Health Journalism 2011: Is enough being done about health care-associated infections?

By Cathleen F. Crowley
Albany Times Union

Dr. Patrick J. Brennan didn't waste time answering the main question of a panel assembled to discuss health care-acquired infections: Is enough being done?

"We should just stipulate that not enough is being done," Brennan said.

About 1.7 million Americans get health care-acquired infections each year and at least 99,000 die. That is the equivalent of everyone in the city of Philadelphia being infected, and those who die could pack the Phillies' stadium two times, said William Marella, director of the Pennsylvania Patient Safety Authority's statewide safety reporting program.

Speaking from the patient's perspective, panelist Kerry O'Connell, a construction company owner, described the agony he experienced when his elbow became infected after surgery to fix the injured joint.

"It's one of the scariest things in the whole world," said O'Connell, who is a member of the Colorado Coalition for Patient Safety.

In a follow-up surgery – one of many – O'Connell took every precaution to avoid infection. He brought a red Sharpie with him on the day of surgery to sign the consent forms, and he added in red letters: "Please, please, please don't infect me."

The Centers for Disease Control and Prevention has 1,200 recommendations for reducing health care-related infections. Brennan, an infectious disease doctor and chief medical officer at the University of Pennsylvania Health System, said health facilities need to adopt all of them.

For reporters trying to assess their local hospitals, here are some questions to ask:

• Which of those 1,200 methods the hospital has implemented?
• What is the hospital's rate of compliance in hand washing?
• Does the hospital have "secret shoppers" to assess hand-washing compliance?
• What is the hospital doing to prevent infections?
• Is it part of a multi-facility effort to reduce infections?
• Does the hospital regularly share infection rates with its board members?

The Centers for Medicare and Medicaid Services recently released data on hospital-acquired complications including infection information.   CMS will soon reduce reimbursement rates for hospitals that are significantly worse than the national average.

Reporters like moderator Marshall Allen, formerly of the Las Vegas Sun and now with ProPublica, have used hospital billing and administrative data to tease out information on infections and other adverse events. (Do No Harm: Hospital Care in Las Vegas) The administrative data is usually held by the state health department and can be requested under the Freedom of Information Act.

About 27 states require public reporting of hospital infection rates, but only 10 states publicly release hospital-specific information. Consumer Union summarizes state laws on infection reporting. Find out if your state is one of them. Also, ask your hospital to voluntarily release its infection rate.

The panelists said that if infections in nursing homes and outpatient centers were better tracked, the rates of health care-acquired infections would be considerably higher.

Marella warned that reporting systems that rely on staff to report adverse events are the least accurate because people are reluctant to report an error, especially if they know it will be made public.

"How many people call the police to tell them they were speeding on the highway?" Marella asked.

Nobody in the audience raised a hand.

But Allen said, "If I ran someone over and killed them, I would turn myself in."