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Invited Critique
July 2011

Life, Liberty, and the Pursuit of HAIs: Comment on “Increases in Mortality, Length of Stay, and Cost Associated With Hospital-Acquired Infections in Trauma Patients”

Author Affiliations

Author Affiliation: Research Medical Center, Kansas City, Missouri.

Arch Surg. 2011;146(7):801. doi:10.1001/archsurg.2011.42

In 1776, Thomas Jefferson penned the words “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.” Glance and colleagues pursued HAIs in trauma patients instead, and they, like Jefferson, state the obvious: infections make trauma patients sicker and sicker patients do worse; they die more, they consume more resources, and they stay longer. Or as my teenage son would say, “Duh, Dad, everyone knows that.” So why do we need another article that states the obvious? Well, for one, we now put science before assumption, even universally self-evident assumption. Yes, discharge databases are messy; yes, they have flaws; and yes, they are still maturing and require validation, but if we dismiss them, why do we even bother collecting the data? Glance and colleagues show that even discharge databases have something to share with us about improving patient care, and this is one of the largest, a cohort of 155 891 trauma patient records. Even with all the small inherent errors in a database (remember, small error rises exponentially when compounded together), we are still left with the fact that HAIs hurt trauma patients and hurt them a lot. Why? Maybe that standard preoperative antibiotic dose is too small for the expanded volume of distribution in trauma, maybe aspiration is more common than we thought, maybe we use too much immunosuppressing blood in resuscitation, maybe, maybe, maybe. We need to pursue those HAIs, and it doesn't seem to matter if it is in an accredited trauma center or not. In fact, only 23.3% of sample hospitals were identified as such in the article. Working in a level I trauma center, I hope I avoid HAIs better than most, but I may have to wait for Glance and colleagues' next article to know for sure.

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