Infections acquired in hospitals remain high following pandemic spike

To Burton Davis, the surgery seemed nothing short of a miracle. The 58-year-old's curved spine had nagged him for the better part of two decades, putting constant pressure on his lower back and sending pain shooting down his right leg. Scoliosis had already robbed him of golf and hunting, and even grocery shopping now required a walker.

But once Minnesota surgeons sliced open his back in December 2021—relieving pressure on the compressed nerves within—a newfound hope filled Davis. He drove to a local community center less than a week later, where he walked a mile straight for the first time in 15 years. He soon returned with his wife for another stroll. "I was kind of set free again," he told Newsweek.

The feeling didn't last long. An unsettling malaise crept over Davis as his back became inflamed and itchy near the healing incision. He went back to the hospital, where doctors discovered he had contracted MRSA, a dangerous, drug-resistant bacteria. After he fell into septic shock, they put him under the knife again.

Davis now spends most days seated in his recliner. Irreversible damage from the infection has left him unable to walk more than 50 feet without assistance. At night, he lies awake while his feet tingle and pound, an unending pain he describes as "an elephant with high heels" trampling him. "My mobility wasn't great with scoliosis, but now it's devastated," he said. "I literally can't stand for five minutes."

Over the past two years, inpatients at hundreds of U.S. hospitals contracted MRSA twice as often, and sometimes three times as often, what federal health officials had predicted would occur. The same was true for bloodstream infections transmitted by catheters inserted into patients' major veins, according to new hospital-level data shared exclusively with Newsweek by The Leapfrog Group, a nonprofit watchdog focused on patient safety.

The numbers illustrate a grim trend. The average risk of hospital-acquired MRSA and bloodstream infections both reached a five-year high during the pandemic, and they remain elevated. Research suggests COVID-19 patients are more susceptible to infection in the hospital. Healthcare experts also fear staffing shortages have undermined the consistency of procedures to sanitize medical equipment such as catheters and surgical instruments. A simple lapse in judgment, such as a caregiver forgetting to wash hands, can cause disaster.

"I think this should be the number one priority for every CEO of every hospital in this country," Leapfrog Group president and CEO Leah Binder said. "That spike is extraordinarily dangerous to any person right now who thinks they might end up in a hospital today, tomorrow, next week, next year."

The organization tracks safety measures at almost 3,000 acute-care hospitals, as well as infection data collected by the Centers for Disease Control and Prevention. Infection-control performance is measured by comparing the number of inpatients who contract new diseases during their stay to how many the CDC predicted would get sick. The latest data runs through June 2022, and it shows some 150 facilities experienced three or more times the number of expected MRSA or bloodstream infections. (Predicted infections are estimated using aggregate disease data from prior years, which are adjusted to account for risk factors such as a hospital's size or its average length of stay.)

Infections push patients over edge

The consequences can be grave. Each year, tens of thousands of patients die after developing an infection during their treatment, federal officials estimate. Most never consider that the IV lines, catheters and ventilators that deliver life-saving care can serve as highways for pathogens to travel past the body's natural defenses. Germs also lurk on contaminated surgical instruments and artificial implants. Once infected, blood can carry disease across a patient's body, causing sepsis and organ failure. MRSA, which infects hundreds of thousands of inpatients each year, is notoriously difficult to cure once it takes hold. "It can become the thing that tips them over the edge and causes their death," said Dr. Lisa Maragakis, senior director of infection prevention for The Johns Hopkins Health System.

It's not only the infirm who are at risk. When Brian Pankey crossed from Ohio into West Virginia for a colectomy reversal in late 2020, he was an independent 46-year-old working full-time at a drug-rehabilitation facility. Four months later he returned home a quadruple amputee.

Pankey later filed a medical malpractice lawsuit against his hospital, alleging the facility had prematurely discharged him after surgery, leading to severe illness and organ failure. Medical documents his attorney provided Newsweek state Pankey contracted MRSA. The hospital denied wrongdoing in the case, court records show. A confidential settlement was reached earlier this year, according to Pankey's attorneys.

"You take for granted simple things that you're able to do as far as scratching your nose or shooing a bug away from your face," Pankey said. "There's a lot of days where I'm down and out."

West Virginia hospitals, on average, saw the largest increases of MRSA and bloodstream infections since the pandemic began, according to The Leapfrog Group. For both diseases, the ratio of recorded to predicted infections more than doubled.

The state has one of the nation's largest senior populations, as well as one of its highest poverty rates, leading to sicker patients in hospitals, said Jim Kaufman, president and CEO of the West Virginia Hospital Association. Last year's surge in hospital-acquired infections coincided with an influx of COVID-19 patients into hospitals, which were running low on healthcare providers and sanitation workers. "It's a great reminder that quality of care is a journey. It never ends, and you're constantly working on it," Kaufman said.

Even as COVID-19's direct impact on hospitals lessened, the rates of some infections remain high. Johns Hopkins' Maragakis blames long-term disruptions in healthcare. Many patients are only now seeking medical treatment they put off during the pandemic. Meanwhile, hospitals are still struggling to replace workers lost to burn out and lucrative opportunities in travel nursing. "It's just harder to keep the machinery of health care, if you will, running smoothly," she said. "Some of the things that we were doing to prevent these infections... while they were successful, they were not as durable, or resilient under stress, as we would want them to be."

One potential solution is to provide doctors and nurses with advanced infection-prevention training, and then allow them to lead hospital rounds focused on patient safety, Maragakis said. Any line inserted into the body must be kept clean, dry and well-sealed at all times. Removing invasive devices as soon as possible is a less considered, but effective, way to cut down the risk of disease.

The CDC's data collection is another area ripe for improvement, Leapfrog Group's Binder said. The federal agency groups multiple facilities together if they belong to the same hospital system, masking individual performance. Infection data is typically released to the public nine months or more after it was collected.

"Your supermarket can find out how many people bought Cheerios yesterday," Binder said. "We ought to be able to know how many people got an infection yesterday."

Medical errors increasing, experts say

Patient safety at hospitals has deteriorated in other ways too, healthcare experts said. Medical errors—which can result in everything from minor drug allergies to bedsores to botched surgeries—have likely risen because of staffing challenges. More than 1,400 incidents resulting in severe or permanent harm were voluntarily reported to the nation's largest healthcare accreditor last year, a decade high and about 500 more than in 2019. Falls accounted for almost half the injuries recorded by The Joint Commission. (While there are thousands of acute-care hospitals nationwide, the organization collected data from only a few hundred healthcare organizations, not all of them hospitals.)

Harvard Medical School professor of medicine Dr. David Bates is among the experts certain that medical errors have increased. Recent analyses of private medical records show little progress was made before the pandemic wreaked havoc on healthcare systems. Earlier this year, Bates led a team that concluded almost one-in-four hospital patients—about 8 million people nationwide—suffered harm because of errors in treatment during 2018. Infections were among the deadliest consequences.

A separate study that focused on Medicare patients hospitalized in October 2018 reached an almost identical conclusion. The results came as a gut punch to the government researchers, who said the rate was virtually unchanged from a decade earlier. "I think you can easily say that patient safety has only gotten worse with COVID," said Amy Ashcraft, a deputy regional inspector general for the Department of Health and Human Services.

Such errors take a steep toll on patients and hospitals alike. Research has found they typically double a patient's length of stay, while annual costs for additional treatment, lost income and disability payments total in the tens of billions. Despite this, critics said the federal government tracks most medical errors far less reliably than infections. At most hospitals, employees flag incidents by manually reviewing a patient's medical records after they are discharged from care. The process misses the vast majority of problems, stymying efforts to reduce harm.

There's even difficulty reaching a consensus on how many people die from medical errors each year, largely because many are in frail condition when they're admitted. In 2016, Johns Hopkins Medicine researchers estimated it was more than 250,000 people, ranking medical errors as the nation's third-highest cause of death. Bates, a leading expert in patient safety, puts the death toll somewhere between 70,000 and 100,000.

Undisputed are the life-long consequences many errors carry. Since contracting MRSA in 2009 during a routine knee replacement surgery, Rosie Bartel said she has been hospitalized more than 200 times and underwent dozens of surgeries. In addition to losing her entire right leg, Bartel estimates her out-of-pocket medical expenses have totaled more than $200,000. She cashed out her retirement savings to pay the bills and later lost her home to foreclosure.

"I believe that many times, doctors don't realize what one infection can do to somebody," she said.

Michael Scott Davidson can be reached at m.davidson@newsweek.com or find him on Twitter at @ByMSDavidson.