LI man's ordeal shows perils of hospital infection

Paul Dlug from Miller Place sits in his Paul Dlug from Miller Place sits in his kitchen with a stack of some of his medical bills. Paul Dlug is a retired chairman of mathematics who lost a year and a half of his life due to a hospital infection following surgery for his broken hip. (Nov. 7, 2011) Photo Credit: Randee Daddona

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Paul Dlug, a retired mathematics teacher, was having more fun than he had experienced in years dancing with his wife, Rita Marie, when he tripped over a chair and broke his hip.

"I was at a St. Patty's Day dance," said Dlug, 66, of Miller Place. "I didn't see that chair."

His fall in the spring of 2010 marked the beginning of a health care nightmare, Dlug said, one that robbed him of almost a year of his life.

He acquired a staphylococcus -- staph -- infection at John T. Mather Memorial Hospital in Port Jefferson, where he underwent emergency hip-replacement surgery. The bacteria probably came from his skin, Dlug and his doctor said.

Harmless on the skin, staph can turn deadly when it burrows deeply, spreads throughout the body and coats an implant, according to Dr. Geoffrey Westrich, an orthopedic surgeon who helped cure Dlug.

 

Long, painful recovery

Dlug was confined for 38 days in three different hospitals, including Mather, because of the infection. He spent eight weeks on potent antibiotic therapy; eight months in a wheelchair, and eight more weeks undergoing physical therapy.

"It felt like a knife going through my leg," Dlug said of the excruciating pain caused by festering staph.

Dlug is one of 18,572 patients in New York State who contracted a health care-linked infection in 2010, the most recent year for complete statistics. About 2,856 of those infections occurred in Long Island health-care facilities, according to state figures.

These infections can be caused by lapses in protocol, contaminated equipment and sloppy hygiene. Hospital bacteria can lurk almost anywhere -- on patients, the hands or uniforms of health care workers, medical instruments, on bed rails or curtains.

The state and Long Island totals include infections linked to hip, colon and coronary bypass surgeries; infections associated with catheters, and infections caused by the emerging bacterium, Clostridium difficile.

While infection rates for two of the three forms of surgery tracked by the state had declined since 2008, the rate for hip replacements has remained steady -- about 1.1 infections per every 100 procedures.

That rate ranks as one of the lowest nationwide, but experts say infections from these procedures can cause extraordinary pain, exceptional expense and in some cases the loss of mobility, and even life.

More than 26,000 hip replacements were performed statewide in 2010, state records show, and 294 infections occurred as a direct result. Fifty-three of those infections, or 18 percent, occurred on Long Island.

One of those was Dlug's.

"I wasn't doing well for some time, months," Dlug said, recalling his postoperative ordeal. His daughter, who attends chiropractic school, he said, left temporarily to take care of him at home because of his need for round-the-clock care.

He doesn't blame Mather, saying doctors did their best under pressure. Still, the mathematician said he's mindful of being a statistic in one of the biggest battles waged today in hospitals: the fight against microbes.

"We consider a post-op infection a catastrophic event," said Raymond Luttinger, Mather hospital's infection control coordinator.

"It is something we don't want to see and we will go to any lengths to prevent. Luckily, for us it's a rare event," Luttinger said, adding there was only one at Mather in 2011.

 

Tracking infections

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There were three infections related to hip replacements performed at Mather in 2010, the year Dlug was infected, according to state statistics.

During that year, Mather performed 85 hip replacements. By comparison, Stony Brook University Medical Center conducted 230 hip procedures and reported zero infections. North Shore University Hospital in Manhasset reported 11 infections after 391 hip operations. Stony Brook and North Shore perform the most hip replacements on Long Island.

The Centers for Disease Control and Prevention estimates nearly 2 million people nationally -- about 1 in 20 patients -- are infected in health care facilities annually, and nearly 100,000 die.

Infection deaths are not tracked in New York, state Health Department spokesman Pete Constantakes said, because it's impossible to determine whether a patient died of an underlying medical condition or the hospital-related infection.

Clostridium difficile, often written as C. diff, accounted for most health care-linked infections in 2010 statewide, 16,053.

Constantakes said 5,928 C. diff infections were detected in newly admitted patients who imported the organism into hospitals, while 10,125 people contracted the infection in health care facilities.

Treatment costs for all types of hospital infections add at least $28 billion annually to the nation's health care bill, about $15,000 per patient, the CDC says.

Numerous infection control initiatives have been sponsored by the Greater New York Hospital Association, the nonprofit that represents the state's 224 public and private hospitals. The association's most recent statistics reveal their programs are helping to beat back potentially dangerous bacteria.

For example, 53 percent of participating hospitals in 2011 reported "zero" central-line catheter infections for six or more consecutive months as a result of the association's protocols, spokesman Brian Conway said.

Striving for an infection rate of zero in all areas of hospital care is a perennial goal, infection control experts say. "We are always chasing zero," Luttinger said.

 

Goal can be elusive

Yet doctors note that when implant surgery is involved, reaching zero can sometimes prove elusive.

"There will always be a risk of infections when you place foreign bodies in people," said Dr. Bruce Farber, chief of infectious diseases at North Shore University Hospital in Manhasset. "When you get a deep infection in a hip or knee [replacement joint], it can be very, very difficult for the patient," Farber said.

At the Hospital for Special Surgery in Manhattan, which performs the largest number of joint replacement operations in the state, doctors have achieved one of the lowest infection rates in the country -- 0.5 percent per every 100 operations.

Surgeons there wear spacesuit-like surgical garb, equipped with its own air supply. The surgical table is surrounded by a Plexiglas shield.

Westrich, who is co-chairman of the hospital's infection control committee, helped cure Dlug of his staph infection by removing the artificial hip implanted at Mather and inserting a new joint.

It was a laborious undertaking, Westrich said, performed in stages over many weeks to prevent the infection from coming back.

"A lot of patients think if they get an infection they can just get some antibiotics and the infection will go away," Westrich said. "But bacteria are very smart now.

"They stick to artificial implants whether it's a knee, a hip or heart valve and form a slime layer on the implant. This prevents the antibiotics from killing them.

"The only way to solve the problem," Westrich added, "is to take the prosthesis out."

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