Pennsylvania's Public Reporting of Hospital-Acquired Infections: How Are Hospitals Addressing the Issue?

In the fall of 2006, the Pennsylvania Health Care Cost Containment Council (PHC4) released a report on the extent and cost of hospital-acquired infections across the state in calendar year 2005. Pennsylvania was the first state to publicly report such information. The findings were stunning: an infection rate of 12.2 per 1,000 hospital cases, leading to over 394,000 infection-related hospital days amounting to hospital charges of $3.5 billion. According to the report, the average commercial insurance payment related to caring for a patient who acquired an infection in the hospital was almost $54,000, compared with approximately $8,000 in commercial insurance payments for each patient who did not acquire an infection.

Efforts to address infection control were already under way at many of the state's hospitals, "but the PHC4 report certainly intensified the national discussion about how to not only reduce, but to eliminate, hospital-acquired infections," according to Joseph Martin, PHC4's director of communications and education. Pennsylvania hospitals have taken dramatic steps to decrease the rate of central line IV–associated sepsis, one of the most common forms of hospital-acquired infection.

For example, in 2005, the Health Care Improvement Foundation created the Partnership for Patient Care, a regional collaborative effort aimed at identifying specific steps that could be taken to reduce infections due to central IV lines. [1] Through the partnership, participating hospitals are addressing all 30 of the National Quality Forum's "safe practices," and in 2006 they showed a 9 percent improvement in meeting infection-prevention goals. [2] Chester County Hospital began using an evidence-based practice bundle developed by the Institute for Healthcare Improvement, and subsequently reduced its central line–associated infection rate by 25 percent last year.[3] The bundle laid out a protocol for creating an entirely sterile environment for placing a central line, including a head-to-foot patient drape with only a small hole near the shoulder, mandatory head caps for staff placing the line, and use of a special antiseptic. As in other hospital efforts to improve quality, nurses and other staff were trained to halt the process if they were uncomfortable with the level of sterility.

The University of Pennsylvania hospital, which has approximately 70,000 central line patient days annually, reduced the infection rate by 30 percent between 2005 and 2006.[4] Other hospitals demonstrating leadership in this area include Allegheny General, Butler Memorial Hospital, Charles Cole Memorial, Hamot Medical Center, and Thomas Jefferson University Hospital, according to Martin. For example, through staff training on infection control, Allegheny General Hospital reduced its rate of central line–acquired infections from one infection in every 23 lines placed to one in every 535 lines placed as of the end of February 2006. More than $2 million and an estimated 47 lives were saved over three years.[5]

There will undoubtedly be more efforts targeting hospital-acquired infections (both central line–associated and otherwise) in the near future, given the recent health care proposal put forth by Governor Rendell. The 47-point proposal advocates for the use of financial incentives (e.g., bonuses based on hospital performance, eventual discontinuation of state payments related to hospital-acquired infections) to reduce hospital-acquired infections.

References
[1] The Health Care Improvement Foundation is part of the Delaware Valley Health Care Council.
[2] Partnership for Patient Care: First Year Assessment.
[3] Josh Goldstein, "Area Hospitals Push to Stem IV Infections," The Philadelphia Inquirer, February 22, 2007.
[4] Ibid.
[5] See: R. Shannon, Testimony before the U.S. House Energy and Commerce Subcommittee on Oversight and Investigations, March 29, 2006; U.S. House of Representatives, Rx: Health Care Reform FYI #48 Subject: Healthier Hospitals: Eliminating Preventable Healthcare-Associated Infections. From: Rep. Tim Murphy (PA-18).