He had to be re-admitted: Rep. John Murtha's hospital acquired infection

U.S. Representative John Murtha, Chairman of the House military appropriations committee, is recuperating in the intensive care unit after a surgical infection from his gallbladder surgery. He'd had laparoscopic surgery to remove the gallbladder in late January, and had to be re-admitted to a hospital because of the infection.

He was in grave condition following the hospital infection. Now the infection is responding to antibiotics, and the condition of the 77-year-old congressman has been improving.

Nurses should provide antibiotics before surgery (prophylactic antibiotics) to prevent surgical infections, but don't always do so. A surgical checklist should remind nurses and doctors about the antibiotics, but checklists are not always used.

Advice to patient advocates of patients undergoing surgery: Ask the surgeon beforehand if he or she uses a checklist. If you don't hear Yes, choose another surgeon. If they don't use a checklist, or if they bristle at the question, that might indicate arrogance that can intimidate their clinical teammates into silence when a surgical error is about to occur.

Read other surgical infection stories. Thanks to Carol D. Leonnig and Paul Kane for their background article in the Washington Post of Feb. 3.

Mr. and Mrs. Republican: A lawmaker's response to their hospital acquired infection

Leo and Rita Pepino were married for almost 60 years. "She was my life," Leo says.

Rita died from bone cancer in 2005, after battling two other cancers. She was affectionately known in New Hampshire as "Mrs. Republican" for her political activism. Her husband Leo was the former Speaker of the New Hampshire House of Representatives.

Rita had acquired several painful infections while in the hospital, getting sicker from the place that was supposed to make her well, Leo said.

"Every time she went to the hospital, she always got an infection," he said. He got one, too, years ago from a different hospital when he had back surgery.

Also a Republican, he kept his word after Rita died, helping to marshal through a new law requiring New Hampshire hospitals to report to the state for public release their rates for the three most serious hospital-acquired infections.

New Hampshire Gov. John Lynch signed the bill into law in 2006, "in memory of Rita." However, public reporting has lagged: the state still does not publish the rates of individual hospitals' infections.

A year ago, Leo vowed at age 81 to run again for the seat he lost last time around to make sure consumers get information to compare hospital infection rates. It's for Rita, he said.

Advice to political activists: Be vigilant to ensure your new patient safety laws are implemented faithfully after they become law.

Read another story about Massachusetts'new law on reporting hospital acquired infections.

Thanks to Helen Haskell, and Nancy West for the source article in the New Hampshire Sunday News of August 10, 2008.

One of those things: A staph infection after spinal fusion

A story from Jeff Knott:
My publisher tells the story of going into a hospital for a spinal fusion procedure known as a lumbar laminectomy (an open decompression). He needed help due to severe pain caused by neural impingement. The surgery is designed to remove a small portion of bone over a nerve root and/or disc material from under the nerve root, giving more space for movement.

At admission, he was in generally good health. On the morning following the surgery, the patient felt comfortable and was encouraged to see if he could sit up, which he could thanks to the morphine blocking any discomfort. However, by that afternoon he began to run a fever and began hallucinating. The nursing team was attentive and eventually called in a doctor (not the admitting physician – he had gone skiing in Colorado) to evaluate the situation. Nurses and techs drew blood and administered fever-lowering medication.

The test results came back and the doctor returned to inform the patient that he had contracted a staph infection – most likely during or just after the surgical procedure. That explained the fever, the hallucinations, the swelling and redness around the wound, and the patient's irritability.

Antibiotics were started and after four additional days in the hospital, the patient was wheeled to his car. In addition to the routine bill for the surgery and hospitalization, there was an increase in the total by four additional and unexpected days of hospitalization – none of which were caused by the patient, but surely to be paid for by the patient and his insurance company.

The patient returned to the orthopedic surgeon's office for check-ups during the weeks that followed. He met with the doctor a couple of times, discussed the success of the surgery, the reduction or near-elimination of pain, and rehabilitation. But not once did the doctor bring up the staph infection. When the patient mentioned it, the discussion was brushed off as "one of those things" that can happen in a blue moon. It was obviously an embarrassment – but it didn’t slow down the flow of patients through his office.

Advice for people who have suffered a hospital-acquired infection: Ask the surgeon what s/he would do differently next time to prevent an infection. And don't pay that part of the bill.

Read a spinal surgery error story.

Thanks to Jeff Knott for the excerpt from his new book, Navigating the Healthcare Maze-What You Need To Know, published by DC Press.