Hospital Infection Rates: A Secret that Needs to Be Told. Entry 26 - 2007

The Centers For Disease Control (CDC) estimates that in 2002, 1.7 million patients acquired an infection in U.S. hospitals and about 100,000 died as a result.(1) On average, one in every 22 hospital admissions will result in an infection, which means in facilities with the highest rates the incidence is even higher (1). More worrisome, the rate of a “superbug” called methicillin-resistant Staphylococcus aureus (MRSA)*, is increasing in hospitals (2), where over 75% of equipment (such as blood pressure cuffs) in inpatient rooms tested have the resistant bacteria (3). In all, the Committee to Reduce Infection Deaths (RID) estimates that infections add an additional $30.5 billion to the cost of healthcare in our country (3).

Almost all healthcare-associated infections are avoidable with appropriate levels of cleaning and hygiene by healthcare providers and facility managers (3). One hospital won an award for a 62% reduction in infections using methods described as “easily and cost effectively reproducible in any organization” (4). Further, patients who are aware of the risk can also take personal steps to help avoid infection (5). So, the rates can be lowered with care and effort—using existing methods of cleaning, ventilation and personal hygiene, such as better hand-washing practices and disinfecting door knobs and bed rails (6).

If you knew the hospital infection rates for the hospitals in your area, would it affect your decision to go there? It just might—IF you could access that kind of information. Unfortunately there is one small problem with that strategy:

In most states, hospitals are not required to report infection rates, so they don’t.

Not surprisingly, the hospital lobby opposes reporting requirements (7) and has been influential in discouraging congress from mandating standard reports. Unlike industries like transportation (8), which is mandated to provide safety information, healthcare facilities have only voluntary reporting guidelines, and few participate.

Since most states do not report rates, with a few exceptions like Pennsylvania and Florida (7), the public has little information on which to base decisions or compare risks.

Let’s examine the economic incentives and disincentives in this hidden problem. Hospitals do not have to report negative events that are, in part, avoidable. Because fee-for-service medicine charges by the service, more services result in more revenue. By avoiding errors, hospitals help their patients, but decrease fees. (8) Thus, a hospital with a higher infection rate actually receives additional revenue due to longer stays and more treatments, than hospitals with better safety ratings (at least until late 2008 when Medicare will stop paying for treatment for some avoidable errors (9)). Since patients have no information about poor infection records to dissuade them from choosing the most dangerous facilities, those facilities do not lose business.

While no one wants to suggest that facilities would allow infections intentionally, the economics are actually aligned to reward facilities whose patients do worse. The consumer site Stopinfectionsnow.org, part of Consumer Reports, has begun collecting anonymous information from patients in an attempt to make safety issues more transparent (10). Perhaps increasing media attention will place pressure on providers to report accurate safety records, or self-police through voluntary systems of confidential reporting by healthcare employees (similar to the transportation industry)(11,12).

At a minimum, all patients would benefit from increased transparency by having more accurate information on which to base decisions. In any industry, when consumers base their purchasing choices on accurate information about quality, overall levels of quality improve. Thus, if this information were public, hospitals would have a strong incentive to reduce infection rates in order to maintain market share.

While our culture tends to hold medicine in high esteem, it seems unacceptable to us that consumers tolerate the added risk, discomfort and cost associated with undisclosed infection rates. Cars have safety ratings, individuals have credit ratings, airlines have ratings on rates of lost baggage… all to allow consumers and businesses to assess their risk and make informed choices. One has to wonder how health facilities have avoided requirements to report such an important safety issue.

In this era, where anyone selling products regularly on E-bay receives a rating from his buyers, and almost any product on Amazon.com gets a rating of one to five stars from purchasers, the absence of patient-reported outcomes represents a missed opportunity. It could be that patients presume that insurance companies and Medicare—the purchasers—would protect them from facilities that have poor infection control. Or consumer may assume that if patients are getting infections more often at specific hospitals, the media would know about it and publicize it.

Unfortunately, neither of these assumptions is true.
Hopefully, new efforts by Google (13) and Microsoft (14) to create a home for consumer-held health records will include mechanisms for more transparency regarding safety and quality among health care users. If so, market forces from consumers demanding clear, accurate information about the healthcare they purchase may reform the system after all.
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* If you are like me, you have heard of multiple cases of MRSA experienced by friends or friends-of-friends in recent months. Yet, our impression is that the news media has not brought the issue to public attention as obviously as one might expect. This trend prompted our investigation for this blog.

References:
(1) Klevens, R. M.; Edwards, J. R.; Richards, C. L. Jr; Horan, T. C.; Gaynes, R. P.; Pollock, D. A., and Cardo, D. M. Estimating health care-associated infections and deaths in U.S. hospitals, 2002. Public Health Rep. 2007; 122(2):160-6, (page 160) (accessed December 4, 2007).

(2) Zeller, J. L.; Burke, A. E., and Glass, R. M. JAMA patient page. MRSA infections. JAMA. 2007; 298(15):1826, (accessed December 4, 2007).

3) McCaughey, B. Unnecessary deaths: the human and financial costs of hospital infections. 2nd ed. New York: Committee to Reduce Infection Deaths; 2006, (accessed December 4, 2007).

(4) Joint Commission. The 2007 John M. Eisenberg Patient Safety and Quality Awards: Innovation in patient safety and quality at the local level, Evanston Northwestern Healthcare, (accessed December 4, 2007).

(5) Committee to Reduce Infection Deaths. 15 steps you can take to reduce your risk of a hospital infection, (accessed December 4, 2007).

(6) Centers for Disease Control, Healthcare Infection Control Practices Advisory Committee. Guidelines for environmental infection control in health-care facilities, 2003, (page 74) (accessed December 4, 2007).

(7) McGiffert, L. Washington lawmaker takes aim at hospital infections. ConsumersUnion.org, February 17, 2006, (accessed December 4, 2007).

(8) In Bid for Better Care, Surgery With a Warranty. New York Times.

(9) Medicare will not pay for preventable conditions acquired at hospitals. Senior Journal.com, August 20, 2007, (accessed December 5, 2007).

(10) Consumers Union. Share your hospital infection story, Stop Hospital Infections.org, (accessed December 4, 2007).

(11) National Transportation Safety Board. Reporting an accident to the NTSB, aviation, (accessed December 4, 2007).

(12) Office of Transport Safety Investigators. Confidential safety information reporting scheme (CSIRS), February 23, 2007, (accessed December 4, 2007).

(13) Allen, J. Health grades, inc.: a google a day. SmallCap Investor.com, November 9, 2007, (accessed December 4, 2007).

(14) Microsoft electronic health records solutions. Microsoft.com, (accessed December 4, 2007).