TUESDAY, JULY 13, 2010


KLMNO POLITICS THE NATION & Basic practices could help prevent hospital infections


Survey finds lack of knowledge, resources leads to needless deaths


by N.C. Aizenman


Deadly yet easily preventable bloodstream infections continue to plague American hospitals be- cause facility administrators fail to commit resources and atten- tion to the problem, according to a survey of medical professionals released Monday. An estimated 80,000 patients per year develop catheter-related bloodstream infections, or CRBSIs — which can occur when


tubes that are inserted into a vein to monitor blood flow or deliver medication and nutrients are im- properly prepared or left in lon- ger than necessary. About 30,000 patients die as a result, according to the Centers for Disease Control and Prevention, accounting for nearly a third of annual deaths from hospital-acquired infections in the United States. Yet evidence suggests hospital


workers could all but eliminate CRBSIs by following a five-step checklist that is stunningly basic: (1) Wash hands with soap; (2) clean patient’s skin with an effec- tive antiseptic; (3) put sterile drapes over the entire patient; (4) wear a sterile mask, hat, gown and gloves; (5) put a sterile dress-


In Ala., bucking the outrage


over spending Democratic congressman leads in polls


by Amy Gardner in montgomery, ala.


F


or a first-term Democrat in a solidly Republican district, Rep. Bobby N. Bright did something curious on a recent


weekday morning while speaking at a Kiwanis Club breakfast: He talked about the goodness of fed- eral spending. Even more curious, perhaps, is


that his audience didn’t mind. Bright, a dry-witted former


mayor of Montgomery, looks on paper like one of the most vulner- able Democrats in Congress, with a winning margin in 2008 of just 1,700 ballots, a district that Sen. John McCain (R-Ariz.) took in that year’s presidential election with 63 percent of the vote, and a constituency deeply unhappy with President Obama and Dem- ocrats in Congress. But Bright, 57, is well liked in southeastern Alabama’s 2nd Con- gressional District. In the most recent polls, he has a double-digit lead over the Republicans vying to face him in the fall. And he’s running ahead with- out riding the anti-government wave sweeping the nation. In some ways, he’s practicing the op- posite: rattling off the schools, bridges, unpaved roads and sewer systems that need funding; cele- brating the jobs that two big local military installations bring; pro- moting earmarks for agricultural research. It’s a reminder that in some places, even among conser- vative voters, “government” and “spending” are not necessarily dirty words. “Keep in mind, Alabama is a poor state,” Bright told a noon- time crowd last week at Wetump- ka City Hall, about half an hour north of Montgomery. “I will nev- er turn my back on resources communities need just because a political party has asked me to do so for political reasons.” Elsewhere in the nation, simi- larly conservative but struggling


areas offer parallel political dy- namics. In western Pennsylvania, for instance, Democrat Mark Critz overcame a powerful anti- Washington tide in May to win a special House election to replace the late John P. Murtha, whose prowess in securing earmarks had been widely hailed across the economically depressed region. The test is yet to come in Ken-


tucky, where Republican Senate candidate and “tea party” favorite Rand Paul has talked of weaning the grindingly poor eastern off its dependence on government. His Democratic opponent, state At- torney General Jack Conway, has said that Paul’s rejection of ear- marks would hurt Kentucky. National Republicans seem to recognize the peril of such con- trasts. Their chosen candidate to challenge Bright, Montgomery City Council member Martha Ro- by, has avoided direct critiques of him and has framed her cam- paign almost entirely against the policies of Washington. Roby, 33, will face tea party candidate Rick Barber in a runoff Tuesday. Barber, 35, who gained nation-


al attention for a TV ad in which Abraham Lincoln compares fed- eral spending policies to slavery, has gone after Bright more direct- ly for not supporting a repeal of the health-care overhaul and for being part of House Speaker Nan- cy Pelosi’s majority. If he scores an upset Tuesday, the fall race will shape up more clearly as a refer- endum on Bright.


Litmus tests Bright’s popularity among con-


servatives is about more than ear- marks. A member of the conser- vative Blue Dog Coalition of House Democrats, Bright passes many of the right’s litmus tests, opposing new taxes and spend- ing, and voting against the stimu- lus package, the budget, the health-care bill and even the Lilly Ledbetter Fair Pay Act, whose namesake is an Alabaman. “My values are your values,” Bright told the Kiwanis breakfast


ing over the catheter site. The approach also calls for cli- nicians to continually reconsider whether the benefits of keeping the catheter in for another day outweigh the risks and to use electronic monitoring systems that allow them to spot infections quickly and assemble a rapid re- sponse team to treat them. Afederally funded program im- plementing these measures in in- tensive-care units in Michigan hospitals reduced the incidence of CRBSIs by two-thirds, saving more than 1,500 lives and $200 million in the first 18 months. Similar initiatives across the country helped bring the overall national rate of these and related bloodstream infections down by


18 percent in the first six months of 2010, according to the CDC. “Our research shows that the cost of implementing [such pro- grams] is about $3,000 per in- fection, while an infection costs between $30,000 to $36,000,” said Peter Pronovost, a professor at Johns Hopkins University School of Medicine who led the program. “That means an average hospital saves $1 million.” So why aren’t hospitals leaping to adopt these best practices? The survey released Monday, which was conducted by the Asso- ciation for Professionals in In- fection Control and Epidemiol- ogy and funded by Bard Access Systems, a maker of catheters, pointed to ignorance and neglect


at the top. More than half of the 2,075 re- spondents, most of whom were infection control nurses em- ployed by hospitals, reported that they use a cumbersome paper- based system for tracking pa- tients’ conditions that makes it harder to spot infections in real time. Seven in 10 said they are not given enough time to train other hospital workers on proper pro- cedures. Nearly a third said en- forcing best practice guidelines was their greatest challenge, and one in five said administrators were not willing to spend the nec- essary money to prevent CRBSIs. Pronovost said part of the prob- lem was that many hospital chief executives aren’t even aware of


their institution’s bloodstream in- fection rates, let alone how easily they could bring them down. When hospital leaders decide


to create a culture in which pre- venting infections is a priority, he added, nurses feel empowered to remind physicians to follow the checklist when inserting cathe- ters, physicians are provided anti- septic soaps as part of their cathe- ter kits and infection control per- sonnel have the best tools to monitor patients. “If anyone in that chain of ac- countability doesn’t work, you won’t get your [infection] rates down,” he said. “But it’s the hospi- tal’s senior leadership that is ulti- mately responsible.” aizenmann@washpost.com


S


A3


2000 PHOTO BY AMANDA SOWARDS/MONTGOMERY ADVERTISER Rep. Bobby Bright, right, who is seeking reelection, has said that because Alabama is a poor state he won’t turn his back on aid.


crowd at the Eastside Grille on the eastern edge of Montgomery. “I’m pro-life. I’m pro-gun. I’m pro-military. I’m pro-family. I’m a Christian and proud of it, and I won’t ever change.” The reaction from the right is positive. “Bobby, I’m a Barry Goldwater right-wing conserva- tive,” Kiwanis old-timer and re- tired Air Force officer Doug Speight said at the breakfast. “I’m sorry to hear that,” Bright


said. “Well, I also support Bobby


Bright,” Speight replied. “Good man,” Bright said. Speight said he likes Bright be- cause he is a “Republican mas- querading as a Democrat.” Yet that doesn’t completely capture the congressman’s pro- file. Bright said Arizona’s new im- migration law “attacks our Con- stitution” because, he says, it could encourage racial profiling. Yet his solution is not to fight the law in court, but to devote billions more in federal money to secure


the border. “Arizona is right there on the front line,” he said. “They are experiencing horrible crime every day. Not just periodically, but every day. The people elected their local leaders to do some- thing.”


Similarly, Bright won’t push to repeal the health-care law be- cause measures he likes, such as protections for people with pre- existing conditions, would be lost. He is also deeply critical of the Republican Party, saying the no- earmark promise that all five of Alabama’s GOP congressmen signed onto this year is little more than an election-year gimmick that amounts to a pledge against the state. “That’s what really makes me mad about my col- leagues,” he said. “They put their own partisan needs ahead of their constituents.”


Impoverished region If the 2nd District is ripe for


Bright’s mixture of conservatism DIGEST INTERNET


U.S. lawmaker warns of al-Qaeda magazine


An al-Qaeda magazine aims to recruit Americans to launch at- tacks in the United States with such articles as “make a bomb in the kitchen of your mom,” a senior U.S. lawmaker said Monday. The first issue of Inspire was posted online late Sunday by al- Qaeda in the Arabian Peninsula. The English-language publication includes an article by Anwar al- Awlaki, a radical U.S.-born Mus- lim cleric based in Yemen who is wanted by U.S. authorities. Aw- laki writes: “The tables have turned and there is no rolling back of the worldwide jihad movement. On the eve of 9/11 it was Afghanistan alone. Today it is Afghanistan, Pa- kistan, Iraq, Somalia, North Afri- ca, the Arabian Peninsula, and the list is growing.” The publication also has mes-


BEBETO MATTHEWS/ASSOCIATED PRESS NEW YORK


While waiting for visas, members of the Iroquois Nationals lacrosse team link hands after a meeting at Times Square. The Iroquois Indian team wants to play in the world championships in England.


sages from Osama bin Laden and his deputy, Ayman al-Zawahiri, and an article on how to send and receive encrypted messages. Rep. Peter Hoekstra (Mich.),


the top Republican on the House intelligence committee, called it “an unfortunately well-done magazine” and “a virtual how-to guide for becoming a terrorist.” —Reuters


NEW YORK


Bloomberg won’t investigate mosque


New York Mayor Michael R. Bloomberg (I) said Monday it would be un-American to investi- gate a mosque that is planned for construction near where the World Trade Center once stood. Rick Lazio, a Republican candi-


date for governor of New York, de- manded last week that his Demo- cratic rival, state Attorney Gener- al Andrew M. Cuomo, investigate the mosque being developed near the Sept. 11 attack site Lazio has refused to say wheth- er he opposes the mosque being built near the site. He said he is concerned that not enough is known about the funding sources. The ranking Republican on the


House Homeland Security Com- mittee, Rep. Peter T. King (N.Y.), said Monday that he also favors


an investigation into the funding of the mosque project. —Associated Press


2 men sentenced in Ohio soldier plot: Two cousins from the Chica- go area were sentenced to prison after admitting in federal court that they wanted to kill U.S. sol- diers in Iraq. Zubair Ahmed and Khaleel Ahmed said they became misguided after the U.S.-led in- vasion overseas.


Byrd replacement expected by Sunday: West Virginia Gov. Joe Manchin III (D) said he will ap- point by Sunday a new senator to replace the late Robert C. Byrd. Once Manchin does that, he will say whether he plans to run for the seat in November.


House in Duke rape case demol- ished: A demolition crew in Ra- leigh, N.C., tore down the house where a woman alleged she was raped by three Duke University lacrosse team members. The play- ers were exonerated by state At- torney General Roy Cooper. The house has been vacant since the allegation was made. —Associated Press


and fiscal advocacy, it is largely because of the region’s poverty. The district includes not only many of Montgomery’s impover- ished blacks but also the rural, struggling stretch of southeast- ern Alabama known as the Wire- grass Region, where Bright was born. The district is also home to Maxwell Air Force Base and the Army’s Fort Rucker, making mili- tary spending a priority. Bright’s brand of populism helps him with both ends of the district’s political spectrum. The 13th of 14 children born to a sharecropper, Bright climbed his way out of poverty by working through college and law school. He likes to tell the story of how his father once used wire to hold his shoes together.


“I remember kicking my sister in the shin, and it got infected, and she had to go to the hospital,” he told an audience at a social ser- vices center in Montgomery. “My daddy didn’t like that too much.” Still, Bright faces challenges on


the left. As mayor, he earned deep loyalty in Montgomery’s black community with a commitment to bringing the racially divided city together and with heavy at- tention to redeveloping the downtrodden downtown. But to- day, his votes against the stimulus package and the budget and his opposition to new taxes and spending make the questions tougher at the city social services center than at the suburban breakfast. “How can you cut Trio?” asked


Charles Jackson, a junior at Rob- ert E. Lee High School, referring to a federal program that helps disadvantaged students finish high school and enter college. “I’m not cutting anything,” Bright responded quickly. But he added: “We can’t continue the ex- penditures that we’ve become ac- customed to. We can’t raise taxes. We can’t continue to borrow. We’ve got to look at cutting waste- ful spending.”


gardnera@washpost.com


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54