Ebony Stewart
May 7, 2014
Estimating Health Care Associated Infections and Deaths in U.S Hospitals as Oppose to Medical Malpractice

Epidemiology

Introduction
This study was conducted for two important reasons. Deaths in the United States as well as an estimation to provide information for the number of healthcare-associated infections (HAI) were the purpose. The data sources used were 1) National Nosocomial Infections Surveillance 2) National Hospital Discharge Survey and 3) American Hospital Association all of these sources were used by Centers for Disease Control and Prevention’s. HAI occur in many different healthcare settings: acute care within hospitals, same day surgery centers, long-term facilities, and ambulatory outpatient care in health care clinics. HAI has resulted from and adverse reaction to toxins and evidence of infection isn’t presented during time of admission to hospital. Surveillance has also been a research base for HAI. NNIS is an ongoing system that has collaborated with CDC to monitor data on HAI”S and other nosocomial infections. It covers intensive care units, high risk nursery, and surgical patients. A major goal of NNIS is to develop data to prevent and control nosocomial diseases. NHDS was designed to meet needs of patients from non-federal hospitals that stayed only for a short period of time. The data collected from these surveys is collected to examine the importance of public health. The survey is conducted in three difference stages. The geographic area plays important part of the survey. AHA is a survey that is used a census for hospitals. This has survey been used since 1946 by hospitals. The number of beds, dischargers, services and occupancy are just a couple things are just a coupe things this survey is used for. Thirty-four million admissions were represented from five-thousand eight hundred hospitals in 2000. HAI has become the most common cause of morbidity as well as mortality over the past years since 2002. It has also become the most common complication of hospital care. March 2006 only seven states have made it mandatory to have HAI’s in hospitals reported. NNIS has provided information from forty-two states from those patients that were confidential as well as voluntary. NNIS only started with sixty-two hospitals in 1970, now has expanded to 300 hospitals by the year of 2000. It has provided surveillance data since 1991 with CDC. This had made it easier or nation estimates of HAI to come NNIS data. In 1998, intensive care units were added to the surveillance for HAI data, since they have become a major source. Four subpopulations were created to estimate infections. 1) Estimate of HAI among newborns. 2) HAI among adults and children in ICUs. 3) HAI among hospitalized adults and children outside of ICUs. 4) Adjustment to include federal hospitals. Urinary tract infection, pneumonia, bloodstream infections, surgical site infections and other combined sites are major areas HAI is estimated in. HAI among newborns come from the NHDS. Days newborns spend in the high risk nursery is calculated by infection rates. This was conducted from 1990-1995 using NNIS data. HAI among adults and children in ICUs comes from the number of days in and out of ICU as well as major site of infections. HAIs among hospitalized adults and children outside of ICUs were analyzed during the early 90s. The number of infections from a single site were used as the distribution percentage from the site NNIS. Adjustment to include federal hospitals uses AHA instead of NNIS. This is used from non-newborn patients. Newborn patients in federal hospitals are very low.
Among the patients only a seventeen percent passed away, in a hospital. Only 98,987 were caused by HAIs, of these deaths, there were percentage of infant deaths. The highest percentage came from adults and children. (See Graph Below).

If a patient passes away with an HAI, while at a hospital is participating with research with CDC (NNIS), an assessment is made for the cause of death. The deaths are usually categorized as unknown, not related, casual, or contributory. Some patients may die from multiple HAIs. This estimate was used from NNIS date from 1999 to 2003. As result from these studies, the infection rate per thousand patient days, ICU was the highest. In 2002, 176.4 million patients were admitted to the hospital. Ninety-three point one percentage, adults and children were held accountable. Newborns that were held accountable for HAIs were six point nine percent. Many surgical infections from the major sites were from adults and children. Most of these infections came outside of the ICUs/ Pneumonia and blood streaming were associated with deaths by HAI. Surgical site infections were in the lowest percentile. The results from the research are being used to improve the prevention and surveillance efforts. Infections by major sites and well-baby nurseries were used for the estimates in the 2002 studies. The 1990s data was used to conduct the 2002 estimates. Adults and children outside of ICUs accounted for 68.8% of all HAIs case studies. The United States has had a lack of data for HAIs since the early 90’s, other countries hold on 20 percent accountable for infants. Researchers believe they have underestimated the total number of HAIs from surgical sites. Some NNIS are not reported to the state or to CDC. Some surgical site infections become less evident after a patient has been discharged. Direct comparison of the estimates should never use for data. Most of the data s based off information from the same hospital. Surrogate date from administrative records can be used for surveillance data purposes. NNIS’s hospitals are ninety percent of time large than other hospitals. These hospitals are academics affiliated institutions and located in the south-Atlantic areas of the United States. It’s hard to determine if patients die from HAI or from their co-morbidities. Other methods are more useful for determining data that is worldwide/global. Greece (1999), Denmark (1999), Spain (1997) and Slovenia (2001) use annual prevalence surveys to determine HAI. Annual surveys are less useful on a facility level. The United States has put into consideration into using NNIS periodically to determine HAI across the nation. HAIs have been very difficult to catch if administrative data is the only being used. New advances in technology can lead to a better understanding HAIs and what causes them if everything is being properly sterilized or thrown away. As well if a work wears the proper gear to protect him or her from infections or other diseases.
Medical Malpractice
Medical malpractice is the negligence of an unplanned event, which consists of behavioral matter, mistake, omission, or substitution. Malpractice may also be the lack of professional knowledge, experience, or skill that can be expected of others in the profession. Many malpractice law suits come from health management, diagnosis, medication dosage, treatment or aftercare. Medical malpractice in the United States may differ from that in other countries. States within the United States do not have all of the same laws, some vary due to jurisdictions. This law has provided ways for many patients to recover compensation from harms that comes from sub-standard treatment. A health care professional is not always liable for medical issues a patient may suffer. They are mainly sued for drug errors and missed diagnoses to patients (Christian 2013). Only under the following conditions, may a patient be consider for a medical malpractice suit, if he or she has a violation of standard care, an injury that was caused by negligence or resulted in other significant damages. The plaintiff must provide proof that one of these conditions took place while he or she was under medical attention. A patient has only a statutory period between one and three years to provide this proof. The statutory period only deferred during infancy and may only start to run on the patient’s 18th birthday (Energy 2011). A patient is given the right to believe that health care professionals will handle them with a great deal of care. If this is not meet in a health care facility then this known as a violation of standard of care. The courts may determine that this was not meet during the patients’ health care term, and then negligence will be established that will lead to a claim for medical suit. Some injuries may be caused by the negligence; this is only when it is not proven that a heath care professional violated the standard of car. The patience must be able to show proof that he or she would have not received an injury if negligence was not shown while under health care supervision. The case must be prove that injury was cause from negligence if this cannot be proven to the courts, then patience has no case. Injuries that result in a disability, unwanted medical bills, suffering, or loss income results in significant damages for patients. These malpractice lawsuits are expensive. This case includes the testimony of health care professional. Negligence has to be shown for a patient to consider significant damages form an injury (American Board of Professional Liability Attorneys 1972).
Cases in Mississippi
(Long v. Hadidi) Long was admitted to Northwest Regional Medical Center. Plaintiff medical history, physicals symptoms, as well as results, showed where she had been transferred to Memphis for an MRI and for surgery. Hadidi sent the patient home. Three days later she was a quadriplegic, she was then sent to Memphis. The trial lasted seven days with 9-3 verdict the plaintiff was awarded 5 million dollars of April 2013(Thomas 2013).
(Long v. Greenwood Leflore Hospital) In 2007, the plaintiff took her ten-year-old daughter to the hospital in Greenwood. The child was treated for an ear infection was sent home with some antibiotics. That same night the child began to worsen, the plaintiff called the hospital twice and was told to give the child more antibiotics and bring her back to hospital that morning. The next morning the child collapsed in the emergency room. She was transferred to UMC where died from bacterial meningitis. The court found that hospital breached the standard of care (giving advice over the phone). The court’s decided that if the hospital wouldn’t have suggested bringing her back in the morning, she probably would’ve survived. The court awarded the plaintiff the maximum damages of $500,000 (Thomas 2013).
(Ford vs. Fairbanks) Ford claimed that Fairbanks negligently performed a left knee replacement. The plaintiff developed sepsis and had multiple revision procedures by other physicians to fix the damages Fairbanks caused. The courts awarded Ford $300,000 for his pain and suffering. This happened in Adams County in 2011(Thomas 2013) In conclusion, bacteria, fungi, and viruses may cause HAIs. These infections may come from urinary Cathers, injections, contamination of health care environment, overuse of antibiotics. About one in every twenty inpatients has an infection that comes from improper hospital care. This can cause the United States millions of dollars. HAIs have a major effect on patients emotional, financial, and medical consequences. In 2013, doctors win about 80% of medical malpractice cases. The most common suit is missed cancers or heart attacks. Medscape surveyed 3,500 physicians, 40% said they had been sued. Only 26% were dismissed, the other 55 were settled before the courts could reach verdict. Some healthcare providers have had law suits because patients miss their follow up appointments, and they are not informed about “known side effects.” Only 1% of physicians were expecting the suit, while 24% suspected a suit might be in the process, while the other 75% said the suits took them by surprise. Medical errors cost more than the medical malpractice insurance physicians buy. Medical errors of the nation are either permanent injury or even worse death.

References * Nordquivist Christian (19 July 2013) “What is Medical Malpractice? Retrieved from http://www.medicalnewstoday.com/articles/248175.php * American Board of Professional Liability Attorneys (1972) “The Top Medical Malpractice Attorneys in America” Retrieved from http://www.abpla.org/what-is-malpractice * Syenergy89 (April 22 2011) “Medical Malpractice and Tort Reform” Retrieved from http://allnurses.com/nursing-activism-healthcare/medical-malpractice-tort-556415.html * Legislative Policy Committee of PAJ (23 February 2013) “Medical Malpractice Myths and Suits” Retrieved from http://www.medmalfacts.com/facts-and-myths/ * The Advisory Board Company (31 July 2013) “Survey explains why doctors are sued—and how it affects their lives” Retrieved from http://www.advisory.com/Daily-Briefing/2013/07/31/Inside-malpractice-lawsuits-Why-so-many-doctors-dont-see-them-coming * Philip W. Thomas ( April 22,2013) “Verdicts in Mississippi” Retrieved from http://www.mslitigationreview.com/tags/medical-malpractice/ * Stephen F. Clarke ( June 2009) “Medical Malpractice Liability: Canada Retrieved from http://www.loc.gov/law/help/medical-malpractice-liability/canada.php * Nurses Service Organization ( 2013Edition) “Special Edition Legal Case Studies” Retrieved from http://www.nso.com/case-studies/casestudy-article/331.jsp * Aaron Larson (July 2004) “ Mississippi Medical Law-An Overview” Retrieved from http://www.expertlaw.com/library/malpractice_by_state/Mississippi.html * Collen M. Flood, Bryan Thomas ( 2011) “Canadian Medical Malpractice Law in 2011: Missing the Mark on Patient Safety” Retrieved from http://www.cklawreview.com/wp-content/uploads/vol86no3/Flood-Cut.pdf * McCullough, Campbell & Lane. (6 Feb. 1998) “Mississippi Medical Malpractice Summary Retrieved from http://www.mcandl.com/mississippi.html