By Bethany Kohoutek

Patti Brush-Stalzer was heartsick. Long hours in the I.C.U. had left her drained. Along with other family members, she alternated between camping next to her father's bedside and catching a few hours of sleep on a cot outside the room. No one was accustomed to seeing Glen Brush - the fit, healthy, 73-year-old retired truck driver who'd never been hospitalized a day in his life - unconscious and tethered to a respirator, tubes snaking in and out of his body.

Brush-Stalzer describes her dad as "an extremely hard worker" who was able to retire at age 60. He spent his time vacationing in Arizona with his wife, Betty, and helping out farmers near his home in State Center, during the spring and fall. He was the type of guy who would mow elderly neighbors' lawns without being asked. When he was still conscious, he would even thank the nurses who drew his blood or inserted an IV, "just because he knew they were trying to help him get better," his daughter says, her voice breaking.

It's been nearly two years since Glen Brush died at the Marshalltown Medical and Surgical Center. By now, his family knows they should be able to move on, but it hasn't been easy. The cause of death listed on Brush's death certificate may officially read "pulmonary fibrosis," but that's not what killed him, his daughter says. She feels deceived by the hospital. She says her dad didn't have to die.

A few weeks after the funeral, Brush-Stalzer began to grow suspicious about the circumstances surrounding her dad's death. He was admitted for pulmonary fibrosis, a relatively serious lung condition, but after a few days in intensive care, hospital staff assured the family that he'd soon begin to improve and eventually be able to return home. He might have to carry a portable oxygen tank, but he'd make it, they said.

As days passed, though, Brush didn't get any better. Instead, his condition deteriorated rapidly. Finally, doctors pulled the family aside and told them he'd contracted something called "MRSA."

"We asked what MRSA was, and they said this great big word," Brush-Stalzer says. "When my dad got it, they told us to wear a mask and gloves around him, because this was nasty stuff, terribly nasty, and we would not want to get it. How he got MRSA was not really mentioned. The family was at such a vulnerable point; we were living in the ICU. When they tell you [the diagnosis], you don't ask questions, you just drop your jaw and you think, 'Oh my gosh. Now there's no hope.'"

That great big word was methicillin-resistant staphylococcus aureus, a wicked cousin of the common staph infection that has mutated and evolved thanks to an extreme over-reliance on antibiotics in hospitals. Once it takes hold, MRSA is nearly impossible to contain; only a tiny number of potent antibiotics are capable of combating it.

Like it's predecessor, MRSA is bred and borne almost exclusively in medical settings. According to the Centers for Disease Control, only about 12 percent of MRSA cases enter hospitals from the outside. Once inside a hospital, germs can hitchhike around the facility on not-quite-sanitized doorknobs, instruments, wound dressings, even doctors' and nurses' dirty shoes or unwashed hands, before finally finding a home on a sick patient.

"We know that infections occur in hospitals when people have invasive procedures - tubes in them, needles, IVs, anything that can get bacteria on it - and the bacteria enters the bloodstream," says Lisa McGiffert, senior policy analyst for Consumers Union, a national advocacy group that is spearheading a campaign to combat infections that patients pick up in hospitals. "Lots of the bacteria is very deadly, but it lives on our skin all the time. But when it enters the bloodstream, it basically eats up your body, eats away at the tissue. It is a gruesome and horrible way to die."

McGiffert says Glen Brush's case is anything but isolated. She's heard hundreds of similar horror stories from patients and their families around the country. Hospital administrators, doctors and nurses are reluctant to admit that the source of a deadly infection is the hospital itself - or that the bug likely could have been prevented with some simple precautions. After all, hospitals are supposed to be where people go to get better, not sicker.

The scope of the problem is far worse than most healthcare consumers realize, McGiffert adds.

"This is much scarier than avian flu. There's all this talk about an avian flu pandemic, and we've got an epidemic in hospitals today."

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If McGiffert's classification sounds overdramatic, consider this: Every year, hospital-acquired infections attack two million Americans, and prove fatal for 90,000 of them, according to the Centers for Disease Control and Prevention. That's twice as many deaths as breast cancer, and four times as many as AIDS in the U.S.

Studies show that the average person has a 1-in-20 chance of contracting an infection every time he or she is admitted to a hospital.

"It's outrageous that the healthcare community hasn't gotten out there and done something really strong and radical about this, because it kills so many people," McGiffert says. "I think the prevalent belief of the general public is that somebody is watching over things like infections. It's shocking to find out that there really isn't anyone."

Rep. Mary Gaskill (D-Ottumwa) agrees. She lost a brother to a hospital-acquired staph infection in 1999. That's one of the reasons she cosponsored legislation, House File 44, last year that would have required Iowa hospitals to publicly report the number of infections originating in their facilities on a quarterly basis. Institutions that did not cooperate would face a fine or a possible suspension of their license.

Currently, Iowa lacks any form of public or legislative oversight for hospital infection rates. What's more, no one's really sure what types of statistics the hospitals themselves gather, as internal numbers, too, are kept private.

This lack of transparency leaves potential patients, and even local doctors, with no way to gauge which facilities may have a poor track record - and therefore could be more dangerous.

"[My brother] was 55 years old. He had a family. So it really just struck me as something that people really need to know," Gaskill says. "I think in order to make good decisions, you have to have good information."

Gaskill never had the chance to find out if the measure could have prevented more deaths like her brother's. It was sent to the Human Resources Committee, where it languished under committee chair Rep. Linda Upmeyer, a Republican, who told The Des Moines Register in January 2005 that she trusts hospitals to police themselves when it comes to infection.

"[House File 44] is not going to see the light of day," says Dubuque Democratic Rep. Pat Murphy, who introduced the bill. "I would argue there's a lot of groups opposed to it. They've been working to bottle it up, and they've been successful at this point."

One of those groups is the Iowa Hospital Association, which lobbies on behalf of the hospital industry at the statehouse. In its position statement on the bill, the IHA wrote that, "...reporting raw infection rates does not create fair comparisons between rural and urban hospitals," and added that House File 44 "would provide little meaningful public data and could actually encourage under-reporting of infections."

"I think our primary problem was that it was a cookie-cutter piece of legislation," expounds IHA spokesman Scott McIntyre, "a template piece of legislation from a national advocacy group that didn't really even think to address... the needs in Iowa. I think given the amount of time it received at the legislature, which was very little, legislators realize that as well."

The national advocacy group to which McIntyre was referring is McGiffert's group, Consumers Union, which has provided sample legislation for states to use in their efforts toward public reporting. The IHA and other Iowa health organizations say the language will score hospitals on an uneven playing field and, what's more, the resulting public statistics will be worthless.

For example, it's futile to compare a large metro hospital that houses a busy E.R. and entire floors devoted to highly complex surgical procedures, to a small county hospital that performs only two or three complex, invasive surgeries per year.

Furthermore, the bill's opponents fear that under a "bottom-line" reporting system, hospitals that admit high-risk patients - low-income, elderly, kids with terminal illnesses, AIDS patients, anyone with a weakened immune system - will be unfairly penalized.

House File 44, McIntyre says, would compare "meaningless apples to oranges."

"If you're just going to report a number, a bottom-line number, that can be very misleading," he says. "There's been no agreement, at this point, on how to come to that number, in Iowa or nationally."

Indeed, Iowa isn't the only state to agonize over infection-reporting standards. Thanks in part to the tenacity of Consumer's Union, as well as national coverage on "60 Minutes," "20/20," and in USA Today, The Washington Post and The New York Times, the issue is beginning to show up on the national radar.

So far, Pennsylvania is the only state to pass legislation and actually begin collecting data for a public report card; McGiffert of Consumers Union estimates that the first numbers will be available next year. Illinois, Florida, Missouri and New York also have passed legislation and are working out the technicalities of implementation. (In 2004, a public-reporting bill passed the California legislature, but was vetoed by Gov. Arnold Schwarzenegger, who argued that existing infection surveillance efforts were adequate.) And at least 30 more states currently have bills percolating in their state legislatures.

Just this week, the U.S. government began holding hearings on the matter in the House of Representatives' Subcommittee on Oversight and Investigations, although most discussion at the federal level deals with the skyrocketing costs of treating hospital-acquired infections. Preliminary results in Pennsylvania found that Medicare or Medicaid footed the bill for 76 percent of infections, McGiffert says. And the CDC estimates that it costs taxpayers $5 billion annually to clean up after hospital infections.

Although Iowa's House File 44 is flat-lined for now, its sponsors are determined to resuscitate it in the near future.

"I know nothing has come of it, but the idea is out there, and I'm willing to work with the hospitals and whoever to make it a better bill for them, more acceptable to them," Gaskill says. "I'm interested in working on it next session."

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For all of the contentious political debate swirling around hospital-acquired infections, the frontlines of the issue are even dirtier - literally.

Troy Wernimont can attest to this firsthand. In 2003, as he was driving home from a Dubuque bar, his pick-up was T-boned by a newspaper-delivery truck, hurling the then-26-year-old construction worker out of his vehicle and onto his left hip.

He was flown to the University of Iowa Hospitals and Clinics in Iowa City, where doctors opened him up from "his breast bone to his pelvis," says his mother Rhonda. Troy suffered severe damage to his spleen, kidneys, pancreas and liver, as well as major breaks in his hip and pelvic bones.

"They left him lay there for 15 days with a broken hip and pelvis," Rhonda recalls. "About the ninth or 10th day, I started asking, 'Why aren't you doing anything about the hip? He wasn't able to move his legs or his feet. We weren't sure if he had done damage to the spine."

Less than a week later, Troy's white blood cell count skyrocketed, indicating the presence of infection. Doctors operated and removed significant portions of his leg and buttock muscles, leaving a "huge gaping wound," his mother says. To be fair, she adds, hospital staff warned Troy and his family that it would be challenging to keep that massive a wound infection-free.

But the Wernimonts never dreamed just how daunting it would prove to be. Troy eventually contracted MRSA, as well as another virulent superbug, VRE. Rhonda calls the hospital's infection-control efforts "a joke." Mother and son agree that the repeated attacks of infection that have plagued Troy in the years since the accident - and ultimately, necessitated the amputation of his left leg, hip and a piece of his pelvis - were largely preventable, if hospital staff had practiced due diligence and better sanitation habits.

She ticks off a laundry list of examples:

While Troy was battling one bout of highly contagious infection, his family had to wear gowns and gloves when they visited his hospital room. Purses, bags and outside packages were prohibited. Yet doctors, trailed by a troupe of med students, would often stride into the room, sans gowns and gloves, and examine Troy with bare hands. And family members were permitted to place Troy, his bedclothes and his blankets in a rolling chair and "take him anywhere in the hospital, including outside" Rhonda says.

In another case, the toilet in Troy's bathroom backed up, and the maintenance worker called in to fix the problem pulled a filthy clod of baby wipes and toilet tissue from the latrine. Rhonda says she watched as the woman carried the soggy mess through Troy's room and out into the hallway for disposal.

"It was literally dripping VRE all over his room," Rhonda charges. "I mean, VRE is spread through bowel movements."

As Troy was preparing to be wheeled down to surgery to clean out yet another infection, Rhonda remembers tearfully pleading with one hospital staffer not to dress Troy in the same contaminated clothing he'd been wearing before the operation.

"I would say things to them, and they would look at me like, 'What's wrong?'" Rhonda says. "I could not believe it. I mean, how do you deal with that?"

"We weren't looking for these things at first," Troy adds. "Until we realized, something is going on around here. Then we started keeping our eyes open. You think you can trust people like that."

Like Patti Brush-Stalzer, the Wernimonts were shocked to learn that a vast majority of hospital-acquired infections should never happen in the first place. According to Consumers Union, steps as commonsensical as hand washing or proper catheter insertion can thwart up to 70 percent of the deadly germs.

"Hand-washing is really basic," McGiffert says. "And yet most of the studies on hand-washing show that compliance among doctors and nurses is about 50 percent."

"Some [prevention techniques] are very simple," agrees Dr. Michael Tapper, a leading infectious-diseases expert who practices in New York City, and who sits on a CDC infection-advisory committee, "but try to get people to change behaviors. Behaviors are the hardest thing to change. The best thing you can do is to create a culture around it."

Tapper is a champion of public transparency; in fact, he helped to draft model legislation (separate from Consumers Union's sample legislation) for states to consider as they enact public-reporting laws. However, he says, healthcare workers are human, too, and despite deterrence efforts, germs likely will continue to plague hospitals, as they have throughout time.

"Having a hospital infection is a bad thing, and we should try to reduce them to the extent we possibly can," he says. "I think patients want to know what's going on, but one also has to expect that people understand that what happens is not necessarily someone's fault or a symptom of bad care."

Still, wondering whether their tragedies could have been prevented by something as mindless as hand washing haunts the Brush and Wernimont families. Both have considered legal action, but they know it would be an uphill battle.

Fredd J. Haas, a Des Moines attorney who specializes in malpractice and medical negligence, says hospital-acquired infection suits are tricky to prosecute.

"In a lot of cases, you can't identify where the infectious host came from," he says. "The sources of infection can be through contaminated instruments, passed from hospital staff to patient, but it can also be passed from the patient's visitors to the patient."

Haas says he is seeing more and more clients whose lives have been devastated by MRSA and other drug-resistant mutations of hospital-originated infections.

"Even though we are developing new strains of infections that are harder to treat, that does not mean that anyone involved in the recognition and treatment of the problem should not do all they can to either reduce its occurrence or timely treat it once it happens," he says.

"When it comes to that type of problem, the patient is really in a position where he or she is relying on the medical profession to do it right."

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Does the epidemic of hospital-acquired infections stem from blatant laziness by those pledged to "first do no harm," as some critics charge? At least 79 Iowa hospitals seem determined to prove otherwise.

These facilities, including Broadlawns and Mercy Medical Centers in Des Moines, have voluntarily signed on to battle hospital infections through the 100,000 Lives Campaign. Launched by the national Institute for Healthcare Improvement, the campaign has persuaded 3,000 hospitals throughout the U.S. to take a serious look at life-saving prevention strategies.

The organization offers six recommendations - from faster diagnosis of infections to post-surgical antibiotic courses to, yes, hand-washing - and hospitals can choose to implement one or all of the suggestions.

McIntyre, of the Iowa Hospital Association, favors this system of enforcement, rather than etching it into law with mandatory public reporting. When asked if he was worried that some hospitals would fudge their results or simply refuse to report, McIntyre says he trusts that the industry itself will root out noncompliant institutions.

"There's a pretty good reception from hospitals, and there will be pressure on those that don't report, or those that are off the mark too far. I think that will be addressed via peer pressure.

McGiffert isn't so sure. While she concedes that any attempt to reduce infection deaths is a positive step, she doesn't trust hospitals to willingly come clean on how dirty they truly are.

"When it comes to reporting for public purposes, hospitals will be very resistant and cautious," she says. "A lot of hospitals want everything to be voluntary, but that leaves the public with gaping holes in the information we have.

"There are so many infections that can be prevented. We want to see hospitals make that happen, but the public has a role in making that happen, too." CV

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