By Valarie Honeycutt Spears and Jim Warren, The Lexington Herald-Leader, Ky.
Mar. 26–Here are some health statistics that might make you a little queasy:
About 2 million Americans get sick each year from infections they acquire while in the hospital, and almost 90,000 die, according to estimates by the federal Centers for Disease Control and Prevention.
Prompted by such numbers, the federal government will make some hospital-infection data public starting next year. And at least six states have passed laws requiring hospitals to make public their rates of nosocomial — or hospital-acquired — infections.
But two bills that would provide for such infection reporting in Kentucky apparently are dead, with the current legislative session set to end this week. A prominent legislator blames hospitals for effectively killing them. Rep. Tom Burch, D-Louisville, who heads the House Health and Welfare Committee, said the measures were strongly opposed by Kentucky hospital administrators.
“I never saw such a smokescreen in my life,” Burch said.
Representatives of all five Lexington acute-care hospitals said in interviews last week that they support the idea of providing hospital-infection data to the public — provided the information is gathered and presented in a standardized, accurate and understandable way. They insisted that the bills being considered in Frankfort wouldn’t do that and instead could result in the release of misleading information that unfairly could put some hospitals in a bad light.
Dr. Mark Dougherty, an epidemiologist at Central Baptist Hospital who also treated Gov. Ernie Fletcher during his recent illness, insisted Friday that infection rates at Lexington’s hospitals are below or significantly below national benchmarks in many categories.
Still, despite several requests over the past month, representatives of Central Baptist Hospital, Samaritan Hospital, St. Joseph Hospital and St. Joseph East declined to provide the Herald-Leader with data on their individual infection rates, arguing that since the hospitals don’t collect infection data in a standardized way, a fair comparison between hospitals would be impossible. They also dispute ratings by a for-profit Internet company that ranks several Lexington hospitals below national averages in infection prevention.
Only the University of Kentucky Hospital was willing to provide some numbers to the Herald-Leader. They showed that, in three specific types of hospital-acquired infections, UK’s infection rates are at or below mean rates at other large centers participating in a national surgical quality improvement program.
‘A sea of bacteria’
No one denies that hospital-acquired infections are a serious health problem. Hospitals are giant repositories for all kinds of infectious organisms that patients bring with them. These bugs can spread to other patients, even though hospitals try to keep that from happening.
“We’re all swimming in a sea of bacteria,” Dougherty says.
But public reporting of hospital infection rates has been a complex, and controversial, proposition in virtually every state that has attempted it.
Pennsylvania began gathering and reporting general hospital infection data on the Internet last summer, though it does not give figures on individual hospitals. Nevertheless, Pennsylvania hospital officials have questioned both the methods and conclusions in the state reports.
In November, Florida became the first state to report infection rates on a hospital-by-hospital basis. Several hospitals that got low marks argued that the reporting system was flawed, although a spokesman for the Florida Hospital Association said last week that initial opposition has eased.
In Florida, Pennsylvania and Kentucky, concerns about infection reporting raised by hospitals and doctors are the same: Reporting could provide useful information to the public, once reporting standards are developed that would put all hospitals on an equal footing. But so far, officials argue, there is no standard system.
Fletcher, a physician, echoed that concern last week in response to inquiries about Kentucky legislation.
“We indeed need transparency, but what is included in ‘hospital-acquired infections’ needs to be clearly defined,” the governor said, speaking through his press secretary Jodi Whitaker.
One of the principal groups pushing for public reporting of hospital infections is Consumers Union, which publishes Consumer Reports magazine. Lisa McGiffert, who runs the organization’s Stop Hospital Infections Project, argues that state laws requiring the reporting of infection rates would force hospitals to do a better job of preventing dangerous, potentially life-threatening infections.
“The public is demanding that hospitals do something about the problem,” McGiffert said. “In the meantime, they’re demanding: ‘Tell us what your results are. We want to know how effectively you’re preventing these infections.'”
McGiffert dismisses hospital officials’ concerns about the potential misinterpretation of infection data.
“I think their concern, justifiably so, is that they are not doing what they should be doing to prevent infections … and they know it,” she said.
‘Apples to apples’
Hospital representatives argue that without a uniform system that also provides interpretation of data, any reporting would be meaningless to the public — and possibly damaging to hospitals.
“Currently there are no agreed-upon definitions,” said Dee Anderson, a certified nurse practitioner who tracks infections at Central Baptist. “It won’t end up apples to apples.”
Many factors could skew a hospital’s infection rates and affect how it looks in any public report, hospital officials contend. A hospital that operates a burn center or organ transplant unit — in which patients often have reduced immunity — could have more infections than hospitals that don’t.
Large medical centers that accept patients referred from other facilities could rack up higher rates if those patients bring infections from other hospitals with them. And a hospital that is aggressive in identifying and reporting infections could come off looking worse than a hospital with a lackadaisical attitude about reporting, officials insist.
“The more honest you are, the more you put yourself in a bad light,” said Dr. John Meek, an epidemiologist for Samaritan Hospital.
Dr. Richard Lofgren, chief medical officer at UK Hospital, says hospital officials nationwide are fearful that without proper interpretation, public reporting of hospital-acquired infections might confuse and frighten the public.
“The debate is whether bad information is worse than no information,” said Lofgren, who helped found a physician-driven infection reporting system in Wisconsin.
Meanwhile, Dougherty suggests that, in the absence of public reporting, patients going into the hospital should ask for details about the facility’s efforts to combat infections and whether it has a paid epidemiologist or certified nurse practitioner tracking infections. Such information could calm concerns, he said.
New standards coming
Some form of public infection reporting is coming. The federal Deficit Reduction Act of 2005, which takes effect in 2007, will require hospitals to provide greater reporting of their infection rates or they will risk reductions in Medicaid payments. That information will be publicly available. Also, the National Quality Forum, a private Washington, D.C.-based health group, is preparing standards for public reporting of hospital infection data. The standards are due next year.
But for now, residents in most states, including Kentucky, have few ways to access information about hospital-acquired infection.
One for-profit health care rating company called Healthgrades does offer hospital quality reports on the Internet at a cost of about $10 per report, but the reports have drawn fire.
Healthgrades’ reports on Lexington’s five major private hospitals show that Samaritan, St. Joseph East, Central Baptist and UK all rate worse than the national average in maintaining a “lack of infections acquired at the hospital.” St. Joseph rated better than the national average in infections acquired at the hospital, but worse in avoiding severe infections following surgery.
Officials at all five Lexington hospitals dispute Healthgrades’ ratings, arguing that it’s unclear how the organization reaches its conclusions.
A 2002 report by Yale University researchers also criticized Healthgrades’ rankings. The report, published in the Journal of the American Medical Association, found that hospitals ranked low by Healthgrades often performed better than higher-rated hospitals.
Meanwhile, Lexington hospitals say they’re working hard to prevent infections by instituting a variety of measures, from redesigning hospital rooms and using sophisticated antibiotic regimens, to emphasizing simple hand washing.
“We want to reassure the public that we are diligent in improving public safety,” Dougherty said.
Still, Dr. Charles Kennedy, epidemiologist at St. Joseph Hospitals, said that despite hospitals’ best efforts, “The risk will never get to zero.”
News researcher Linda Niemi contributed to this report.
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