Infections – we all get them, and astoundingly, many people will die from them. But, you’d never think that we’d get them in the hospital while being treated for another illness. Or see the needless loss of life of a newborn baby because of an infection in a nursery.
Some individuals will become infected in an ambulatory care facility. These infections are called health-care-associated infections (HAIs), also referred to as hospital acquired infections.
HAIs are a serious and pervasive issue afflicting our health care system. According to the Centers for Disease Control and Prevention (CDC), HAIs are estimated to be one of the top 10 causes of death in the US, totaling 100,000 per year. That means more patients die of HAIs than from HIV/AIDS (60,000 per year) and automobile accidents (40,000 per year). Specifically, central-line infections occur in 250,000 people a year in the US, and are fatal between 5% and 28% percent of the time.
HAIs are very costly, should be mostly preventable, and everyone – patients, employers, hospitals and even state and federal government (Medicare) – bears the burden of these costs. It is reported that HAIs add as much as $20 billion in additional costs to the health care industry. In 2005, the average payment for a hospitalization in Pennsylvania was over six times higher for patients who contracted a hospital-acquired infection than for patients who did not acquire infections, according to a report by the Pennsylvania Health Care Cost Containment Council. Moreover, a 2007 study of 1.69 million patients who were discharged from 77 hospitals found that the additional cost of treating a patient with an HAI averaged $8,832. This is alarming when data show that Medicare, alone, the federal health insurance program for persons over 65, paid for over one-third of all hospital costs in 2005, according to the American Hospital Association.
Ironically, the Federal Office for Human Research Protections shut down a Michigan HAI project, even as it proved itself to be effective. I think it is time for Congressional action.
Can we reduce HAIs? The leading hospitals in the nation successfully tackling them are Allegheny General Hospital in Pittsburgh, Johns Hopkins in Baltimore, and a consortium of hospitals in Michigan. Allegheny, under Dr. Jerome Granato’s leadership the past five years, and with support from Dr. Peter Perreiah of the Pittsburgh Regional Health Initiative, reduced central-line HAIs by 90% in two years, and sustained a 15 month period in their ICU with no infections.
In this state, the Puget Sound Health Alliance (Alliance), a regional consortium of employers, providers, health plans, unions, and patients aimed at improving the quality of health care in Puget Sound, has made HAIs a priority (www.pugetsoundhealthalliance.org). An Alliance workgroup recommends “highlighting the incidence of hospital acquired infections to lower their occurrence and resulting costs to the system.” The Alliance is currently working with the State Department of Health to make the data more transparent and more consumer-friendly, and will include HAI outcomes data in future reports of its own Community Checkup Report (www.wacommunitycheckup.org). The Alliance is also researching how it can help accelerate current HAI efforts in the Puget Sound region using the proven interventions from Pittsburgh and Johns Hopkins.
Mirroring national efforts, the Washington State Hospital Association (WSHA) and Washington State have been engaged in patient safety efforts. Washington was the first state to get all its hospitals participating in Institute for Healthcare Improvement’s 100,000 Lives Campaign. WSHA is actively engaged in national efforts in addition to its own effort, which includes providing technical assistance to hospitals and disseminating posters and brochures to promote hand washing and staff training. Washington State, in 2007, passed SB1106 to mandate public reporting of certain HAIs beginning in January 2009. A phased-in approach, in July 2008, all hospitals were required to start collecting and reporting all central line-associated infections in ICUs. (When this data will be available to the public has not yet been determined.)
We know what works, as evidenced by efforts in Pittsburgh, Baltimore, and Michigan, and now it’s our turn to implement these best practices here and work with the federal government to break down barriers to efforts that will save patients’ lives. It is imperative that we publicly report the incidence of health care associated infections by facility in King County and the State of Washington, in order to shed light on the problem and save lives.
- Health-Care-Associated Infections in Hospitals Report, General Accounting Office (GAO)
- Consumers Union’s website
- The Checklist, Gawande, Atul. The New Yorker.
- Dispelling the Myths: The True Cost of Healthcare-Associated Infections: Pennsylvania Health Care Cost Containment Council
- CDC Library