Sat, July 20

Panel explores ways to curb hospital infections

PHOENIX -- A special panel studying how to cut down on hospital infections that kill 2,000 Arizonans a year is looking at solutions -- everything short of actually telling would-be patients which hospitals have the worst record.

"It's more important to focus on prevention efforts in hospitals and other health care organizations than it is to report rates,' said Kris Korte, a member of the committee. She also is a nurse in charge of infection prevention at Banner Thunderbird Medical Center.

But Korte also acknowledged there's a more basic reason why hospitals oppose any sort of public reporting. She said patients would not understand the data.

"Infection rates are very difficult to explain to people that are not involved in creating those rates,' she said.

And state Health Director Will Humble, who said more Arizonans die from infections they get in hospitals than motor vehicle accidents, said he isn't going to push for a change in state law to make this kind of information available. That means more than the public being denied access. access. It also means the data is not provided to his own agency.

Humble said that, given the size and complexity of his agency, he has to "rely on stakeholder groups' to analyze problems and make recommendations to him.

"I'm not in a position to second-guess the committee,' he said.

Humble said he understands the desire of people who have options on where to have a procedure performed to have access to that kind of information.

"On an intuitive level, it does make some sense to report,' he said. But Humble said he told committee members to find what works elsewhere to bring down infection rates.

He said some of what the panel learned is that most of the effective infection-control practices are "really low-tech and simple.' They're also inexpensive.

"It's things like doing a better job of hand washing, both surgeons but also the nursing staff,' Humble said.

"It's paying attention to details when you're doing central lines' designed to provide medications directly into a patient's blood vessel, he continued. And it includes trying to prevent infection on cutting into the body, like swabbing antibacterial cream onto surgical patients.

And public disclosure?

"The data suggest that, in fact, it's not the most effective tool at driving down infection rates within hospital and health care facilities,' Humble said. "What I want to do is focus on those things that actually work.'

But the Committee to Reduce Infection Deaths, headed by former New York Lieutenant Gov. Betsy McCaughey, reports Arizona appears to be in the minority in keeping this information from the public.

It reports on its web site that 27 states have laws requiring public reporting of what are formally known as "healthcare-acquired infection rates. That allows, for example, New York residents to view a 135-page report which shows each hospital's rate of infection for various medical procedures.

Two other states have confidential reporting to state health officials.

Shoana Anderson, deputy chief of the health department's Bureau of Epidemiology and Disease Control, said raw data could be misleading.

"Some hospitals that are large research-level hospitals tend to get patients that are more ill,' she said, at least in part because they are better capable of taking care of those people. Anderson said there needs to be a baseline that takes factors like that into account "to make sure you're comparing apples to apples.'

She said pure numbers might find one case of healthcare-associated infections at one hospital, with another one showing 20 such incidents.

"That might not mean Hospital B is worse,' Anderson said. "That just might mean they tend to see patients with that type of illness more frequently.'

Humble said there will be outside pressure on hospitals to control infection rates, even if patients don't have access to the data. The bottom line, he said, is financial.

He said the federal government is becoming more and more the entity paying for health care for the poor and the elderly.

"They have a big interest in driving down what the costs are,' Humble said. And he said the government is monitoring those hospital costs closer and is going to stop reimbursing hospitals for the additional care required when patients get infections because of deficient practices.

"That's a strong motivator for medical facilities when you're no longer going to be reimbursed and paid for very, very expensive events,' Humble said.

"The costs that are entailed on a person who get a healthcare-associated infection that came in clean are enormous,' he continued. "When the federal government no longer pays for those, it's a powerful motivating tool.'

Cathy McCanna, program manager of the health department's office of medical facilities licensing, said consumers are not entirely in the dark. She said her agency publicly posts reports on its web site any time a hospital inspection results in a finding of deficiencies, whhich could include a conclusion by inspectors of inadequate infection control.

But the full reports, including exactly what inspectors found, are not publicly available.