In U.S. hospitals, an estimated 1 in 20 patients pick up infections they didn't have when they arrived, some caused by dangerous `superbugs' that are hard to treat.
The rise of these superbugs, along with increased pressure from the government and insurers, is driving hospitals to try all sorts of new approaches to stop their spread:
Machines that resemble "Star Wars" robots and emit ultraviolet light or hydrogen peroxide vapors. Germ-resistant copper bed rails, call buttons and IV poles. Antimicrobial linens, curtains and wall paint.
While these products can help get a room clean, their true impact is still debatable. There is no widely-accepted evidence that these inventions have prevented infections or deaths.
Meanwhile, insurers are pushing hospitals to do a better job and the government's Medicare program has moved to stop paying bills for certain infections caught in the hospital.
"We're seeing a culture change" in hospitals, said Jennie Mayfield, who tracks infections at Barnes-Jewish Hospital in St. Louis.
Those hospital infections are tied to an estimated 100,000 deaths each year and add as much as $30 billion a year in medical costs, according to the Centers for Disease Control and Prevention. The agency last month sounded an alarm about a "nightmare bacteria" resistant to one class of antibiotics. That kind is still rare but it showed up last year in at least 200 hospitals.
Hospitals started paying attention to infection control in the late 1880s, when mounting evidence showed unsanitary conditions were hurting patients. Hospital hygiene has been a concern in cycles ever since, with the latest spike triggered by the emergence a decade ago of a nasty strain of intestinal bug called Clostridium difficile, or C-diff.
The diarrhea-causing C-diff is now linked to 14,000 U.S. deaths annually. That's been the catalyst for the growing focus on infection control, said Mayfield, who is also president-elect of the Association for Professionals in Infection Control and Epidemiology.
C-diff is easier to treat than some other hospital superbugs, like methicillin-resistant staph, or MRSA, but it's particularly difficult to clean away. Alcohol-based hand sanitizers don't work and C-diff can persist on hospital room surfaces for days. The CDC recommends hospital staff clean their hands rigorously with soap and water - or better yet, wear gloves. And rooms should be cleaned intensively with bleach, the CDC says.
Michael Claes developed a bad case of C-diff while he was a kidney patient last fall at New York City's Lenox Hill Hospital. He and his doctor believe he caught it at the hospital. Claes praised his overall care, but felt the hospital's room cleaning and infection control was less than perfect.
"I would use the word `perfunctory,'" he said.
Lenox Hill spokeswoman Ann Silverman disputed that characterization, noting hospital workers are making efforts that patients often can't see, like using hand cleansers dispensers in hallways. She ticked off a list of measure used to prevent the spread of germs, ranging from educating patients' family members to isolation and other protective steps with each C-diff patient.
The hospital's C-diff infection rate is lower than the state average, she said.
Westchester Medical Center, a 643-bed hospital in the suburbs of New York City has also been hit by cases of C-diff and the other superbugs.
Complicating matters is the fact that larger proportions of hospital patients today are sicker and more susceptible to the ravages of infections, said Dr. Marisa Montecalvo, a contagious diseases specialist at Westchester.
There's a growing recognition that it's not only surgical knives and operating rooms that need a thorough cleaning but also spots like bed rails and even television remote controls, she said. Now there's more attention to making sure "that all the nooks and crannies are clean, and that it's done in perfect a manner as can be done," Montecalvo said.
Enter companies like Xenex Healthcare Services, a Texas company that makes a portable, $125,000 machine that's rolled into rooms to zap C-diff and other bacteria and viruses dead with ultraviolet light. Xenex has sold or leased devices to more than 100 U.S. hospitals, including Westchester Medical Center.
The market niche is expected to grow from $30 million to $80 million in the next three years, according to Frost & Sullivan, a market research firm.
Mark Stibich, Xenex's chief scientific officer, said client hospitals sometimes call them robots and report improved satisfaction scores from patients who seem impressed that the medical center is trotting out that kind of technology.
At Westchester, they still clean rooms, but the staff appreciates the high-tech backup, said housekeeping manager Carolyn Bevans.
"We all like it," she said of the Xenex.
At Cooley Dickinson Hospital, a 140-bed facility in Northampton, Mass., the staff calls their machines Thing One, Thing Two, Thing Three and Thing Four, borrowing from the children's book "The Cat in the Hat."
But while the things in the Dr. Seuss tale were house-wrecking imps, Cooley Dickinson officials said the ultraviolet has done a terrific job at cleaning their hospital of the difficult C-diff.
"We did all the recommended things. We used bleach. We monitored the quality of cleaning," but C-diff rates wouldn't budge, said nurse Linda Riley, who's in charge of infection prevention at Cooley Dickinson.
A small observational study at the hospital showed C-diff infection rates fell by half and C-diff deaths fell from 14 to 2 during the last two years, compared to the two years before the machines.
Some experts say there's not enough evidence to show the machines are worth it. No national study has shown that these products have led to reduced deaths or infection rates, noted Dr. L. Clifford McDonald of the Centers for Disease Control and Prevention.
His point: It only takes a minute for a nurse or visitor with dirty hands to walk into a room, touch a vulnerable patient with germy hands, and undo the benefits of a recent space-age cleaning.
"Environments get dirty again," McDonald said, and thorough cleaning with conventional disinfectants ought to do the job.
Beyond products to disinfect a room, there are tools to make sure doctors, nurses and other hospital staff are properly cleaning their hands when they come into a patient's room. Among them are scanners that monitor how many times a health care worker uses a sink or hand sanitizer dispenser.
Still, "technology only takes us so far," said Christian Lillis, who runs a small foundation named after his mother who died from a C-diff infection.
Lillis said the hospitals he is most impressed with include Swedish Covenant Hospital in Chicago, where thorough cleanings are confirmed with spot checks. Fluorescent powder is dabbed around a room before it's cleaned and a special light shows if the powder was removed. That strategy was followed by a 28 percent decline in C-diff, he said.
He also cites Advocate Christ Medical Center in Oak Lawn, Ill., where the focus is on elbow grease and bleach wipes. What's different, he said, is the merger of the housekeeping and infection prevention staff. That emphasizes that cleaning is less about being a maid's service than about saving patients from superbugs.
"If your hospital's not clean, you're creating more problems than you're solving," Lillis said.
--- Online: CDC: HTTP://WWW.CDC.GOV/HAI/
The Missouri House has approved legislation requiring employers to check potential employees' legal resident status. Missouri already requires public and private employers that receive state money to participate in a federal work authorization program. The bill would extend the requirement to all Missouri employers.
There's no high-profile quarterback destined to go No. 1 and instantly become the face of a downtrodden franchise. There's not even a running back or wide receiver worthy of the top overall pick, someone with the kind of swagger that wins over fans weary of losing.
Nope, there's just beef. And lots of it.
There's 6-foot-6, 306-pound Luke Joeckel, the offensive tackle from Texas A&M whom the Kansas City Chiefs are expected to select first overall. There's also Eric Fisher of Central Michigan and Lane Johnson of Oklahoma, two more 300-pounders who could be snapped up in the first 10 picks.
Even the defensive side of the ball is big on bigness: Florida's Sharrif Floyd, Utah's Star Lotulelei and Sylvester Williams of North Carolina are considered premium space eaters.
Utilitarian? Sure. Flashy? Not so much.
"There are a lot of good football players there," Broncos President John Elway insisted. "It's kind of a matter of what kind of flavor you like, but there are plenty of defensive linemen - not only defensive ends but defensive linemen - in this draft, and it's deeper than most."
Only twice since the AFL-NFL merger in 1970 has an offensive tackle been chosen first overall, but the Chiefs figure to make it three when NFL Commissioner Roger Goodell reads off the name of the league's newest millionaire shortly after 8 p.m. EDT at Radio City Music Hall in New York City.
Joeckel is considered the surest thing in a draft full of uncertainty.
He protected the blind side of Heisman Trophy winner Johnny Manziel last season, won the Outland Trophy as college football's top interior lineman, and wowed just about everyone at the NFL's annual scouting combine with his speed, agility and, yes, his size.
"I think this year, the offensive line position has some true prospects in it," Chiefs general manager John Dorsey said. "Every draft has its own unique set of characteristics. Last year's draft had its own unique set of characteristics. This year's draft has its unique characteristics."
Last year's draft made for must-see TV.
One of the deepest quarterback crops in recent years stoked the passions of fan bases in several NFL cities, including Indianapolis, which took Andrew Luck with the first overall pick.
It was the fourth straight year that a quarterback went No. 1.
The run of signal-callers didn't stop there, either. The Redskins traded up to select Heisman Trophy winner Robert Griffin III at No. 2, and two more quarterbacks went in the first round.
West Virginia's Geno Smith is expected to go in the first round this year, perhaps as early as No. 2 to Jacksonville. But outside the strong-armed but erratic quarterback, the market at the NFL's most critical position is weak. That means a handful of teams in need - Oakland, Buffalo, Cleveland, Philadelphia and Arizona among them - might wait until later in the draft to make their move.
That's all assuming that no trades are made on the opening night.
Quarterbacks who could still be on the board when the draft resumes with the second round Friday night include USC's Matt Barkley, Florida State's E.J. Manuel and Ryan Nassib of Syracuse.
"This is really a meat-and-potatoes draft, certainly early in the first couple of rounds with linemen, which is exciting," said Eagles general manager Howie Roseman, who will pick fourth.
"It may not be the flashiest thing, but it's exciting," he said. "It's hard to find big guys who can move, play with power, and there are lot of guys in this draft."
Guys who can protect those expensive quarterbacks.
Joeckel may be the top offensive tackle available, but Fisher and Johnson are both expected to go early in the draft. And they'll probably spend their careers lining up against a slew of players on the defensive side of the ball who could be picked early in the first round, too.
The Oakland Raiders, who pick third, have had their eye on Floyd and Lotulelei, among others, and defensive ends Dion Jordan of Oregon, Ziggy Ansah of BYU and Barkevious Mingo of LSU should have their names called in the first couple hours Thursday night.
Defensive back Dee Milliner is a trendy choice to go in the top 10, and offensive linemen D.J. Fluker and Chance Warmack - Milliner's teammates from national champion Alabama - also are expected to go early in a draft that is more wide open than any in recent history.
"You can go and ask every scout in the room and you'd probably get a favorite player that differs from the other," Raiders general manager Reggie McKenzie said. "But that's the fun part of this job is trying to get all those opinions and come to a common goal to choose one."