Hospitals Start to Report on Infections Acquired By Patients

By Heerwagen, Peter

Infections during hospital stays are not only discomforting to patients and very costly, they can be deadly.

The federal Centers for Disease Control and Prevention estimate about 90,000 Americans die each year from hospital-borne infections. Another 1.9 million people nationwide who develop such infections endure longer stays in the hospital recovering and getting treated. The national health care bill for the 5% to 10% of all patients who develop infections is nearly $5 billion.

The Pennsylvania Health Care Cost Containment Council in Hamsburg published a research brief, “Hospital-Acquired Infections in Pennsylvania,” which indicated that infections in that state were associated with 1,793 deaths and $2 billion in extra hospital charges.

State politicians are mandating that hospitals report to their health-care agencies data on infectious diseases caused by patient hospital stays. Five states have passed such laws-Pennsylvania, Virginia, Illinois, Florida and Missouri-but none has produced a public report on each hospital’s experience. Legislation has been introduced in 39 other states, including Maryland and West Virginia.

The Keystone state was the first one to actually collect data from hospitals, done through the Pennsylvania Health Care Cost Containment Council (PH4C). Joe Martin, spokesperson for council, said acute care hospitals in his state are slowly getting around to reporting, with some clearly not doing an adequate job. “There is a huge variation in the data; 20 hospitals, including some of the larger ones, reported zero infections for 2004. No hospital has refused to submit the data, but the number of infections reported is going up each quarter.”

As an example of under-reporting by some hospitals, the PH4C said that 20 hospitals, which accounted for 25% of all statewide admissions, accounted for 50.6% of the 11,668 infections reported throughout the state.

It will be several years until the PH4C puts infection information about all 173 hospitals on its Web site. “It won’t be until we get more complete data,” said Martin. “The idea is that publicizing the data will encourage hospitals to reduce the incidence of infections.”

Martin said the PH4C i s expanding the data collection coverage from four types of hospital-acquired infections in 2004, to all surgical areas in 2005 and to the whole hospital beginning next January.

Martin gave examples of how infections are transmitted. They include health-care providers not washing their hands; catheters left in beyond the best practice protocol; intravenous catheters inserted in the groin area rather than chest area or neck vein; instruments being dropped on the floor and then reused; and the heads of patient beds not being elevated when ventilators are used.

The two hospitals in Franklin County have found difficulty with the PH4C’s reporting system. “The controversy here, with the hospital and with my colleagues, is not that we report infections, but the way we report them,” said Dr. David Carlson, vice president for medical affairs at Summit Health in Chambersburg, parent company for Chambersburg and Waynesboro hospitals.

“We in medicine are required to practice consistent with evidenced based practices, and we look to higher authorities that give us guidelines, like the CDC-the Center for Disease Control.

“The PHC4 folks have defined infections differently than the CDC. That leaves us with a conundrum. Is the evidence right? That’s an important issue that needs to be resolved.

“Most hospitals have tracked infections for a long time. There is a movement towards transparency, and I applaud it. It is the beginning of a broader, healthy trend, but it is important to provide information that is meaningful. The CMS [Centers for Medicare and Medicaid] quality initiative is a great start, but only the beginning.

“Our goal should be zero infections. We have to be able to figure out the various modes of transmission. They often come from life- saving interventions, but we will never stop doing those.”

Most hospitals have infection , control nurses on staff, and Chambersburg and Waynesboro have one at each their facilities. “We will need additional help,’-’ said Carlson. “The job is getting bigger because of the reporting and surveillance that is required.”

Under legislation that takes effect on July 1, 2008, acute care hospitals in Virginia must report information about infections to the Centers for Di sease Control and the State Board of Health. The board will develop regulations outlining the data that hospitals will be required to report, including the type of-infections covered. Hospital infection data will evenroaHy be released to the public.

“It is important for the state to take time to develop a reporting system and define what infections to report,” said Cynthia Rawlinson, corporate director of ‘ quality at Valley Health System, parent of Winchester Medical Center and Warren Mcmonal-and Shenandoah Memorial hospitals. “We don’t want to have the problems encountered by Pennsylvania.”

Copyright News for Business, Inc. Oct 2005