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Why Would You Want to Have Your Precious Baby in One of the FILTHIEST Places in the United States:  A Hospital?

Note: For additional information and footnotes, please see the 2nd edition of RID's popular publication, Unnecessary Deaths: The Human and Financial Costs of
Hospital Infections

 

Every day in hospitals across, the United States wondrous medical procedures rescue patients from the brink of death. But there's a catch. In these same hospitals, hygiene is so inadequate that one out of every twenty patients contracts an infection.

Infections that have been nearly eradicated in some countries are raging through American hospitals. In 2003, the Society for Healthcare Epidemiologists of America warned that although hospitals have infection prevention programs, "there is little evidence of control in most facilities."

The danger is worsening because hospital infections, increasingly, cannot be tamed with commonly–used antibiotics. One of the deadliest germs is methicillin—resistant Staphylococcus aureus (or MRSA). Patients who do survive MRSA often spend months in the hospital and endure repeated surgeries to cut out infected tissue. In 1974, 2 percent of Staph infections were MRSA. By 1995, the number had climbed to 22%, in 2003 an alarming 57%, and now over 60%.

Denmark, Holland, and Finland once faced similar rates, but brought them down below 1 percent. How? Through rigorous hand hygiene, meticulous cleaning of equipment and rooms in between patient use, testing incoming patients for MRSA and other drug resistant bacteria, and taking precautions to prevent transmission to other patients. Wheelchairs and other equipment used to transport patients who test positive for MRSA are not used for other patients, and hospital staff have to change their uniforms and footwear after entering the rooms of MRSA patients, before they are permitted in other areas of the hospital.

A few hospitals—too few—in the United States are proving these precautions work here too. The University of Virginia Hospital eradicated MRSA. The Veterans Hospital in Pittsburgh reduced MRSA by 85 percent in a pilot program. The University of Pittsburgh–Presbyterian Medical Center slashed MRSA by 90 percent in the medical intensive care units in a pilot program, and a Yale–affiliated hospital in New Haven, Connecticut, cut MRSA infections by two thirds in a surgical intensive care unit.13 Brigham and Women's Hospital in Boston reduced MRSA bacteremia 77% in intensive care and 67% hospital–wide. Twenty–nine healthcare institutions in Iowa eliminated another drug–resistant germ, vancomycinresistant Enterococcus (or VRE).

Unfortunately, most U.S. hospitals have not implemented these precautions.

 

Please Keep in Mind:

We have the knowledge to prevent hospital infection deaths.

We don't have to wait for a scientific breakthrough. ·Yet most hospitals have failed to act.

The situation is growing more dangerous because, increasingly, hospital infections cannot be cured with commonly-used antibiotics.

U.S. Hospital Infection Essential Facts:

 

1. Infections contracted in hospitals are the fourth largest killer in America. Every year in this country, two million patients' contract infections in hospitals, and an estimated 103,000 die as a result, as many deaths as from AIDS, breast cancer, and auto accidents combined.
   
   
2. A few hospitals in the U.S.—too few—are proving that infections are almost entirely preventable. How are they doing it? Through rigorous hand hygiene, meticulous cleaning of equipment and rooms in between patient use, testing incoming patients to identify those carrying dangerous bacteria, and taking precautions to prevent these bacteria from spreading to other patients.
   
   
3. In 2003, the Society for Healthcare Epidemiologists of America (SHEA) announced the precautions that research proves can eradicate most hospital infections. Yet only a few hospitals have taken these precautions, and the CDC still has not called on all hospitals to implement them.
   
   
4. Hospital infections add an estimated $30.5 billion to the nation's hospital costs each year. Patients, insurers and taxpayers pay part of that cost, but hospitals have to absorb much of the cost. As a result, infections erode hospital profits. Preventing infections can turn a financially failing hospital profitable.
   
   
5. Better infection prevention in hospitals is essential to prepare the nation for avian flu or bioterrorism. If avian flu were to wing its way to the U.S., the death toll would depend largely on what American hospitals did when the first avian flu patients were admitted. If hospitals have effective infection controls in place, they can prevent bird flu from infecting other patients who did not come in with it. If not, bird flu could sweep through hospitals. Right now, most hospitals are woefully under prepared. Hospitals have failed to stop the spread of ordinary infections spread by touch and would not be able to contain flu viruses, which are communicated by droplets from coughing and sneezing as well as touch. Even more challenging would be small pox, plague, and other bioterrorism weapons that can travel through the air. Shoddy infection control is poor preparation for a flu epidemic and poor homeland security as well.
   
   
6. Hospital infection is a far deadlier problem than the number of uninsured.
   The Institute of Medicine estimates that as many as 18,000 people a year die prematurely because they don't have health insurance. That's tragic. But five times as many people die each year from hospital infections, and most of them are insured.
   

Special Implications for New Mothers and Babies

About 4% of Group B streptococcus (GBS) isolates demonstrate penicillin tolerance (from Merck Manual).  Consider alternative treatment aimed at reducing colonization without relying on antibiotics.

VRE is not generally dangerous to healthy individuals with fully functioning immune systems. However, it is very dangerous to newborn babies because they have an immature immune system that cannot cope with many different types of germs. VRE is a drug–resistant germ, vancomycinresistant Enterococcus (or VRE)

In the U.S., most women give birth in hospitals. Unfortunately, the emergence of VRE as an increasingly common pathogen can make the hospital a very dangerous place for your baby. Hospitals have always recommended that newborns be kept away from hospitals because of the increased danger to their immature immune systems. This danger becomes even more serious when the hospital germs cannot be treated with antibiotics.

The Center for Disease Control warns that the primary concern about VRE is that it could easily share its resistance with staph bacteria, which can easily infect a baby's skin. Two strains of staph resistant to vancomycin were reported in the U.S. in the summer of 1997, and it is expected that this number will increase rapidly.

What are the dangers to my baby?

There are two primary dangers.

1) The first is that your baby may be exposed to VRE or resistant staph through contact with hospital equipment or personnel.

2) The second is that you may become a VRE carrier and take the bacteria to your home, where you may spread it to other family members, including your new baby. Your own body might become an incubator for resistant strep or staph, which could cause serious infection in your baby.

What are the dangers to me?

In addition to the risks of becoming a carrier, you are at increased risk for exposure every time the integrity of your skin is broken by an IV or injection. An unnecessary episiotomy or Cesarean wound puts you at particular risk.

Germs introduced vaginally are particularly dangerous because if they migrate to the placenta site, they can move directly into the larger vessels in the mother's bloodstream and cause systemic infection quite rapidly.

How can I minimize the dangers?

The best way to avoid hospital-acquired infections is to avoid hospitals. Consider the possibility of an out-of-hospital birth:

 

• Birth Centers - Birth Centers are different from hospitals in that they are much less likely to harbor antibiotic-resistant germs. This is because Birth Center clients aren't typically taking antibiotics.

At the AquaNatal Birth Spa, none of our personnel or students work in a hospital.  Therefore, they are NOT ABLE to bring VRE or MRSA into the Birth Spa.  Our equipment, tubs, etc. are meticulously cleans after each clients’ use.

At home - The best way to protect your baby from dangerous germs is to give birth at home. It's very unlikely that VRE is present in your home, unless you or someone else in your family became a carrier through previous exposure to VRE. In addition, a baby born at home is always kept very close to the mother, thereby ensuring that the mother is exposed to the same germs the baby is exposed to. This allows the mother's body to customize the antibodies in her breastmilk to be exactly the ones her baby needs.

If your pregnancy is complicated by high-risk factors that limit your out-of-hospital options, you can still make choices that minimize your exposure to hospital germs:

• When you are deciding on a childbirth education class, ask the instructor about their knowledge of hospital infections and how to avoid them.
• Learn as much as possible about pregnancy and birth so that you can make informed choices about your care and decline procedures that increase your risk of exposure without providing benefits. Get a copy of A Guide to Effective Care in Pregnancy & Childbirth by Enkin, Keirse, Renfrew and Neilson. This excellent book provides an easy-to-read guide to all the tests and procedures that might be recommended by your care provider. The authors have evaluated all the available research and categorized everything in simple tables: Beneficial forms of care, Forms of care likely to be beneficial, Forms of care with a trade-off between beneficial and adverse effects, Forms of care of unknown effectiveness, Forms of care unlikely to be beneficial, Forms of care likely to be ineffective or harmful. With this knowledge, you can make better decisions about choosing or declining invasive procedures that might introduce infection.
• Choose out-of-hospital providers for prenatal diagnostic tests such as ultrasound and bloodwork.
• Plan to labor at home as long as possible. By using the services of a professional labor assistant, you can have the benefits of professional care in your home without the dangers of the hospital.

When you go to the hospital, follow these safety guidelines:

• Maintain Fastidious Hygiene - Wash your hands frequently, and use the paper towel as a shield on the door handle. Consider wearing gloves.
• Minimize Interventions - Any intervention that causes a break in your skin could result in a serious infection. Avoid these risks by declining unnecessary IVs or injections.
• Avoid an Epidural - Epidurals are especially dangerous because a pathway for germs is created from the outside directly into your spinal space; a spinal is even more dangerous, as it could introduce germs into your spinal column and cause meningitis. In addition, 15% of women who have an epidural develop an epidural fever. This usually necessitates the baby's being admitted to the Neonatal Intensive Care Unit (NICU) for a number of tests and observations. The most dangerous infections are generally found in the NICU. For information about the baby's experience of pain in the NICU, see the section on Pain of Neonatal Intensive Care in this Paper on Infant Pain by David B. Chamberlain, Ph.D.
• Avoid Being Catheterized - Urinary tract infections are the most commonly acquired infections in hospitals; they are usually caused by catheterization.
• Avoid Ingesting VRE - Eat only cooked hospital food, and wash your hands thoroughly before eating.
• Breastfeed Your Baby - By breastfeeding your baby, you protect your baby in a number of ways. You minimize the number of times the baby is handled by hospital staff, and you prevent the introduction of VRE through bottle equipment or formula. In addition, your breastmilk provides antibodies that protect your baby against infection. Even if your baby is primarily fed artificial human milk (formula), occasional breastfeeding can still offer a significant immunity boost to your baby. This is especially important while you are in the hospital. Once you are away from the hospital, continue to breastfeed as much as possible. Babies who do not receive the immune boost from breastmilk are ten times more likely to develop an infection that requires hospitalization.
• Wash Your Hands Fastidiously Before Breastfeeding so that your baby doesn't ingest germs along with the breastmilk. This will also reduce the risk of mastitis and other breast infections in cracked nipples.
• Avoid Procedures that Break the Baby's Skin - One quarter of newborns in hospitals acquire a staph infection. Every injection or heelstick breaks the baby's skin and can become an avenue for serious infection. Although the vitamin K shot is best given close to the time of birth, other breaks in the skin can sensibly be delayed. (Some progressive hospitals are offering oral vitamin K, which doesn't require breaking the baby's skin; you can request vitamin K.)  In particular, vaccines can often be delayed for some months, and the newborn screen (PKU heelstick) can be done by a health care provider after the baby is safe at home. (In any case, the PKU is most accurate when done at six days; newborn screens performed before the baby is a couple of days old miss 10-15% of cases of hypothyroidism.  It is also significantly less traumatic to do a heelstick on a six-day-old baby than a day-old baby since newborns are often dehydrated in the first couple of days.  The task of "getting blood from a stone" requires significant and repeated stabbing of the baby's heel.)  If you are unable to find a CNM, Licensed Midwife or pediatrician who makes housecalls to do the newborn screen heelstick at 6 days, it is still safer to have the PKU heelstick done in the pediatrician's office than in the hospital.
• Insist everyone (yes, even the doctors) wash their hands in your presence for at least 30 seconds before touching you or your baby.
• If someone comes in your room already wearing gloves, make them take them off, wash their hands and put on new gloves!
• Minimize Handling of Your Baby by Hospital Personnel - Insist that the staff maintain fastidious hygiene and handle your baby only with fresh, clean gloves. One way to ensure that the staff doesn't touch the baby with bare hands is to decline to have the baby bathed after the birth. You might choose to do a little spot cleaning here and there, but if the baby is not bathed, then the staff will be careful about handling the baby for their own protection. In addition, this will protect the baby from the germs found in the bath water.
• Keep Your Baby in Your Room - This reduces handling of your baby by hospital staff, and ensures that your body will produce the antibodies to the germs your baby is exposed to.  The World Health Organization's discussion of Umbilical Cord Care offers clear advice about keeping your baby in your room in order to minimize infection.
• Return Home as Soon as Possible - Leaving the hospital as soon as possible after the birth will reduce your chance of acquiring a hospital infection or being exposed to antibiotic-resistant germs. In California, the law to reduce so-called "drive-through deliveries" requires HMOs and health insurers to cover at least a 48-hour hospital stay for a mother and newborn or to provide for a follow-up exam within two days after discharge. Astute consumers can use this law to negotiate for care to be provided in their home. You can arrange for an in-home visit by a Licensed Midwife and a week of household help for less money than it costs for a single day in the hospital. This will allow you to recover in the comfort and safety of your own home, surrounded by the people of your choice, while providing access to the health care and practical help you may need.
• Avoid Returning to the Hospital or a Doctor's Office Where Your Child Can Be Exposed to Nasty Germs - Once you've successfully brought a health baby home from the hospital, it's important to remember that hospitals and medical offices filled with sick children continue to be a threat to your child.  A child's immune system doesn't develop completely until around 5 years of age.  It's important to minimize your child's exposure to other sick children, especially the very sick children in a doctor's office.  Develop a good relationship with the phone nurse, instead, and develop skills at caring for minor problems at home.