The State Comptroller's report reveals: at least 4,000-6,000 Israelis die from infections from resistant bacteria contracted in hospitals every year

At least a thousand of these deaths could have been prevented. If they had maintained hygiene, something that, according to the auditor, was avoided due to the heavy burden on the employees of the medical system

State Comptroller Yosef Shapira revealed yesterday (Wed) in the first annual report he submitted to the Speaker of the Knesset about deficiencies in the Ministry of Health, including many infections in hospitalization institutions and in the community. This is due to infection of patients with antibiotic-resistant bacteria during routine medical treatment.

The State Health Insurance Law states that the health services included in the "basket of health services" will be provided of reasonable quality. Reasonable quality means, among other things, under conditions that will not cause unnecessary harm to the patient.

"In recent decades, an increase in the rate of infections caused by bacteria, fungi and violent viruses, which harm patients hospitalized in hospitals, has been observed in the world and in the State of Israel. According to the professional literature, infections caused by pollutants present in the hospital affect 7%-10% of all hospitalized patients. A large part of the infections acquired in hospitals can be prevented."

"In 2006, there was an outbreak in Israel of the Klebsiella bacterium, resistant to many drugs; Hundreds of patients were affected by it and some died as a result. Following this, in 2008 the Ministry of Health established a national unit for the prevention of infections and resistance to antibiotics that operates within the framework of the National Center for the Prevention of Infections in Medical Institutions and the Prevention of Antibiotic Resistance. . The national center establishes national policy, standards and methods of intervention in epidemics and emerging diseases. The national unit deals with epidemiological research and works with the medical institutions and the community.

audit operations

In the months of January-August 2012, the State Comptroller's Office inspected, alternately, the activities of the Ministry of Health, the government general hospitals, the government-municipal general hospitals and the general hospitals of Klalit Health Services; and the health funds: the general, Maccabi Health Services, United Health Fund and National Health Services to reduce the phenomenon of infections and its damage. The activities of the Office for the Regulation of Infection Prevention, the activities of the government general hospitals, the government-municipal hospitals and the general hospital for infection prevention were examined - the existence of procedures and how they are implemented. For this purpose, the state auditor's office sent a questionnaire to 18 hospitals. Inquiries were also made with experts dealing with infection prevention in other public hospitals and academia.

The main findings

Lack of data regarding infections and direct mortality from them

According to a calculation made by the National Center in 2012, the number of deaths related to infection acquired in hospitals from bacteria resistant to or sensitive to antibiotics in Israel is estimated at approximately 4,000-6,000 patients per year. According to the same calculation, it is possible to prevent between a quarter and three quarters of the infections acquired in the hospitals, that is, about 1,000 to 4,500 deaths. In most hospitals there are no data on direct mortality from acquired infections; There is no clinical follow-up by an infectious disease specialist for all patients with acquired infections; There are no references regarding the deaths and the reasons for this because the Ministry of Health does not require it.

The causes of multiple infections in medical institutions

1. Poor hand hygiene: The compliance of the care staff to the instructions regarding hand hygiene is the most effective way to prevent the transmission of pathogens. According to the hospitals' reports to the State Comptroller's Office, the reason for the "heavy load on the staff" is the common explanation for the low responsiveness of the medical staff to strict hand hygiene.

2. Lack of awareness of the public visiting hospitals: The hospital managers told the State Comptroller's office that the large number of visitors and the lack of knowledge of the visiting public about what is allowed and what is prohibited when visiting patients in the hospital contribute to the transmission of infections.

3. Hospitalization conditions and lack of manpower: Due to the overcrowding in the hospital rooms, ward corridors and departmental dining rooms, and the burden on the nursing staff, the risk of the patients becoming infected, among other things, with resistant bacteria also increases. The control reports of the national unit indicate that due to a lack of storage spaces, clean medical equipment intended for the treatment of hospitalized patients is stored near a contaminated area, such as an area where dirty laundry carts and a potty room are concentrated. Also, there is no directive according to which any activity of building or renovating buildings will be done in collaboration with an infection prevention expert to ensure that the hospital spaces and the storage spaces for the items used by the department will be designed and built in a way that prevents the transmission of infections.

4. Absence of patient isolation: (a) Before hospitalization - the audit revealed that contrary to the guidelines of the Ministry of Health, the hospitals do not have preliminary isolation for the majority of patients who are feared to be carriers of pollutants. This is due to physical distress (lack of isolation rooms) and the lack of manpower to isolate and treat patients suspected of being carriers.

(b) During hospitalization - the audit revealed that, given the conditions of hospitalization and the burdens existing in the hospitals, it is not possible to guarantee hospitalization under isolation conditions for every patient who requires such hospitalization.

It was found that the ministry does not have verified data on the extent of patients who are not hospitalized in isolation as required: either before hospitalization until it is proven that they are not carriers or during hospitalization, after it has already been found that they are carriers. The hospitals told the state comptroller's office that about 75% of the patients for whom hospitalization under isolation conditions is required are given the conditions. On the other hand, the national center estimates, as of 2012, that less than 25% of all patients who according to the literature should be isolated stay in a solitary room.

The Ministry of Health's response: "In our opinion, the number of deaths as a result of infections already embodies the results of the Ministry's intensive efforts, and actually reflects the situation after prevention. In recent years, the hospitals have invested over 150 million NIS in the purchase of infection prevention equipment and have carried out information and training programs for staff. The importance of the issue within hospitals is steadily increasing. The ministry has set a goal to lower the rate of acquired infections and has outlined a plan and tools to achieve this, and the director general of the ministry is personally dealing with the issue."

"The situation described requires the hospitals to be extra careful. Following the auditor's comment, the ministry appointed a committee with the aim of developing guidelines on the wise use of antibiotics, and 'permissible and prohibited' rules when visiting hospitals and other hospitalization institutions."