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Deadly Admissions: Hospital-Acquired Infections Are 4th-Largest Killer in U.S., But Ohioans Cannot Get Statistics to Compare Facilities

Posted on: Monday, 9 January 2006, 09:00 CST

By Tracy Wheeler, The Akron Beacon Journal, Ohio

Jan. 9--But for 20 million Americans each year -- about one in every 10 to 20 patients -- a trip to the hospital results in dangerous, lingering infections, whether through surgery, dialysis, ventilators, IVs, or catheters.

At an estimated 90,000 deaths a year, these hospital-acquired infections kill as many people in the United States as AIDS, breast cancer and car accidents combined.

But if patients want to choose a hospital based on how well it controls infections within its wards, they can't. At least not in Ohio. At least not yet.

Only four states -- Pennsylvania, Illinois, Missouri and Florida -- require hospitals to publicly report their infection rates. Ohio could have become the fifth, but a bill introduced last year in the Ohio House of Representatives was rewritten to set aside infection reporting for now.

"It's an important issue, and we're not going to ignore it," said Ohio Rep. Jim Raussen, R-Cincinnati, who introduced the bill. "Clearly that is an area that consumers and patients need to know about."

But intense opposition by the Ohio Hospital Association persuaded the House Health Committee to remove infection reporting from the bill. Instead, the bill will require hospitals to provide data on average patient charges for the top 60 procedures, average length of stay, and re-admission, complication and death rates.

If the bill becomes law, all that data would be compiled by the Ohio Department of Health and listed on a free, public Web site where consumers could compare one hospital to another.

The issue of hospital infection rates will be raised again only if the bill is approved by the House and the Senate.At that point, Raussen said, an advisory panel would be created to set standards on how infection data should be collected and reported.

A 2003 report in the New England Journal of Medicine called infections "by far the most common complications affecting hospitalized patients."

Hospital-acquired infections are the fourth-largest killer in the United States, according to the Committee to Reduce Infection Deaths (RID), a New York-based nonprofit group. And the threat is only becoming more dire, as more and more germs are growing resistant to commonly used antibiotics.

In 1974, for example, only 2 percent of staph infections resisted drug treatment. By 2003, three in every five staph infections were drug-resistant. Overall, 70 percent of hospital-acquired infections are caused by drug-resistant germs.

Urinary tract infections, usually caused by catheter use, are the most common infection in hospitals, though they are also the least deadly. Bloodstream infections (often associated with IV use) and pneumonia (often caused by ventilator use) are less common, but much more deadly.

Deadliest one on rise

Methicillin-resistant Staphylococcus aureus (MRSA) is among the fastest-growing and deadliest infections.

According to a 2005 study published in the Archives of Internal Medicine, patients with staph infections, on average, will stay in the hospital three times longer (14.3 days compared to 4.5 days) and pay three times as much ($48,824 vs. $14,141) as patients without staph infections nationwide.

More important, though, patients with staph infections will die five times as often (11.2 percent vs. 2.3 percent) as patients without staph infections.

In Pennsylvania, the first state to release hospital infection data, the death rate among hospital patients who developed infections was even higher at 15.4 percent in 2004, compared with 2.4 percent among other patients.

Pneumonia most deadly

Pneumonia from ventilator use was the most deadly infection, killing 32 percent of those infected, according to the report from the Pennsylvania Health Care Cost Containment Council.

Recently, Clostridium difficile (C. diff) has grabbed the attention of the health-care community. C. diff is not a new infection; it has long been the main cause of antibiotic-associated diarrhea. However, a new, deadly strain of the bacterium has begun to show up in hospitals throughout Canada and the United States.

Just this month, the Ohio Department of Health will begin collecting reports of C. diff from hospitals, nursing homes and long-term care facilities. The first reports are expected to be available at the end of the week. And those reports will identify which hospitals are dealing with C. diff infections.

"We need to examine how widespread this bacterium is in hospitals and long-term care facilities," Ohio Department of Health Director J. Nick Baird said in a statement. "While C. diff thankfully does not spread easily from person to person, a new, aggressive strain of C. diff is of growing concern."

Ohio data only regional

Ohio's hospitals report other infections to ODH, but most of the data are listed as city, county or state totals -- not as total cases found in individual hospitals. And none of the data is listed on an easy-to-use Web site as the House bill had proposed.

Those calling for individualized hospital reporting argue that state and local totals do little to help consumers. What consumers need, they say, is the ability to compare Hospital A's infection rate to Hospital B's.

But the Ohio Hospital Association argues that such comparison could be misleading and confusing.

"The question goes back to what is it exactly the public wants to know?" said Carol Jacobson, OHA's director of emergency preparedness. "Is giving them infection rates something they can grasp ahold of?"

Infection statistics don't differentiate between those caught in the hospital and those that patients brought with them into the hospital, she said. The statistics also don't take into account whether the infection was spread from patient to patient or from health-care worker to patient.

In some cases, she said, there's even little agreement about what constitutes an infection, as some hospitals may rely on lab confirmation while others may rely on symptoms.

"One hospital's definition of pneumonia may not be another hospital's definition," Jacobson said.

But Barb Bradley, the Ohio Department of Health's chief of infectious disease control, said the advisory panel being created by Raussen's House bill should be able to work out all those details, setting common definitions and adjusting for hospitals' differing patient populations.

Consumer groups believe that the problem with hospital infections will only get better if hospitals are forced to share their data.

On its Web site, Consumers Union argues, "If consumers can choose a hospital based on good information about the quality of care, including hospital infection rates, hospitals will quickly implement better practices."

Proven solution exists

Fixing the problem is relatively simple, according to the CDC. If doctors and other caregivers washed their hands in between treating patients, infection rates would plummet.

Research in a Swiss hospital showed that increased hand-washing cut hospital infection rates from 16.9 percent to 9.9 percent over four years. In the case of drug-resistant staph infections, hand-washing reduced the incidence from 2.2 percent to 0.9 percent.

"Doctors with dirty hands!" the Committee to Reduce Infection Deaths says on its Web site. "It's outrageous."

Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.

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Copyright (c) 2006, The Akron Beacon Journal, Ohio

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Source: Akron Beacon Journal (Akron, Ohio)

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