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HHS Warns of 'Disturbing' Trends in Hospital-Associated Infections

By Jane Norman, CQ HealthBeat Associate Editor

April 13, 2010 -- A new report issued Tuesday by the Department of Health and Human Services pinpoints "disturbing" findings when it comes to infections acquired in hospital settings and warns such infections are on the rise in the United States. Rates of postoperative sepsis, or bloodstream infections, and catheter-associated urinary tract infections top the list.

Sepsis is a life-threatening infection that kills a third of those who contract it, while urinary tract infections generally are treatable with antibiotics but still troubling when combined with other problems in a hospitalized patient.

"In hospitals, safety remains a significant problem," says the report by the Agency for Healthcare Research and Quality (AHRQ), adding that it is "unfortunate" that rates of healthcare-associated infections are not declining and little progress is being made.

Overall, the report concludes that health care quality in all settings is improving slowly, especially for preventive care and chronic disease. The uninsured remain less likely to receive needed care.

HHS Secretary Kathleen Sebelius told reporters in a conference call that the problem with hospital infections is "incredibly serious" and that as many as 100,000 deaths annually are due to hospital infections. Provisions in the new health care law (PL 111-148) enacted by President Obama will start to address the problem by reducing reimbursements under Medicare for certain conditions acquired while under hospital care, as well as preventable re-admissions.

Sebelius said there are proven strategies for reducing infections — they are just not in place in hospitals in most parts of the country. "Eventually there will be a financial disincentive for hospitals that don't take this very seriously," said Sebelius, citing the new law.

The figures on infections are included in the National Healthcare Quality Report mandated by Congress and issued annually since 2003 that examines U.S. health care quality and includes a new section on infections contracted by patients while in the hospital.

"It is evident that more attention devoted to patient safety is needed to ensure that health care does not result in avoidable patient harm," says the report. Rates of postoperative sepsis, or bloodstream infections, increased by 8 percent between 2006 and 2007, while postoperative catheter-associated urinary tract infections were up by 3.6 percent and selected infections due to medical care were up 1.6 percent.

Unchanged was the number of bloodstream infections associated with central venous catheter placements, which are tubes placed in a large vein to administer medication or fluids or collect blood samples. Rates of postoperative pneumonia did improve by 12 percent.

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, said in an interview that hospitals take the issue of patient safety very seriously and have been working on the issue for many years, especially in the past decade since a landmark report on medical errors was issued by the Institute of Medicine.

"With regard to infections, in particular we have taken enormous strides by trying to reduce infections by using the best available science to show us what strategies are likely to work," said Foster. While the data in the AHRQ report is the best currently available, it's still a couple of years old and hospital improvements may not yet be visible in data, she said.

The rate of increase in sepsis documented in the report was surprising, Foster said, perhaps because the data is being collected and analyzed more so than in the past. At the same time hospitals fared well in the AHRQ report on processes tied to reducing infections, such as timely administration of antibiotics. "That leaves us sort of wondering — what are the other things we need to be doing consistently?" Foster said. "We don't have that answer. If we did, we would be implementing that."

More basic research – and government support for it – is needed at the Centers for Disease Control and the National Institutes of Health to help provide some of the solutions, Foster said.

Carolyn Clancy, director of AHRQ, said that generally, U.S. health care quality is improving though the pace is too slow. Overall, across all settings, measures of health care quality are improving at about 2.3 percent a year and 5.8 percent a year in hospitals, she said. Outpatient care is improving at 1.4 percent annually. "Though the trends are good the pace is unacceptably slow," said Clancy.

Focused attention on reducing hospital infections can work dramatically as has been evidenced through a government-funded project over three years in intensive care units in Michigan ranging from small rural facilities to academic centers, said Clancy. All of them adopted standardized procedures and reduced the rates of central line-associated bloodstream infections to nearly zero. The project will be expanded to all 50 states, the District of Columbia and Puerto Rico. "This became part of the fabric of delivery of care in these hospitals," she said.

A second mandated report, the 2009 National Healthcare Disparities Report, found that members of minority groups and low-income Americans, especially those without insurance, continue to lag when it comes to quality health care. Many of the disparities are not decreasing, said Howard K. Koh, assistant secretary of health. Reducing disparities means more emphasis on raising awareness and improving training and communication, said Koh. Sebelius said the new law will help by creating a new national institute on minorities and minority health and mandating new data on disparities.

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