By: Dan Sperling, MD

Today’s hospitals are “under the microscope” due to increasing revelations about the dangers of being in one. It is disturbing to think that a center meant to be a haven of safe treatment and nursing care can endanger patients. Estimates of how many patients experience highly undesirable events (HUEs) are staggering, though real numbers can be difficult to obtain. A 2013 study on assessing the probability of hospital-related harm and injury points out that “hospital incident reports do not capture most harm that occurs in hospitals,” inferring from data on administrative claims that an average of almost 8% of hospitalizations result in at least one HUE.[i]

According to WebMD[ii], the six most common risks are:

• Medication errors leading to injury, at an estimated 450,000 per year (though it’s impossible to know how many are unreported).
• Infection with bacteria or virus, determined by the Centers for Disease Control to number 1.7 million incidents, of which 32% are urinary tract infections, and 22% are infections of surgical wounds. The CDC estimates that infections contracted while in the hospital lead to 99,000 deaths per year.[iii]
• Pneumonia, the third most common infection, is a common hospital risk for patients after surgery, those in intensive care, and those on ventilators. Hospital-contracted pneumonia mortality rates are as high as 33%.
• Deep vein thrombosis (DVT) means the development of a blood clot typically in the deep veins of the leg. Factors contributing to this include anesthesia-related relaxation of blood vessels leading to slower blood flow, being immobile in bed, and surgical trauma increasing clotting tendencies. A clot that breaks free can result in death.
• Bleeding after surgery, which is now less common than it used to be.
• Complications of having anesthesia, though these are increasingly rare.

An infection contracted in the hospital is called a nosocomial infection. This means the patient did not have the infection at the time of hospital admission. The infection can occur up to 48 hours after hospital admission, up to 3 days after discharge or up to 30 days after a surgical procedure. Of particular concern is the rapid evolution of drug-resistant strains of bacteria that are called Gram-resistant, because they do not respond to antibiotics. In one sense, they are “superbugs.” The rates of super bug infections are rising. Many patients enter a hospital with a vulnerable immune system due to an existing medical condition such as cardiac disease or diabetic complications, and they are most susceptible to Gram-resistant bacteria. However, anyone can become infected. Gram-resistant organisms can survive for a long time on surfaces such as floors, bed rails, counters, door handles, etc. They can enter the body through surgical wounds, catheters and ventilators. In fact, any staff persons who are lax about hygiene can carry the organisms from one place to another. According to WebMD, “One of the most frightening hospital infections you can pick up is MRSA (methicillin-resistant Staphylococcus aureus) — a type of staph infection that’s resistant to many antibiotics. A 2007 study by the Association for Professionals in Infection Control and Epidemiology (APIC) suggested that almost one out of every 20 hospital patients is either infected with MRSA or carries it.”[iv] What’s particularly frightening is that the longer the hospital stay, the more likely that a person infected with a Gram-resistant bacterium will become multidrug resistant; according to researchers at the Medical University of South Carolina, the chances of this go up 1% per day spent in the hospital.[v]

Common sources of infection transmission include direct contact with an infected person, or a person carrying the bacterium or virus; droplet transmission from coughing, sneezing or talking; airborne transmission via very tiny microorganisms that can stay suspended in the air or attach to small particles such as dust; vehicle transmission by means of medical devices, equipment, food or water; and vector transmission from insects, vermin, and even other humans.

Although no medical facility can guarantee 100% sterility (no living bacteria or viruses), there is a great advantage to clinical services offered by small specialty medical centers. They are far less likely than hospitals to harbor dangerous organisms for the following reasons:

1. Far fewer patients
2. Far less variety of disease conditions (patients less likely enter with an infection)
3. Small staff
4. Less equipment, fewer devices
5. Better control of facility cleanliness and staff hygiene

In addition, outpatient facilities without surgical suites or operating theaters, like the Sperling Prostate Center, do not perform procedures that require general anesthesia (no use of intubation or need for a ventilator) or result in surgical wounds. Procedures such as MRI-guided focal laser ablation of prostate cancer require minimal time in the MRI suite, and patients walk out after a very brief recovery time, usually within a few hours of having walked in the door. Because small specialty centers are not incubators of Gram-resistant bacteria, there is virtually zero risk of becoming infected with them. Regarding the other five risks associated with hospitalization-related harm (medication errors, pneumonia, deep vein thrombosis, bleeding after surgery, and anesthesia complications) they are nonexistent threats at facilities like the Sperling Prostate Center.

There will always be a need for hospitals, and some disease conditions will require the kinds of surgery, intensive care, isolation units, etc. for which hospitals are designed. However, given the scrutiny under which hospitals now exist because of nosocomial infections, and the resulting press coverage, patients who need a specific minimal-to-noninvasive procedure are turning to alternative locations such as the Sperling Prostate Center. Our Center takes pride in offering not only an advanced imaging and treatment facility for the detection, diagnosis and treatment of prostate tumors, but also in providing a safe environment for our patients.

[i] Rocco J. Perla, Samuel F. Hohmann, Karen Annis. Whole-Patient Measure of Safety: Using Administrative Data to Assess the Probability of Highly Undesirable Events During Hospitalization. Journal for Healthcare Quality, 2013; 35 (5): 20 DOI: 10.1111/jhq.12027

[ii] http://www.webmd.com/a-to-z-guides/features/before-surgery-your-top-six-hospital-risks

[iii] Pollack, Andrew. “Rising Threat of Infections Unfazed by Antibiotics.” New York Times, Feb. 27, 2010.

[iv] Ibid.

[v] Paddock, Catharine. “Superbug Infection Risk Increases With Length of Hospital Stay.” Medical News Today, Sep. 8, 2014. http://www.medicalnewstoday.com/articles/282177.php