Rx: Health Care FYI #48 Healthier Hospitals: Eliminating Preventable Healthcare-Associated Infections

The Centers for Disease Control and Prevention reports that health care-acquired infections contribute to 90,000 deaths in the United States[1] each year adding over $50 billion in annual medical costs.[2] Most of these infections are preventable. Information on healthcare-associated infection rates is not collected nor available to the public in most states.

Healthcare-associated infections lead to higher costs for taxpayers, families and businesses:

* Health care-associated infections include surgical site infections, ventilator associated pneumonia, central line related (IV) blood infections, urinary tract infections, methicillin-resistant Staphylococcus aureus (MRSA) and additional infections transmitted to patients when there is inadequate adherence to clean sanitation and patient safety procedures that would otherwise prevent infectious disease.
* Central Line-Associated Blood (CLAB) infections increased costs by nearly $27,000 per patient according to a study of 2 Intensive Care Units (ICUs). The hospital's estimated cost to reduce infections by sanitizing hands and hospital equipment was approximately $18,000 in the first year and $8,000 per year thereafter. Preventing one infection would recoup the costs of patient safety improvements for a full year.[3]
* Pennsylvania is the only state requiring full public reporting of healthcare-associated infection rates. Medicare costs for patients who contracted an infection while hospitalized is 5 times higher than for patients without these infections. For Medicaid patients, costs are 14 times higher.[4]

Hospitals have successfully reduced infections:

* Hospitals and other health care providers have been able to drastically reduce infection rates by implementation of clean techniques, including:
o Strict adherence to handwashing before and after contact with any patient;
o Sterilizing all equipment used with patients;
o Clean up before and after patient procedures;
o Use of antibiotics before and after surgery;
o Pre-testing patients on admission to evaluate presence of infection; and
o Use of infection control boards at hospitals to monitor and manage procedures.
* Allegheny General Hospital in Pennsylvania reduced the rate of central line-acquired infections from nineteen to almost zero within 90 days through staff training on infection control. Hospital savings over 3 years were estimated at over $2 million and 47 lives were saved.[5]
* A major teaching hospital in St. Louis reported a reduction in central line acquired infection rates through a 10-page educational program with mandatory tests for all staff. The estimated cost savings from this educational program was up to $1.5 million.[6]
* Mercy Health Center in Oklahoma has performed 400 surgeries without any infections by tracking infections and administering antibiotics immediately to surgical patients.[7]

Health care prevention of infections remains a problem:

* To reduce infections, it is recommended patients receive antibiotics before surgery and 24 hours after. One study of about 3,000 acute-care hospitals nationwide found more than 44 percent of patients did not receive antibiotic doses within the recommended time frame; nearly 10% did not receive initial medication until four hours after surgical incisions were made.[8]
* One study of 120 nurses reports that 70% do not adhere to handwashing and sterilization procedures.[9]
* Another study found that while such factors as diabetes or obesity played a role in the risk of contracting certain surgical wound infections, healthcare-associated factors such as hand-washing practices played a bigger role.[10]
* When information is not disclosed the public cannot make informed choices regarding clinics and hospital quality, nor can they be active partners in preventive infection control.

Recommendations:

* Establish a Medicare pilot program to provide financial incentives to hospitals from the savings gained from reducing healthcare-associated infections to zero.
* Require uniform and accurate public reporting of health care-associated infections by hospitals and ambulatory surgical centers so the public and health care providers can work to reduce healthcare-associated infections, enhance informed consumer choice of health care quality providers, reduce health care costs and save lives.

For further information on this legislation to eliminate preventable healthcare-associated infections, please contact my office at (202) 225-2301.

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