to keep infection at bay. To wit, recent news reports show that in Norway, cutting back on the amount of antibiotics used to treat patients has led to its ability to Methicillin-resistant Staphylococcus aureus (MRSA), a strain of Staphylococcus aureus bacteria that resists many antibiotics, including penicillins and the cephalosporins.

This AP story from December 31 details Norway’s approach—which, in a nutshell, entails prescribing significantly fewer antibiotics than patients are likely to receive in other countries and then isolating patients that do develop serious infections due to bacteria such as MRSA.

Reports the AP:

In Norway, MRSA has accounted for less than 1 percent of staph infections for years. That compares to 80 percent in Japan, the world leader in MRSA; 44 percent in Israel; and 38 percent in Greece.

And it’s not just MRSA that Norway has been successfully dodging—it’s also been avoiding the high costs of treating it. “In the U.S., cases have soared and MRSA cost $6 billion last year,” the AP reported. “Rates have gone up from 2 percent in 1974 to 63 percent in 2004.”

So does this mean that when it comes to avoiding infections in a low-cost, sustainable way, Norway is on the right track? Physicians and researchers around the world who have followed Norway’s lead in outlawing specific antibiotics known to be linked to MRSA (as well as using isolation and better hygiene to treat infections) say that Norway has it right.

Likely detractors, of course, are manufacturers of antibiotics. Dr. Satoshi Hori, chief infection control doctor at Juntendo University Hospital in Tokyo, told the AP that “doctors overprescribe antibiotics because they are given financial incentives to push drugs on patients.”

But Hori bucked that trend, limiting antibiotics only to patients in who really need them, and screening and isolating high-risk patients. And it appears to be working: cases of MRSA are down by two-thirds in his hospital.

Of course, forestalling the use of antibiotics can also mean that patients need to rough out illnesses for longer than they are used to–and then there’s the psychic worries (and, in some cases, the real risk) that might accompany fighting sickness the natural way. Do you think this approach would fly with Americans?


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