3 ms·

I want to see studies to measure the impact of disease transmission in a hospital. Pick a random (perhaps new) hospital, and make every patient live in their o

I want to see studies to measure the impact of disease transmission in a hospital. Pick a random (perhaps new) hospital, and make every patient live in their own sealed plastic bubble. No air goes in or out - instead it is recirculated per-patient like a space station. Make staff wear hazmat suits. Then, after a few weeks, compare patient outcomes.

userinanother 3y ago
Hospitals in the USA are not super concerned about patient outcomes at the administrative level. Everyone just wants to be middle of the road “good enough” to not get sued for negligence. There isn’t really any incentive for doing better than that and it costs a lot to be better
- snitty 3y ago
  Hospitals in the US are actually pretty concerned with hospital acquired infections. For the sole reason that medicare/medicaid and insurance typically don't cover costs associated with them. So the hospital itself is on the hook for diagnosis, treatment, and any associated costs.
  - rubyfan 3y ago
    Does this create a moral hazard to not diagnose?
    - JoshTko 3y ago
      Yes
      - networkchad 3y ago
        [dead]
    - haldujai 3y ago
      Not really because moral hazard occurs when you’re protected from consequences. Missing an early nosocomial infection means you’re now on the hook for very long admissions with expensive treatments and interventions. Personal experience in US academia also suggests not, far more concern for early diagnosis of infection and IPAC than I saw practicing in Canada.
  - giantg2 3y ago
    "Hospitals in the US are actually pretty concerned with hospital acquired infections." Some more than others.
- londons_explore 3y ago
  The goal wouldn't even be to be better - it would be to measure how much benefit could be had with perfect biological isolation, so that we could decide where on the cost/effort/benefit scale to put our hospitals.
- Scoundreller 3y ago
  USA might be best in the world for this, as they look at 30 day réadmission and 30 day post-discharge mortality for various conditions. Of course these stats have their own gameability, but good luck getting this level of data elsewhere.
Teever 3y ago
I worked at a hospital years ago and during the orientation session we had a speaker tell the audience that 1/8 pepe who go into the hospital will acquire an infection from the hospital.
- londons_explore 3y ago
  My n=1 experience is that every time I walk into a hospital (even just to visit nana for an hour), a few days later I find myself sick... I suspect that the true figure for hospital acquired infections is far higher than 1 in 8, but that they are only recorded if the infection is serious enough to cause immediate medical treatment to be necessary.
  - tobiasSoftware 3y ago
    Perhaps you should consider wearing an N95 while visiting the hospital. You can a pack on Amazon for $15 (even in stylish black), and they really aren't that bad wearing. In my opinion, the practice of wearing N95s in medical settings is the one response to Covid that should be permanent. Unfortunately even in peak Covid medical advisors were too scared to advise proper masking and settled for cloth and surgical masks, while KN95/N95 offers far more protection for yourself. Looking back, we could have done away with social distancing, quarantining, shutdowns, and all the other extreme procedures if we had just ramped up N95 production and told everyone to wear them in public while we were waiting on the vaccines.
- cjrp 3y ago
  MRSA was a big worry in UK hospitals for a while. Maybe still is, but just doesn't get the press coverage.
  - adhesive_wombat 3y ago
    From the official stats, it's about 0-5 cases of MRSA bacteraemia per NHS trust per month. When I was in hospital a few years ago, they swabbed on every admission to test for it so it's definitely a concern. https://www.gov.uk/government/statistics/mrsa-bacteraemia-monthly-data-by-location-of-onset https://www.gov.uk/government/statistics/mrsa-bacteraemia-mo...
b800h 3y ago
There are lots of ongoing experiments like this. Certain agencies maintain experimental wards for this purpose.
- corndoge 3y ago
  Can you share any more information?
krisoft 3y ago
I wouldn't be surprised if your proposal, naively implemented would lead to worse patient outcomes. Just simply the staff having to change hazmat suits between patients, porting in and out between plastic bubbles, would add a lot of overhead and less time to offer actual care. Not talking about all the risks involved with that "space station" like air recirculation. "Sorry about your grandma. She did not pick up an infection, but she died when the overworked technician forgot to replace her bubble's CO2 scrubber." Not saying that the current situation is peak optimum and the best possible. Just that infection control is not the only goal to optimise for in a hospital.
KaiserPro 3y ago
It doesn't have to be that extreme. For example, you can't run a food preparation place like a hospital. However the NHS have done studies for side rooms vs group wards. there is a lot of prior research out there.

userinanother 3y ago

Hospitals in the USA are not super concerned about patient outcomes at the administrative level. Everyone just wants to be middle of the road “good enough” to not get sued for negligence. There isn’t really any incentive for doing better than that and it costs a lot to be better

snitty 3y ago
Hospitals in the US are actually pretty concerned with hospital acquired infections. For the sole reason that medicare/medicaid and insurance typically don't cover costs associated with them. So the hospital itself is on the hook for diagnosis, treatment, and any associated costs.
- rubyfan 3y ago
  Does this create a moral hazard to not diagnose?
  - JoshTko 3y ago
    Yes
    - networkchad 3y ago
      [dead]
  - haldujai 3y ago
    Not really because moral hazard occurs when you’re protected from consequences. Missing an early nosocomial infection means you’re now on the hook for very long admissions with expensive treatments and interventions. Personal experience in US academia also suggests not, far more concern for early diagnosis of infection and IPAC than I saw practicing in Canada.
- giantg2 3y ago
  "Hospitals in the US are actually pretty concerned with hospital acquired infections." Some more than others.
londons_explore 3y ago
The goal wouldn't even be to be better - it would be to measure how much benefit could be had with perfect biological isolation, so that we could decide where on the cost/effort/benefit scale to put our hospitals.
Scoundreller 3y ago
USA might be best in the world for this, as they look at 30 day réadmission and 30 day post-discharge mortality for various conditions. Of course these stats have their own gameability, but good luck getting this level of data elsewhere.

Teever 3y ago

I worked at a hospital years ago and during the orientation session we had a speaker tell the audience that 1/8 pepe who go into the hospital will acquire an infection from the hospital.

londons_explore 3y ago
My n=1 experience is that every time I walk into a hospital (even just to visit nana for an hour), a few days later I find myself sick... I suspect that the true figure for hospital acquired infections is far higher than 1 in 8, but that they are only recorded if the infection is serious enough to cause immediate medical treatment to be necessary.
- tobiasSoftware 3y ago
  Perhaps you should consider wearing an N95 while visiting the hospital. You can a pack on Amazon for $15 (even in stylish black), and they really aren't that bad wearing. In my opinion, the practice of wearing N95s in medical settings is the one response to Covid that should be permanent. Unfortunately even in peak Covid medical advisors were too scared to advise proper masking and settled for cloth and surgical masks, while KN95/N95 offers far more protection for yourself. Looking back, we could have done away with social distancing, quarantining, shutdowns, and all the other extreme procedures if we had just ramped up N95 production and told everyone to wear them in public while we were waiting on the vaccines.
cjrp 3y ago
MRSA was a big worry in UK hospitals for a while. Maybe still is, but just doesn't get the press coverage.
- adhesive_wombat 3y ago
  From the official stats, it's about 0-5 cases of MRSA bacteraemia per NHS trust per month. When I was in hospital a few years ago, they swabbed on every admission to test for it so it's definitely a concern. https://www.gov.uk/government/statistics/mrsa-bacteraemia-monthly-data-by-location-of-onset https://www.gov.uk/government/statistics/mrsa-bacteraemia-mo...

b800h 3y ago

There are lots of ongoing experiments like this. Certain agencies maintain experimental wards for this purpose.

corndoge 3y ago
Can you share any more information?

krisoft 3y ago

I wouldn't be surprised if your proposal, naively implemented would lead to worse patient outcomes. Just simply the staff having to change hazmat suits between patients, porting in and out between plastic bubbles, would add a lot of overhead and less time to offer actual care. Not talking about all the risks involved with that "space station" like air recirculation. "Sorry about your grandma. She did not pick up an infection, but she died when the overworked technician forgot to replace her bubble's CO2 scrubber." Not saying that the current situation is peak optimum and the best possible. Just that infection control is not the only goal to optimise for in a hospital.

KaiserPro 3y ago

It doesn't have to be that extreme. For example, you can't run a food preparation place like a hospital. However the NHS have done studies for side rooms vs group wards. there is a lot of prior research out there.