Report calls for better hospital standards

The Baltimore Sun

WASHINGTON -- The federal government isn't doing enough to protect patients from getting infected at hospitals, endangering tens of thousands of lives and costing billions of dollars, congressional researchers reported yesterday.

The government has not established sufficient standards for hospitals to follow or prodded hospitals to follow those standards to reduce infections, the Government Accountability Office reported. Private groups representing doctors and hospitals demand more from hospitals, including simple steps like requiring doctors and nurses to wash their hands.

About 90,000 Americans die after contracting infections at hospitals every year, and 1.9 million more are sickened by the bacteria, says Consumers Union, an interest group that has been advocating for more action to prevent hospital-associated infections. The deaths alone add an estimated $5 billion in health care spending.

"Safety needs the equivalent of a polio campaign," said Dr. Peter J. Pronovost, medical director of Johns Hopkins' Center for Innovation in Quality Patient Care, who testified before the House Oversight and Government Reform Committee yesterday on the issue.

Patients often get the infections through intravenous tubes, catheters and ventilators they're hooked up to. Bacteria, often antibiotic-resistant types such as methicillin resistant staph or MRSA, contaminate the blood, urinary tracts and surgical sites.

Michael Bennett is suing Sinai and Northwest hospitals in the Baltimore area, alleging the wrongful death of his 88-year-old father, Mark. Bennett says his father went for treatment of a respiratory virus in 2004, only to get infected by six different bacteria that contaminated his blood, consumed his kidneys, heart and lungs, destroyed a leg and, four months later, killed him.

Bennett, of Pikesville, called government efforts "woefully inadequate." "Their policies, their guidelines are not focused on what's best for the patient," he said. (Sinai and Northwest hospitals don't comment on litigation, but have been taking various steps to prevent infections, including screening for bacteria and putting patients on antibiotics before surgery, officials said.)

Starting this fall, the Centers for Medicare and Medicaid Services won't pay hospitals more to treat patients who developed infections at the facilities. But federal health agencies haven't taken the additional steps necessary to make sure hospitals reduce infections, the GAO said in a 54-page report.

Medicare has established too few standards for hospitals, and they tend to be vague, the GAO said. Meanwhile, the Centers for Disease Control and Prevention has failed to give hospitals direction about which of the 1,200 practices it recommends are the most important to follow, strongly recommending 500.

"It feels like you're trying to walk through mud when you get volumes of recommendations," said Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association. Industry and physician associations offer more specific guidelines, such as requiring hospitals to offer flu vaccinations to staff, the GAO said.

While acknowledging shortcomings, federal officials said in a letter to the GAO that the department cites hospitals for improper practices and requires hospitals to take steps to fix the problems. Officials also said they are improving data collection and sharing, another shortcoming highlighted by the GAO.

Hopkins' Pronovost, who has helped hospitals in Michigan sharply reduce infection rates, said the federal government should fund research into effective preventive steps, beef up collection of infection data from hospitals, and use Medicare and Medicaid payments more to secure improvements.

"We can get to zero, and that should be the goal," said Lisa McGiffert, who leads Consumers Union's campaign to eliminate hospital infections.

Recommended measures include making sure staff members wash their hands more, increasing the use of medical devices coated with antibacterial agents and properly ventilating operating rooms. The GAO report urged the government to prioritize its standards and improve data collection. Consumers Union is pushing for more public reporting of infection rates at hospitals.

States have taken the lead on the hospital infection issue. Since Illinois passed the first law in 2003, more than 20, including Maryland, have enacted measures to publish the infection rates at hospitals, considered a key step to reducing infection rates. But only a handful of states have begun issuing reports as they struggle with technical issues in collecting and analyzing the information.

Maryland's response has been typical. Under a 2006 law, it will begin collecting infection information from hospitals in July and issue the first report on blood infections in intensive care units early next year, said Pam Barclay, director of the Maryland Health Care Commission's Center for Hospital Services, an independent agency.

The Health Care Commission will add reporting of more kinds of infections in future months, Barclay said, but will stick to infections in intensive care units, rather than expanding to other hospital departments.

New regulations requiring hospitals to develop infection control programs go into effect Monday, said Wendy Kronmiller, director of the Office of Health Care Quality at the Department of Health and Mental Hygiene. The state won't tell hospitals what to do, just make sure they take precautionary steps.

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