Just Don’t Bug Me: Infection Control in a Far Country

Back to Priština, new capital of a new country, Kosovo. Our hadrons lost an argument about occupying space on a crosswalk. We’re taxi-struck and dazed. Ambulance doors open. Sign says Emergency.

Another sign, University Clinical Center of Kosova, is the only other English sight or sound amid a mix of patients, nurses, doctors, family members, who all speak Albanian. Otherwise it could be an emergency ward in America. Or so I think.

I am sore but okay. A leap into thin air before the impact saved my bones. Soon my wife is vital-signed and blood-typed, X-rayed and then CAT-scanned (ambulanced to there and back). I can see the double pelvic fracture as her doctors chatter at the X-rays on the light box on the wall.

The osteopathic ward’s a nightmare at first sight. Potholes in the floors of dingy halls. Five beds crammed into each two-bed room. Without a blanket unless you bought one before you arrived. Window that won’t shut, and it is cold. Antiquated room equipment. Absence of basic supplies. Relatives add to the crowding; they are the providers of most patient care. So I’m thinking, as she’s lifted from the gurney, that this place is perfect for infections, sub-type hospital-acquired. I know they are so normal they have their own labels: nosocomial and HAI.

Headline: U.S. HOSPITALS KILLED 270 YESTERDAY BY INFECTING THEM! This is not bad news. The bad news is: This is not news! HAI’s a slow and ugly way to die but it is business as usual. Almost 100,000 died from it in the U.S. alone in 2012.

Every nosocomial death can be prevented with existing remedies. For example, enter stage left, soap. Though quantum-based, the physics of hand-washing’s easy: A soap molecule has two ends; one of them likes water and the other one likes dirt. Soap doesn’t kill bugs; it helps water to remove them. Wet hands, soap them, rub until the soap’s washed off. Most of the bugs go with it. Most of the bugs is often good enough.

Estimated saving from not killing people with HAI in the U.S.: half a trillion dollars in a decade. Yes, Carl, that’s $500 billion with a ‘b’! Looking round, my thought’s illogical: This clinic in Priština could put a few million to good use.

Come evening, my wife is offered bread and thin potato soup. Guiltily I dine well in an inexpensive but sophisticated Brasserie.

In the next few days I am astounded. These Kosovan doctors are top-notch. And this dingy-looking hospital is squeaky clean. The primitive cold-water basin in the corner of each room is disinfected many times. The uneven floors are washed and the cracked window ledges wiped each day. The head nurse even checks the light fixtures for dust. Before they touch a patient, nurses don fresh gloves. Family members often wash their hands.

Fact is, this place has the best infection control I have seen―and I have seen some―using little more than soap.

Five days later my wife is discharged with mending bones and no bad bugs. The total bill is just over a hundred bucks. I ponder this as we make plans to get back to America, where hospitals that cost much more kill patients as a matter of routine.

Sources:     

U.S. Department of Health & Human Services, “National Action Plan to Prevent Health Care-Associated Infections: Road Map to Elimination”, last updated 29 March 2014; http://www.health.gov/hai/prevent_hai.asp

David Heitz (2013), “99,000 Americans Die of Healthcare-Acquired Infections Every Year”, Healthline, http://www.healthline.com/health-news/aging-healthcare-acquired-infections-kill-nearly-a-hundred-thousand-a-year-072713

Other reading:

Centers for Disease Control and Prevention (2014), “Healthcare-Associated Infections in the United States”; https://www.youtube.com/watch?v=-FfMCv8FUXI&feature=youtu.be

Tackling the problem in Kosovo: Lul Raka et al., “Denial, Media and Endurance in Infection Control, Int. J. Inf. Contr. v. 5 (2009) p. 1; http://www.ijic.info/article/view/2609/2810

Lots of details: Margaret Dudeck et al, US Centers for Disease Prevention and Control, National Healthcare Safety report, Am. J. Inf. Contr. v. 41 (2013) p. 1148; http://www.cdc.gov/nhsn/PDFs/2012-data-summary-nhsn.pdf

Bobbyoblog (2011) “Carl Sagan – Millions, Billions and Trillions. All the illions from Cosmos and in order”, http://www.youtube.com/watch?v=HZmafy_v8g8