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In January, the Centers for Disease Control and Prevention launched an urgent public alert regarding a deadly bacterium, resistant to virtually all known antibiotics, which has made over a dozen Americans operated on. elective surgery at the Grand View Hospital in Tijuana, Mexico.
But when similar outbreaks occur in hospitals located on US soil, the C.D.C. do not make such a public announcement. Indeed, in the context of its agreement with the States, the C.D.C. It is forbidden to publicly identify hospitals that are struggling to contain the spread of dangerous pathogens.
The rise of a drug-resistant fungus called Candida auris, at the center of a New York Times report last weekend, has raised new questions about the secrecy surrounding infectious outbreaks in US medical institutions .
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Patient advocates say hospitals and health authorities are often slow to alert the public to drug-resistant germs, potentially putting patients at risk.
"They might not get up and go to another hospital, but patients and their families have the right to know when they are in a hospital in the event of an outbreak," said Lisa McGiffert, of the Action Network for Patient Safety. "That said, if you have to undergo hip replacement surgery, you can choose to go somewhere else."
Kevin Kavanagh, chairman of the Health Watch USA advocacy group, contrasted the TDC's treatment of Tijuana infections with an outbreak in 2016 of another drug-resistant pathogen known under the name Carbapenem-resistant Enterobacteriaceae, in a rural hospital. in Kentucky. It is only at the beginning of 2018 that the CSD.C. published a report on this outbreak – and even then the agency did not name the hospital where it occurred.
The CRE sometimes kills up to half of those infected. No deaths were reported in the Kentucky outbreak, but at least two dozen patients in the hospital were infected with the virus, which means they were not sick but could have passed it on. 'other.
The report identified a cleaning cart as a possible source of spread of the pathogen, which had traveled between the hospital emergency room and its surgery department.
C.D.C. refused to comment, but in the past, officials said their approach to confidentiality was needed to encourage cooperation from hospitals and retirement homes, who might otherwise seek to hide infectious outbreaks.
Those who advocate greater transparency say they are confronted with powerful medical institutions wishing to protect their reputation, as well as with state health officials who also protect hospitals from public scrutiny.
In California, Sen. Jerry Hill, a long-time Democrat and advocate for tougher restrictions on antibiotic use, has been stuck in his efforts to improve industry reporting of drug-resistant infections. A bill that he presented to the state legislature would have required hospitals to regularly disclose resistant infections and deaths. In 2017, the Senate passed the bill, 40-to-0, but it had powerful opponents, including the California Hospital Association, the Infectious Disease Association of California, and the state's Department of Health. The bill was then sent to the Assembly, where last year it was blocked for want of support.
Federal legislation to combat antibiotic resistance through enhanced surveillance and better data collection is also blocked. The bill, introduced by Senator Sherrod Brown, Democrat of Ohio, has not yet emerged from a Senate health committee. "We have not considered this looming crisis by doing nothing," said Senator Brown.
Hospital administrators and public health officials said the focus on greater transparency was flawed. Dr. Tina Tan, a leading epidemiologist at the New Jersey Department of Health, said that it would not be helpful to warn the public of hospitals where cases of Candida auris have been reported because the most people were little exposed to the risk of exposure and that public disclosure could scare people. far from seeking medical care.
"This could pose greater health risks than those of the body itself," she said.
Nancy Foster, vice president of the American Hospital Association responsible for quality and patient safety, agreed, saying that publicly identifying health care facilities as being at the origin of An infectious focus was an imperfect science.
"It's a lot of information to pass on to people," she said, "and many hospitals are big places. Therefore, if an outbreak occurs in a small unit, a patient who goes to an outpatient surgery center may not be in danger.
Nevertheless, hospitals and local health officials sometimes hide epidemics even when their disclosure could save lives. Between 2012 and 2014, more than three dozen people in a Seattle hospital were infected with a drug-resistant organism from a tainted medical system. Eighteen of them died, but the hospital, the Virginia Mason Medical Center, did not reveal the outbreak, stating at the time that it was did not see the need for it.
Art Caplan, a bioethicist at the NYU School of Medicine, said the issue of full disclosure could be tricky, especially when large hospitals that host a significant number of critically ill patients are compared to smaller facilities. "If you are a hospital of last resort, you will meet repeat clients with serious infections, most of whom are resistant to drugs," he said.
Nevertheless, he thought that it was better to promote transparency. Public awareness of life lost because of drug-resistant infections, he said, could put pressure on hospitals to change how they manage infection control.
"Who is talking about the stuck baby of a hospital employee or patient who has contracted MRSA?" He asked, referring to a life-threatening bacterial infection. "The idea is not to embarrass or humiliate anyone, but if we do not draw more attention to the epidemics of infectious diseases, nothing will change."
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