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Hospitals Face New Pressure To Cut Infection Rates

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Hospitals Face New Pressure To Cut Infection Rates

Health

Hospitals Face New Pressure To Cut Infection Rates

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SCOTT SIMON, host:

Another medical matter that's drawn attention among the states is the rates of infections contracted in hospitals. Laws requiring hospitals to tell the public how well they're preventing infections are catching on, which by patient advocates who say that hospitals administrators and state regulators were not making, sometimes deadly infections a priority.

But as Sarah Varney from member station KQED and our partner, Kaiser Health News, reports, it remains unclear whether this public shaming works.

SARAH VARNEY: It's been more than a decade since a panel of top scientists declared hospital safety a national priority, yet tens of thousands of people still die each year as a result of preventable infections from routine surgeries and hospital care. Many more are irreparably harmed.

Mr. DAVE MEYER: My name's Dave Meyer. I live in Fair Oaks, California, and I was a general contractor before my accident.

VARNEY: Dave Meyer broke his ankle during a nasty motorcycle accident. Records indicate he contracted an infection at a Sacramento-area hospital that prevented his ankle from healing. He endured several surgeries and excruciating wound cleanings.

Mr. MEYER: Imagine taking a ice cream scoop and just taking half of your foot off. It's this gaping hole. I know it would have been so much better if they would have just used the proper hygiene in the hospital.

VARNEY: Under new Medicare rules and state laws, hospitals now face financial penalties if they don't report how often patients get infections like Dave Meyer's. That's left hospital administrators, like Clark Todd of Pacific Hospital in Long Beach, California, weighing the cost of fessing up with the cost of fines.

Mr. CLARK TODD (CEO, Pacific Hospital, Long Beach, California): If we hide it from the public, then the tendency to keep the status quo is stronger than ever, and that's just not going to get the job done.

VARNEY: Todd is isn't hiding from the public. He's gotten aggressive against infections, so much so that Pacific now has some of the lowest rates of infections acquired in the hospital anywhere in the country. One of the first things he did was hire doctor Alfonso Torres Cook.

Dr. ALFONSO TORRES COOK (Head of Infection Control, Pacific Hospital, Long Beach, California): Hospitals are dirty. We clean very good certain area. We wash our hands. We demand clean uniforms, but we don't clean the patients.

VARNEY: Torres Cook says the medical staff used to view infections as largely unavoidable and treated them with antibiotics. That approach was costly. An infection can add $42,000 to a patient's bill in the intensive care unit.

Now, Torres Cook has reshaped the hospital's whole approach to cleanliness. His first priority: everyone on the staff is urged to wash their hands a lot.

(Soundbite of water running and talking)

Walking around the hospital, Torres Cook greets anyone with a warm smile. He lets us into a closet that contains one of the weapons in the hospital's anti-infection arsenal. It's an ultraviolet light that wipes out germs.

Dr. COOK: The air comes through it. It's passed through these lamps and it's clean.

VARNEY: Nurses here now wash patients every day. Janitors are given enough time to properly clean rooms. Patients coming in for surgery are asked to shower before they arrive.

At first, the employees resisted the efforts, says hospital CEO Clark Todd, but he says, California's new public reporting law and Medicare's decision to start withdraw 2 percent of payments from hospitals who keep their infection numbers secret have helped his cause.

Mr. CLARK: I think that gives administrators like me even more reason to get involved in this matter. And more clout with our medical staffs to work against some of these traditional behaviors.

VARNEY: Indeed scores of hospitals across the nation have eliminated certain infections and researchers have found that concern over a hospital's public image is a powerful motivator.

Dr. Michael Rapp runs the quality measurement group at the Centers for Medicare and Medicaid.

Dr. MICHAEL RAPP (Director, Quality Measurement and Health Assessment Group, Centers for Medicare and Medicaid Services): Many hospitals actually will measure quality and voluntarily put it up, even without the government involved, but certainly once it's required before all hospitals are required to do that, there's the peer pressure, and they're going to be looking at how they do compared to others.

VARNEY: The fear of losing millions of dollars isn't an idle threat either. Right now only half of U.S. hospitals volunteer their data on infections. Rapp anticipates that nearly all will comply, as the sanctions begin to sink in.

Right now it's bloodstream infections related to infusions. Next year hospitals will lose payments if they fail to reports after surgery. The list will grow longer in the coming years.

Still, the stigma that comes with the public perception of unclean wards and the fear of lawsuits can make hospitals reluctant to report. And hospitals say competitors may undercount and some do more surgeries or have sicker patients, so the rate is higher.

Nancy Foster represents the American Hospital Association.

Ms. NANCY FOSTER (Vice President, Quality and Patient Safety Policy, American Hospital Association): It is absolutely true that the measures are not perfect and don't adequately account for some of the differences among patients.

VARNEY: And that hits small rural hospitals especially hard. Ukiah, California is a verdant and woodsy town a few hours north of San Francisco. Outside the local hospital it's a brilliant spring day and patients and visitors all seem to know each other, trading warm hellos. Like many rural towns, it's not hard to imagine how quickly word of even on infection could spread.

Ms. SUE MASON (Ukiah Valley Medical Center, Ukiah, California): We have nothing to hide. It's just the interpretation that you wonder about.

VARNEY: Sue Mason has a big job, and only 20 hours a week to do it. She's a half-time nurse charged with tracking and preventing infections at Ukiah Valley Medical Center. Every morning she checks the computerized lab tests and tries to chase down new cases. But with the need to collect data for the new reports, she has little time to eliminate the very infections she's charged with reporting.

Ms. MASON: I'd like to out on the floor more with the nurses. I could monitor their, you know, hand hygiene compliance and educate them as I actually see them doing their job.

VARNEY: And this is as you're kind of crunching data?

Ms. MASON: Yeah, I spend most of my day in front of the computer. Yeah.

VARNEY: Mason must report not just the infections that occur, which are rare here, but details of every surgery, every patient who test positive or even negative for gruesome antibiotic resistant bugs. Keeping track can be daunting for small and big hospitals. It will take some time before patients can know how well a hospital is doing.

But there is great hope among researchers and hospital chiefs that this double-barreled approach of public reporting and amped-up financial sanctions may be the best cure for what has proven to be a chronic condition in hospitals.

For NPR News, I'm Sarah Varney.

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