Faced with a modern-day medical challenge, states increasingly are taking steps to track the number of patients who acquire serious infections while hospitalized.
Eight states - including four with new laws this year - now require hospitals to track the number of patients who acquire staph and other infections while hospitalized, amid indications that the cost of these medical complications - in both dollars and lives - is mounting.
Last month, Pennsylvania became the first state to release statistics on hospital-acquired infections. The Pennsylvania Health Care Cost Containment Council reported that 11,668 patients contracted infections at hospitals in the state in 2004, resulting in 1,800 deaths and $2 billion in medical costs.
These new totals suggest that infections' impact on the health-care system might exceed predictions. The Centers for Disease Control previously estimated that hospital-acquired infections each year add $5 billion to U.S. health costs and result in 88,000 deaths - more fatalities than in highway accidents.
Many infections stem from surgical sites or the use of catheters or ventilators. Others result when basic sanitary precautions are not taken. Recent studies of hospitals suggest that as many as 10,000 lives could be saved annually through better hand washing.
Of the eight states now tracking infection rates, six tack on the requirement that hospitals must publicly release their numbers. New York and Virginia passed new laws this year while Florida, Illinois, Missouri and Pennsylvania already required disclosure.
Nevada and Nebraska enacted laws this year calling requiring hospitals to collect but not publicly reveal the number of infections. Legislatures in Louisiana, Tennessee and Texas approved resolutions to study the process of hospital reporting to design future legislation.
Measures to reduce hospital infections were submitted in 35 states this year. Bills are still under consideration in California, Michigan, Massachusetts, New Jersey and Ohio.
President Bush signed on July 29 the Patient Safety and Quality Improvement Act of 2005, which encourages health-care providers to log and report all medical errors to certain patient-safety groups but keeps the data anonymous. The bill provides that the reports could not be used against hospitals in malpractice suits, but would instead be used to monitor the standard of care.
Efforts at the state level put a stronger emphasis on public reporting, fueled in part by consumer advocates and patients' rights groups. One particularly active group is Consumers Union, which created StopHospitalInfections.org. The organization advocates for disclosure of infection rates to increase hospital accountability and to allow patients to make informed choices about their health care.
In states that have not passed legislation requiring public reporting, hospitals have been reluctant to comply with state rules requiring statistics on infection rates. Some worry that hospital-specific data could be misleading, as certain hospitals might have higher infection totals because of the types of cases they treat. Many hospitals do not screen for infections at admittance, so any count could include previously contracted conditions.
In other cases, hospitals have set their own guidelines. In Maryland, the state hospital association created its own data collection and reporting system and will begin releasing updates on infection rates in the next year. The state Legislature had considered but failed to pass a mandatory reporting rule, which was opposed by the hospitals.
"Our position was that it was not necessary to legislate because that process was already being tackled by the [Maryland Health Care Commission (MHCC)]. They were already ahead of the curve," said Nancy Fiedler, senior vice president of communications at the Maryland Hospital Association.
Fiedler added that the MHCC's approach is to gradually determine how to best collect and understand data.
"The problem is trying to get your arms around this issue. What do you want to report? What is it that you can count, and how do you do it in a cost-effective manner? It sounds straightforward, but there are so many different aspects," she said.
The Pennsylvania report may illustrate potential obstacles to accurate reporting. Sixteen hospitals reported no infections, a result met with incredulity. And while close to 12,000 infections were reported by hospitals, nearly 10 times as many were billed by consumers. The state commission has declined to release hospital-specific information because of such inconsistencies.