State report on HAIs yields sobering results
High number of infections reported in study
The first-ever accounting of statewide data on hospital-acquired infections, taken from 1.5 million discharges from 173 general acute care hospitals in 2004, shows that hospitals reported 11,668 confirmed hospital-acquired infections. These were associated with 1,793 deaths, an estimated 205,000 extra hospital days, and $2 billion in additional hospital charges.
Last year, Pennsylvania became the first state to begin collecting and reporting information on hospital-acquired infections, with its project "Hospital-acquired Infections in Pennsylvania." Pennsylvania hospitals were required to submit data on four types of hospital-acquired infections: three surgical site infection categories (cardiovascular, neurosurgery, and orthopedic surgery); Foley catheter-associated urinary tract infections; ventilator-associated pneumonia; and central line-associated bloodstream infections. Beginning January 1, 2006, hospitals will be required to submit data on all hospital-acquired infections.
The data are submitted electronically in a format required by the Pennsylvania Health Care Cost Containment Council (PHC4), author of the report. PHC4 is an independent state agency charged with collecting, analyzing and reporting information that can be used to make more informed decisions to improve the quality and restrain the cost of health care in the state.
"The way it is transmitted is not substantially different from the way they transmit data to their third-party payers," notes Marc P. Volavka, executive director of PHC4.
PHC4 payment data show that in 2003, the average payment for the treatment of a patient with an infection was more than $29,000, compared to an average payment of $8,300 for a patient without an infection. Much of the extra cost is for additional days in the hospital.
A logical next step
According to the report, the average additional length of stay for patients who contracted either a bloodstream infection or pneumonia was about 26 days. Patients with urinary tract infections (the most commonly reported infection) spent an average of 12.4 additional days in the hospital, while those with surgical-site infections spent an average of 7.8 additional days.
"We as a council had been looking at this issue for several years," Volavka explains. "Back in 2000 we had started to look at readmissions for complications. As we started to look at what caused them, we were astounded to find almost 50% of readmissions were due to infections acquired from previous admissions."
Cost consequences
In July 2003, with patient safety very much in the forefront, "Our government and the legislature added language which was particular to us to report," Volavka continues. "This was part of the impetus for us to move forward."
As a leader in statewide quality initiatives, Pennsylvania might seem to be one of the least likely states to see such a high rate of hospital-acquired infections. Did the results of the report surprise Volavka? "I think my honest answer is they were astounding, and I know full well we’re not getting anything close to full compliance in data capture," he says. "The cost consequences of getting an HAI are huge. This is not only clearly a patient safety issue, but a cost issue for everybody; in virtually all instances where a patient acquires an HAI, the cost to the hospital exceeds the payment they get, even though the payments skyrocket, so they lose money."
While 2005 data has not yet been released, Volavka says, "We see the same trend continuing into the first quarter of 2005."And the numbers we have are just the tip of the iceberg," he emphasizes.
Improving compliance
While giving credit to the Pennsylvania hospitals that are reporting data, Volavka says there are a number of things PHC4 can do to increase compliance.
"We will continue to identify what the reporting compliance of the facilities is," he notes. "We have also had a conversation with our state Secretary of Health, who licenses hospitals, and one of the requirements of retaining licensure is to be in full compliance with all state laws, and I suspect at their upcoming meeting in September the council will ask me to write a letter to every hospital we feel is not compliant. We also have fines and penalties we can impose."
There’s another way to encourage compliance that doesn’t involve laws or agencies, Volavka says. "It’s amazing what happens when a local paper runs an article about a hospital that does not meet state law," he hints, adding that "It is the goal of the council to get complete compliance across board."
The ultimate goal of such reporting, of course, is to improve patient safety. The ironic thing, says Volavka, is that many of the "answers" to minimizing HAIs are already known.
"It involves some of the most simple things a hospital can do to improve processes," he points out, "Like washing your hands; making sure catheters are put in and cleaned appropriately and removed quickly; elevating a vent patient in their bed by 30 degrees. These are not new; they’ve been documented in the literature for 20 years. And, the CDC has a wealth of things providers can do; the real question is why aren’t they doing them?"
Need More Information?
For more information, contact:
- Marc P. Volavka, Executive Director, Pennsylvania Health Care Cost Containment Council, 225 Market St., Suite 400, Harrisburg, PA 17101. Phone: (717) 232-6787. Fax: (717) 232-3821.
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