Influenza killed nearly 80,000 Americans in 2018, according to the Centers for Disease Control. Public health initiatives and public service announcements encourage us to get our flu vaccination every autumn. Celebrities even get flu shots on television to promote immunization.

And yet, about three times as many Americans die of medical errors while hospitalized than die of the flu, according to several studies. And there is almost no news coverage of this startling statistic, and little effort to make patients and their caregivers aware of the risks of being treated in an emergency department or hospital.

The Informed Patient, written by a Karen Friedman, a physician, and Sara L. Merwin, a medical researcher, aims to make the hospital experience less mysterious and confusing, and more survivable. In a hospital setting, confusion and passivity can be fatal.

It’s stunning to think that hospital medical errors could outpace all other causes of death save heart disease (the leading cause of death, killing over 647,457 Americans in 2017) and cancer (number two, killing 465,679 the same year.) However, hundreds of thousands of Americans are dying annually from hospital errors.

Most of the annual mortality estimates start at around a quarter of a million hospitalization-related deaths. One meta-study (a study of the results of several other studies)  estimates that as many as 440,000 Americans are killed as a result of their hospital experience annually.

Hospital deaths fall into two categories: errors of omission, and errors of commission. One of the easiest errors of omission to fix is hand-washing. Hospitals are breeding grounds for antibiotic-resistant bacterial infections, which can largely be prevented by simply washing hands between patients. In fact, the CDC estimates that at any given time, about 1 in 25 hospitalized patients, or 1.7 million patients a year, develops an infection acquired in the hospital.

More than 98,000 Americans die of Hospital Acquired Infections (HAIs), which accounts for about half of all deaths from hospitalization. Good hand-washing hygiene from healthcare workers, patients, and their visitors, could cut the hospitalization death rate nearly in half.

The CDC reports that healthcare workers only clean their hands about half as often as they are supposed to. According to The Informed Patient, it’s your right and duty as a patient to insist that each and every healthcare worker—even your doctor—wash her hands before touching you in the hospital.