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Pulling the covers off hospital infection rates

Patient advocates ask why it's taking so long to reveal the data, as required by state law.

By LISA GREENE
Published February 21, 2005

Germs lurk in every hospital, creeping into surgical wounds, seeping into IV lines, hitching rides on dirty linens and unwashed hands.

Most hospitals would rather not talk about them, even though infections kill more than 80,000 Americans each year.

That makes it hard to tell which hospitals do a better job of stopping their spread. Hospitals have traditionally closely guarded their infection rates. Even hospitals that report infection data to a federal database are promised confidentiality.

In Florida, that veil of secrecy is supposed to lift - but just how soon remains a question.

State health officials say it will be a year before they make hospital infection rates public, as required in a bill that became law last year.

"I'd like to do this tomorrow," said Alan Levine, secretary of the state Agency for Health Care Administration. "But I have to recognize that if we get it wrong, we'll take a step backward."

Rep. Frank Farkas, sponsor of last year's bill, is concerned by the delay. "I'm kind of bothered by "next year,"' he said.

But Farkas, R-St. Petersburg, said he needs to talk more to AHCA officials and plans to meet with them this week. "I'm disappointed they're not ready, but more important is to get the correct information and get it right."

Hospital administrators say making such rates public is more complex than it sounds, and done incorrectly could mislead consumers and create burdensome paperwork.

"We're trying to work on the consumer aspect," said Kim Streit, chairwoman of an AHCA committee working on the rates and a vice president at the Florida Hospital Association. "It's just not something that can be up and running in three months or six months."

Some patient advocates agree.

"This is something that requires an awful lot of thought and analysis," said Jay Wolfson, director of the University of South Florida's Suncoast Center for Patient Safety Research.

Some data will become public this fall. AHCA is requiring hospitals to track and report how well they comply with basic measures to prevent infections, such as giving antibiotics before surgery and making sure staffers wash their hands.

Consumer advocates want to make infection rates public to give patients more power. Publicity also would pressure hospitals to try to lower their infection rates, they say.

"People will go somewhere else if you tell them there's an infection problem at that hospital," said Calvin Warriner, a Palm Beach lawyer. "It promotes infection control, because no hospital ... is going to ignore that."

Warriner represented more than 100 patients who alleged that they got infections after cardiac surgeries at Palm Beach Gardens Medical Center. They settled the lawsuit in December for $31-million.

Infections are becoming a greater worry for hospitals as powerful bacteria that are resistant to most antibiotics become more common. In the past few years, even bacteria that can't be killed by vancomycin, once known as the drug of last resort, have appeared in a few U.S. hospitals.

Consumer groups, notably Consumers Union, have been pushing for disclosure of infection rates. Florida is among the first states in the nation to pass the requirement. Illinois, Pennsylvania and Missouri have done so as well.

But with few standards for what to document and how to count infections, state officials are trying to develop their own.

The federal Centers for Disease Control and Prevention is expected to come out with a report on the issue in the next few weeks. Streit hopes these standards will help states develop national measures, so hospitals can be compared from state to state.

"If we create one system in Florida, and they have it different in Georgia or Pennsylvania, then we haven't done any favors for consumers," she said.

One problem is what to count. Many hospital administrators want to count only the most serious infections, such as those in surgical wounds or central lines. Those carry the most risk to patients.

If hospitals are given broad instructions to count every infection, they would have to make workers write up the most minor incidents. In theory, that could include even one of the most common ailments, such as newborns' diaper rash, said Dr. Juan Dumois, infectious disease chairman at All Children's Hospital.

"You've got to decide what to look at," he said. "You've got some unimportant causes of (hospital) infections."

Hospital officials also worry that hospitals that are more vigilant about tracking infections may have higher rates because sloppier hospitals ignore them.

And officials at larger hospitals worry about infection rates being higher there than at small, community hospitals, where fewer surgeries take place and patients are not as sick. Several hospital officials pointed to the same place as an example: Tampa General Hospital.

It has Tampa Bay's only Level I trauma center, burn center and adult transplant program. Higher-risk patients often go there, and the sickest patients are transferred there from smaller hospitals.

"If you compare South Bay Hospital with Tampa General, I guarantee you South Bay looks better than Tampa General," said Levine, who was once South Bay's CEO. "But that's because Tampa General does all the high-risk cases no one wants to do."

Hospital administrators want a formula that accounts for such differences, so patients don't assume larger hospitals are worse.

Dr. John Greene, chief of infectious disease at Tampa's H. Lee Moffitt Cancer Center & Research Institute, said many of his colleagues in the field oppose making rates public for that reason.

Greene, however, supports it, and will tell anyone who asks that Moffitt's infection rate for surgical wounds is about 3 percent. Still, he said, not only does data have to be compared carefully, but hospitals need to use data to improve sterility, not punish staffers.

For example, stamping out infections involves some work that is simple: enforcing strict hand-washing policies and even requiring staffers to get rid of fake fingernails, under which germs can hide.

Other measures are more difficult. Cancer hospitals worry especially about mold infections so they must make sure any roof or wall leaks don't harbor mold.

Hospitals should work with problem doctors and wards to find and fix problems so people don't fear disclosing when infections occur, Greene said.

"If a surgeon has a high infection rate, we don't want to fire the guy, because it sends the message, "I won't report any infections,"' he said

[Last modified February 21, 2005, 01:32:19]