CMS requires hospitals to report bloodstream infections in ICUs

With the new year came a new requirement that hospitals start reporting the number and rate of adult patients in their intensive care units who acquire central line-associated bloodstream infections or else lose 2% in Medicare pay.

The catheter-related bloodstream infections kill an estimated 31,000 people annually and have been the focus of successful statewide quality initiatives using infection-prevention checklists, said the Centers for Disease Control and Prevention.

The Centers for Medicare & Medicaid Services rule was adopted in August 2010 and took effect Jan. 1, with data to be publicly reported on the government's website, HospitalCompare.hhs.gov, starting later in 2011. The rule also requires that hospitals start collecting data on surgical site infections in January 2012.

Consumer advocates said the move to require nationwide public reporting of hospital infection rates was long overdue.

"This is what we've been working towards for a long time," said Lisa McGiffert, manager of Consumers Union's Safe Patient Project. "Our strategy was to go to the states first and pass legislation, and 27 states now have hospital infection reporting. Now we've gotten to the point where the federal government took notice and decided that it was time to require this of all the states and all the hospitals throughout the country."

Physicians and other health professionals said they were pleased that the regulation calls for reporting using the definitions and data-submission process of the CDC's National Healthcare Safety Network -- as opposed to relying on claims information.

"Some of the data that have previously been reported are what we'd call administrative data," said Linda Greene, RN, who is on the Assn. for Professionals in Infection Control and Epidemiology's board of directors. "The information that will be entered into Hospital Compare is based on CDC definitions using very objective criteria. That, to us, is so very important, because as much as we support transparency, we also realize how important it is to compare apples to apples."

Investing in prevention

More than 3,000 of the nation's hospitals participate in the CDC's National Healthcare Safety Network, according to the agency's website. Twenty-two states require hospitals to report infections using the network. One of these states is New York, where Greene is director of infection prevention at Rochester General Health System.

For her, the new federal requirement "means no extra work whatsoever."

Transparency could encourage hospital administrators to pour more money into infection prevention, she added.

"Administrators have many competing priorities for funding allocations, so this definitely spurs them to look closely at their infection prevention programs and examine if they have appropriate resources for them," Greene said.

Nearly 500 hospitals in 27 states are taking part in "On the CUSP: Stop BSI," a project funded by the Agency for Healthcare Research and Quality. The project seeks to build on the success of the "Keystone: ICU" collaborative in Michigan, where intensive care units at more than 100 hospitals cut their median central-line infection rate to near zero per 1,000 catheter days, compared with a national average of 5.2.

The achievement was due to improving hand washing, using full-barrier precautions when inserting central venous catheters, cleaning the skin with chlorhexidine, avoiding the femoral site for insertion and removing unnecessary catheters. Physicians, nurses and others were encouraged to speak up when they saw colleagues failing to follow the prevention checklist.

The surgical infections that hospitals will have to start reporting in 2012 are those that arise in adult and pediatric patients after coronary artery bypass graft, hip or knee arthroplasty, colon surgery, hysterectomy and vascular surgery.