Pennsylvania's New Hospital Infection Report
Sunshine not only fights infection—sunshine laws push data out of the shadows into the public arena, where it belongs. So let's salute yesterday's release of the second annual "Hospital-Acquired Infections in Pennsylvania." It's a 98-page report on how well in 2006 the state's 165 acute-care hospitals, each one named, kept patients from being infected while being treated within hospital walls. It is illuminating, if you'll excuse one more sunshine reference.
- More than 3,700 patients with hospital-acquired infections died in 2006. Hospital-infected patients died at a rate nearly six times that of uninfected patients—about 1 in 8, compared with 1 in 50.
- Urinary tract infections were by far the stickiest problem, yet it is well known that the UTI rate would drop if urinary catheters were simply removed as soon as they were no longer medically necessary.
- Aside from the human toll, the financial impact of hospital-acquired infections is horrendous. At one hospital, the average charge for treating its 111 UTI patients was $450,000 per case. Another hospital rang up more than $1.25 million for each patient who developed pneumonia while on a ventilator and $1.4 million per patient with multiple infections.
Publishing a report such as this is a courageous act. Kudos to the Pennsylvania lawmakers who voted to require hospitals to turn over infection data to a state agency called the Pennsylvania Health Care Cost Containment Council—PHC4, as it's called—and Marc Volavka, who as director of the council snapped at legislators' heels for years to make them appreciate the need for public reporting. Volavka stepped down a couple of weeks ago. His forceful passion will be missed.
Leafing through the report and fizzing indignantly about the performance of some of the hospitals, I was overheard by Bernadine Healy, my next-office physician colleague (a former medical school dean and director of the National Institutes of Health). She reminded me that there could well be reasons for a number that seems outrageous. A hospital might treat a disproportionate number of patients vulnerable to infection because of HIV or old age, for instance. The data are important and impressive, she said, but the primary purpose is to alert a hospital with high numbers that something may be badly amiss. "Before jumping to conclusions, you need to drill down into the data," she said. "Investigate. Find out what's going on."
She is right, of course. In the report, the PHC4 notes that the art of collecting and reporting hospital-acquired infections is far from perfected. "[T]he most important use of the report is to measure individual hospital performance over time and as a tool to ask physicians and hospital representatives informed questions about infection control and prevention," the report cautions, "rather than to compare hospitals to each other." I'll accept that. It's sober, responsible, and measured.
Then why aren't more states following Pennsylvania's lead? "Stand up and be counted" works for data and for politicians, too.
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Reader Comments
The most recent report on hospital-acquired infections is another welcome example of how Pennsylvania has led the nation on many health care related issues. While many other state legislatures have succumbed to the constant and well-funded stream of PR from hospital associations and their related "Patient Safety" initiatives on how wonderful and progressive they are, Pennsylvania has chosen to take action.
Mark Volavka, who has worked tirelessly, valiantly and amidst much opposition, is applauded by patient advocates and health care consumers across the country.
Others, such as Dr. Carlene Muto of UPMC who has championed the cause of controlling the most egregious of hospital-spread bugs, MRSA and VRE, are also looked up to with admiration and great respect by all of us.
While Dr. Muto and Mark Volavka may have had their differences over the years, the combination of these two true public health servants has been a winning combination for health care in Pennsylvania and beyond. And no one should forget that the idea of public reporting of hospital infections began with and continues to be fueled by Consumers Union and the manager of the Stop Hospital Infections campaign, Lisa McGiffirt. To those of us who have been the victims and the families of victims of these preventable diseases, Lisa McGiffirt has been an oasis of comfort and a source of strength, and much more, with which to fight to fix this decades old problem and the institutionalized negligence which has enabled it.
Other states, such as Illinois, have also been among the true leaders in this effort. Pat Merryweather of the Illinois Hospital Association, who fought against powerful interests, is a champion in getting that states law makers to enact groundbreaking MRSA screening and reporting legislation. She continues her noble and life saving struggle.
And to all of the unnamed individual advocates and consumer groups across the country, you all have been and continue to be the driving force for much needed and long overdue change.
There is a lot more that needs to be done in this area. It's a shame that all of our country's health care leadership has not lived up to the best ideals that these people and organizations have. But what a wonderful testimonial are the efforts and accomplishments that these wonderful people have made to American democracy. Can anyone begin to estimate the suffering that their efforts have prevented or the numbers of lives that have and will continue to be saved?
Michael Bennett
My Mother
In 1988 my mother had open heart surgery in a hospital in PA. Because they left the urinary catheter in too long my mother contracted a urininary tract infection. Even though we brought this to a staff nurse's attention a urine test was never performed. The outcome was that my mother died, was resusitated and ended up in the hospital for more that 3 months. She had to go to physical therapy to learn to walk again and ended up with bed sores so large you could fit your fist in them. The care for these went on for another 6 months.
We took the case to an attorney and guess what the hospital had no record of us going to the staff nurse requesting the doctor be contacted and tests be done.
Bottom line, law makers should have gotten their heads out of the sand 20 years ago.
the first beams of sunshine
Congratulations to Pennsylvania for shining light on the performance of hospitals when it comes to hospital infections! It is exactly this kind of information that citizens need to know in order to press hospitals to strive to make quality as important to their board of directors as profit. New Jersey will soon be following suit in tracking certain hospital infections by facility. But these are just the first beams of sunshine in the Garden State. It is tragic that only two states in the nation will shine light on the number of serious preventable medical errors (or NEVER EVENTS as they are often called) that occur in our hospitals each year. Publicly funded institutions should no longer be allowed to hide these deadly but entirely preventable errors--let the public know how many errors have occured in your hospital, and then tell us how you will prevent them in the future!
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U.S. News's Avery Comarow has been editor of the America's Best Hospitals annual rankings since their debut in 1990. In his reporting on all aspects of clinical medicine from the latest cholesterol guidelines to robotic surgery, he has kept one question in the front of his mind: What does this mean to patients? That perspective uniquely qualifies him to observe and comment on the efforts by hospitals and other healthcare providers to improve care and patient safety.
