Studies link infections to hospital processes

Poor infection-control practices are more to blame for the costs, morbidity and mortality that hospital-acquired infections cause than how sick patients are at admission, according to three new studies.

The research, published in a supplement to the November-December 2006 American Journal of Medical Quality, challenges longstanding beliefs about hospital-acquired infections, said David B. Nash, MD, the journal's editor and chair of the health policy department at Thomas Jefferson University in Philadelphia.

"The supplement has presented compelling evidence that it's process, process, process and that it is the system's nature of providing care that we have to attack" to reduce hospital-acquired infections, Dr. Nash said.

One study of 54 patients who acquired central-line-associated bloodstream infections at Allegheny General Hospital in Pittsburgh found that patients admitted with low-severity illnesses were infected at a similar rate to those with high-severity illnesses. Researchers also concluded that while the hospital was paid $64,484 to care for patients who contracted central-line infections, it cost Allegheny General $91,733 to provide post-infection care.

Another study of more than 180,000 surgical discharges in Pennsylvania found that while sicker patients were more likely to acquire an infection in the hospital, facility-specific factors such as hand hygiene, traffic in the operating room and length of surgery were one-third more predictive of infection rates than the severity of patients' illnesses.

Two of the three studies used 2004 data compiled as part of the Pennsylvania Health Care Cost Containment Council's report on hospital-acquired infections issued last year. A November 2006 report from the council -- a government agency to which hospitals must report -- set out infection rates, mortality and cost estimates for each hospital in the state in 2005. Nearly 20,000 hospital-acquired infections were reported, adding 394,129 hospital days and $3.5 billion in hospital charges. Patients who acquired infections in the hospital were 82% more likely to die there, the report said.

Doctors and hospitals have disputed the accuracy of the council's estimates because they are based on claims data rather than clinical records. But Pennsylvania Medical Society President Mark Piasio, MD, said physicians see room to improve.

"The great deal of infections are preventable, and that's what we're focused on," Dr. Piasio said. "Infections cost a lot both in terms of money and morbidity, and we need to look for solutions to reduce that waste and not quibble over the data."

The council report is available at the agency's Web site (link).