25 October 2007

Screening That Works

Terrorist screening doesn't work. Germ screening apparently does, despite doubts that it would from health professionals.

[T]he staph germ called MRSA [pronounced Muhr-suh, which stands for methicillin-resistant Staphylococcus aureus]. . . . causes dangerous infections that sicken more than 90,000 Americans each year and kill nearly 19,000. . . . People in health care settings, like hospitals and nursing homes, are most at risk for MRSA infections. Doctors and nurses who treat staph-infected patients and then don't carefully wash up can spread the germ to other patients. Germ-contaminated medical devices used on people having dialysis or medical procedures also can spread staph. [It] has been around for decades and in recent years has spread to schools, prisons and crowded public housing projects. . . . Other worrisome bugs include C-difficile (an intestinal infection), vancomycin-resistant Enterococcus (linked with intestinal, skin and blood infections), and drug-resistant Acinetobacter (which can cause pneumonia, skin and blood infections); none of them accounts for more than 10 percent of hospital infections [the percentage caused by MRSA]. . . .

[I]n Pittsburgh. . . the Veterans Affairs hospital tested new patients for staph, using a nose swab. They isolated those who had the germ, and annual infection rates fell from about 60 to 18 cases . . . The staph bug used to cause "occasional" deaths, but no patient has died since 2005 when testing of all patients began[.] . . . In May, the VA began putting a $28 million testing system in place for all 155 hospitals. . . . Denmark, Iceland, Norway, and the Netherlands have reduced their MRSA rates and all test high-risk patients . . . . [S]ince 2005 at three Chicago area hospitals in the Evanston Northwestern Healthcare system [test all patients]. There, the MRSA infection rate has dropped 60 percent . . . at the VA hospital in Pittsburgh . . . . The rates for other hospital-acquired infections also fell after MRSA testing began. Why? The testing may have caused hospital workers to pay more attention to hand washing and other prevention efforts[.]

Experience has show that one of the most important cognitive biases of most doctors is to underestimate the benefits and importance of good systems. The VA is one of the few bastions that takes a strongly systems oriented approach instead and because of this approach achieves good results despite having some of the lowest paid doctors in the country.

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