08/05/2021
WHAT IS HOSPITAL-ACQUIRED PNEUMONIA? Is this tantamount to neglect of duty of the attending physicians?
This refers to an infection which developed to a patient's respiratory tract specifically in the lungs 48-72 hours after admission to a hospital. This is in contrast to community-acquired pneumonia which the patient had developed while in the community (not admitted). Otherwise known as nosocomial infection, hospital-acquired pneumonia usually happens to immunocompromised patients admitted for longer period of time. Presence of comorbid diseases such as cardiac, renal, immunologic, etc. complicate matters that put patient to serious conditions that may even cause his/her demise. Nosocomial infection may also happen to a previously healthy patient but during bouts of infection his condition rendered him/her vulnerable to hospital-related infection. A typical example is when a patient came in with severe trauma or critical pneumonia (which is community-acquired) but necessitates intubation and mechanical ventilation (putting patient on respirator). As the patient stays inside the hospital especially in intensive care unit (ICU), virulent microbes which are common resident in the ICU such as gram negative bacteria ( pseudomonas aeruginosa, haemophilus influenzae, other anaerobes) or gram positive bacteria (staphylococci such as Methicillin-resistant staphylococcus aureus otherwise known as MRSA, streptococcus pneumoniae, etc) can be contracted leading towards sepsis or widespread blood infection causing hemodynamic derangement presenting as low blood pressure or hypotension, fast heart rate or tachycardia, and disorientation which eventually lead to multi-organ failure (kidney, liver,heart) rendering patient's inability to urinate with a tendency to bleed (appearance of bruises, black tarry stools, etc.), and the patient develops shortness of breath due to accumulation of fluid in the lungs (called pulmonary congestion or edema). This might increase morbidity that may lead to patient's death. Doctors attending with this kind of patient may find it hard looking for appropriate antibiotics and other medications to reverse patient's condition. Drugs that increase blood pressure (called inotropics) can be necessary to augment patient's hemodynamics, diuretics maybe used to induce urination and to decongest the lungs from flooding of fluids, IV fluids must be properly regulated so as not to overload or dehydrate patient, electrolytes such as sodium, potassium, calcium, etc.should be regularly checked and corrected, blood gas (ABG) is also monitored to correct acidity or alkalinity of the blood as well as its oxygenation. Level of patient's consciousness is also evaluated through Glasgow Coma Scale (GCS).
Patient's watchers sometimes overheard medical terms like BUN (blood urea nitrogen) or creatinine. These are laboratory parameters for kidney function. Elevation of such kidney function tests may sometimes lead towards temporary dialysis to correct acute renal failure. This doesn't mean forever dialysis but temporary only to overcome the overwhelmed kidney of wastes (BUN, creatinine). In cases of permanent kidney damage due to prolonged kidney injury (maybe due to presence of pre-existing kidney problems such as diabetic nephropathy or indecision of relatives to subject patient to immediate dialysis) permanent kidney failure may insue leading towards chronic dialysis (dialysis forever). Time is of the essence and decisiveness is of paramount importance. Chronic renal failure sometimes happen due to delayed decision-making and poor judgment.
Critical covid patients especially those who undergo necessary invasive procedures such as intubation or tracheostomy for assisted ventilation, femoral or intrajugular venous catheter insertion for hemoperfusion and/or dialysis are vulnerable to develop hospital-acquired nosocomial infection. This is due to the fact that these procedures increase accessibility of infection to the patient. Presence of co-morbidities such as diabetes, hypertension, COPD, obesity with metabolic syndrome, etc increase likelihood of sepsis. Even how good your attending physicians are, sepsis may compromise patients that death is sometimes inevitable.
Covid patients cannot easily be discharged even with waiver against medical advice. The high virulence and communicability of SARS COV2 limit covid patients to be discharged at their will even if they sign a waiver. The law prohibits them. No doctors on their right mind especially the specialists (infectious disease, pulmonary) would neglect their duty of saving lives.To those who think being a doctor is a good money-making business, let me tell you that most of our patients are indigents that cannot even afford to buy life saving medications. Promissory notes are very much rampant that doctors cannot refuse for humanitarian reason. Patients cannot be held to hospital once recovered and discharge is ordered. Illegal detention can be filed in court to a hospital or doctor once patient is held for reason other than health. But sometimes, insurance policies can be an issue in holding patients from discharge. For example, the PhilHeath requirement of isolation with 14 days admission to hospital may delay release of patient even fully recovered.( I hope this is not for real but fake news). If this policy is true, this may add burden to both patients and the medical service provider. Problem of decongestion of the hospital and accommodation of covid patients on wait list for admission will insue. This will lead to demoralization of both health care workers and hospital management as their effort to save lives will be in vain as their Philhealth claims will be denied. More backlogs of patients on wait list for admission, hospital bills of patient will increase and unnecessary spending for patients hospital stay will bloat due to this policy. Morbidity or even death will increase due to congestion or overcrowding of hospitals. To whom shall we point our fingers? Who shall be blamed?
I hope that government leaders, policy makers and implementors,private sectors, and health care workers/providers will talk and discuss matters for the best interest of the people. Let us not make rules to avoid our obligations for the detriment of others. Let a policy be humane and God-centered so as to limit if not eliminate graft and corruption. May our mind and body be united in Him so as our thoughts and actions may reflect His goodness. God bless us all!...........................................................................
Hebrews 13:16
And do not forget to do good and share with others, for with such sacrifices God is pleased.
............................................................................
https://www.facebook.com/101187944892154/posts/313169220360691/
