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Dead reckoning: 98,987 patients die in single year
"So many, I had not thought death had undone so many."
— T.S. Eliot, The Wasteland
Let's not round it off to a cool — make that cold — 100,000 deaths. No, leave it as it lies: 98,987 people with health care-associated infections (HAIs) listed as a contributing cause of death over the span of a single, miserable year.
None shall know what that breaks down to in numbers of grieving but never-to-be-the-same survivors — be they parents, siblings, widows, or orphans. The devil has those details, and we can but stare blankly at those five digits, a number that epidemiologists and their computers arrived at that is:
The 100,000 annual infection deaths has been used as a stark estimate for years, but the Centers for Disease Control and Prevention recently published an elaborate analysis that gives us the more chillingly precise 98,987 for the year 2002.1 According to the authors, the main source of 1990-2002 data was gleaned from the CDC's National Nosocomial Infections Surveillance (NNIS) system. In addition, data from the National Hospital Discharge Survey (for 2002) and the American Hospital Association Survey (for 2000) were used to supplement NNIS data. The percentage of patients with an HAI whose death was determined to be caused or associated with the HAI from NNIS data was used to estimate the number of deaths, the authors explained.
In other words, it still is a dead reckoning based on statistical analysis of surveillance data and other sources, but somehow arriving at an exact number has a humanizing effect. These lives may have ended but they have not been rounded off. Researchers estimated that a staggering 1.7 million patients had an HAI that year and 155,668 of them died. The aforementioned 98,987 were those cases where death was caused by or associated with the HAI. The death totals included 35,967 for pneumonia, 30,665 for bloodstream infections, 13,088 for urinary tract infections, 8,205 for surgical site infections, and 11,062 for infections of other sites. Need we remind that there was nothing particularly unusual about 2002, and that death toll may represent an underestimate. "Our death estimate is limited in that attributable mortality is often difficult to determine from a patient's records," the CDC researchers concluded.
What is not difficult to determine is why people — consumer advocates, legislators, patients — stare in blank disbelief at such numbers. They may be told that some of the 2002 dead were no doubt very sick patients being kept alive by medical interventions that would not have been possible in past years. Some infections are inevitable, the deaths to follow unavoidable. Perhaps, but there is another common answer to the inevitable "why?" that loses epidemiological rigor, sounding almost criminally trivial: Too often, health care workers do not wash their hands between patients. There it is, and even with a thousand infection control presentations somewhere still echoing as evidence, it still seems far short of an acceptable explanation. And for that matter, not much of an epitaph.
— Gary Evans, Editor