SAN DIEGO — It’s relatively easy for the average U.S. health care consumer to find out how well their local hospital handles infections.
Enter your ZIP code into the government’s Hospital Compare website and, in six clicks, it’s possible to review recent data on half a dozen different hospital-acquired infection types. With a few more clicks, it’s possible to easily compare the results of several hospitals in a given area to each other.
But that’s often not the case in other countries.
Dr. Victor Rosenthal, a Buenos Aires, Argentina-based researcher and chairman of the International Nosocomial Infection Control Consortium, has spent 30 years studying infection monitoring and prevention in dozens of countries, traveling more than 12 million miles to promote better practices.
Most countries don’t have nearly as robust systems as can be found in the United States and Europe, he said.
“It’s just not easy to know what the true infection rates are in many, many countries because this kind of information, it’s just not systematically reported,” Rosenthal said.
This fact is very relevant given the travel advisory from the U.S. Centers for Disease Control and Prevention issued on Jan. 9 that advised travelers to avoid Tijuana, Mexico’s Grand View Hospital “until the Mexican government can confirm that the drug-resistant form of pseudomonas aeruginosa bacteria is no longer there.”
The CDC reiterated that warning this week and, on Friday, a CDC spokeswoman said that the number of Tijuana-linked confirmed cases has increased from 11 to 14 with three more suspected and awaiting confirmation.
Most of the cases involved medical tourists who went to Mexico for weight-loss surgeries.
“The two most recent confirmed cases are patients who reported having surgery at Grand View in January, when the surgical area of Grand View was reportedly closed, and developed infections after they returned home to the U.S.,” said Martha Sharan, a CDC public affairs specialist, in an email.
Considered a “superbug” for its evolved resistance to many common antibiotics, multidrug-resistant pseudomonas kills about 440 people, and infects about 6,700, each year in the United States, according to the CDC.
But it’s pretty clear that infection is far from the first concern of medical tourists who leave the states for weight-loss surgery in Mexico.
Price tag is often the main deciding factor, said Dr. Maher El Chaar, co-medical director of bariatric surgery at Temple University and St. Luke’s University Health Network in Allentown, Pennsylvania.
There is a strong financial incentive for Americans to travel south of the border for procedures such as lap band and sleeve gastrectomy, surgeries that greatly reduce the amount of food a person’s stomach can hold, eventually causing weight loss.
Obesitycoverage.com, a website that helps potential patients understand what their health insurance will cover, lists the average U.S. cost of each procedure as nearly $15,000 per patient.
But a site called weightlossagents.com, which courts medical tourists, advertises gastric sleeve at Grand View for just $3,999 and lap band at $3,749.
That price difference, El Chaar insisted, reflects the amount of pre- and post-surgical care that bariatric patients receive in U.S. centers is much greater.
U.S. bariatric surgical centers, El Chaar added, must carefully select the patients likely to have successful outcomes because regulatory agencies are watching. Too many infections and readmissions after an initial operation can quickly become a black mark on a surgical center’s reputation, making it harder to broker contracts with health insurance companies, in addition to leaving patients with less-than-optimal results.
“People really don’t realize that the standards are not the same, the surgical outcomes are not the same, there’s no follow-up,” El Chaar said. “You may be saving money, there’s no doubt about it, but there is a reason those procedures are cheaper in Mexico. They just aren’t required to have the same training or follow the same standards that we do.”
American health insurance companies do cover weight-loss surgery for those with severe weight problems, generally defined as anyone with a body mass index of 40 or greater — 35 for those with another co-occurring medical condition.
This means that medical tourism for bariatric surgery, El Chaar said, tends to be for those who are healthier and have body mass indexes in the 25 range. Because these patients tend to be more mobile and feel healthier, they may feel more comfortable traveling.
In terms of infection control, the specialist said effective prevention starts with each individual hospital becoming familiar with the particular microorganisms present in their particular environment. Knowing this information, he said, is critical in selecting the proper broad-spectrum antibiotics to give patients just before and just after surgery.
Following infection-control protocols is part of the inspections and audits most American hospitals must undergo to remain licensed. Using the right types of disinfectant in operating rooms and for surgical equipment, he said, is just one part of controlling infection in bariatric surgery.
Allowing a patient’s blood oxygen level to drop too low after surgery, not operating on patients with out-of-control diabetes and having the right kind of airflow in operating rooms are also critical infection factors.
It’s hard to know, when visiting a hospital in a foreign country, whether these kinds of procedures are being followed. Mexico’s General Health Council does certify hospitals, and anyone can download a 42-page list of certified hospitals in Mexico, though it’s not clear exactly what appearance on the list implies.
Grand View does not appear on the list, and Mexican government officials were not available this week or last to explain why or to detail routine infection-prevention protocols or enforcement, oversight and surveillance of hospital-acquired infections in the Mexican health care system.