Hospital-acquired infections in most cases are the result of poor hygiene

Hospital-acquired infections in most cases are the result of poor hygiene within the facilities and not of how sick patients were at the time of admission, according to three studies published on Monday in the American Journal of Medical Quality, the Washington Post reports.

Two of the studies examined data in a recent report by the Pennsylvania Health Care Cost Containment Council, the first state agency to track and publish statistics on hospital-acquired infections. The report, which included data from 168 hospitals and 1.6 million patients in the state, found that 19,154 patients contracted infections in hospitals in 2005, compared with 11,668 in 2004, an increase that researchers said partially was because of better reporting. For one study released on Monday, researchers from Allegheny General Hospital in Pittsburgh analyzed data on 54 patients who acquired central line-associated bloodstream infections over three years (Lee, Washington Post, 11/21). The study found that insurers paid the hospital an average of $64,894 for each infected patient. The average expense of caring for the patients was $91,733, resulting in an average loss of $26,839 per patient, according to the study (USA Today chart, 11/21). The hospital broke even or made a profit on four of the patients, the study found. Co-author Richard Shannon, vice chair of clinical affairs in the Department of Medicine at the University of Pennsylvania, said that the study "adds economic strength to the notion that we ought to be doing away with infections" (Appleby, USA Today, 11/21). In the second study, researchers from Cardinal Health in Massachusetts found that the severity of the effects of an infection could not be attributed to the severity of a patient's illness at admission. In addition, the study found that patients who contracted hospital-acquired infections had longer hospital stays, were more likely to die and accumulated higher costs than similar patients who did not contract infections. For the third study, lead author Christopher Hollenbeak, a professor of surgery at the Pennsylvania State University College of Medicine, examined PHC4 data on more than 180,000 surgical patients. The study found that underlying factors such as age, obesity and diabetes helped determine whether a patient was likely to acquire a surgical wound infection, but to a lesser degree than hospital procedures such as hand washing, length of surgeries and traffic through the operating room.

David Nash, editor of AJMQ and chair of the Department of Health Policy at Thomas Jefferson University, said, "It's the process, not the patients" that leads to hospital-acquired infections. "These three groups independently found that despite hospitals' claim that in the sickest patients it's inevitable that someone is going to get a hospital-acquired infection, that's just not the case," Nash said, adding that health professionals should promote more hand washing among hospital workers, use greater care with gowns and other clothing that can prevent infections during procedures, reduce traffic in operating rooms and be more selective in the use of antibiotics (Washington Post, 11/21). Marc Volavka, executive director of PHC4, said, "The simple fact is that every patient who enters a hospital in Pennsylvania and in this country is at risk for a hospital-acquired infection," adding that many infections "are about flawed processes and the chaos currently existing within our health care delivery system." Volavka and Nash said the federal government should encourage hospitals nationwide to follow Pennsylvania's model for tracking infections (Sherman/Fahy, Pittsburgh Post-Gazette, 11/21). Shannon said, "Not only is it the right thing to do from the patient perspective, but infections are in fact costing payers and hospitals lots of money" (USA Today, 11/21). Rep. Tim Murphy (R-Pa.), co-chair of the congressional health care caucus, said, "I think the federal government has to take the lead on this." Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association, said the federal government is considering linking Medicare payments to hospital infection rates (Pittsburgh Post-Gazette, 11/21). "The new wave of research is showing that our previous expectations around what was preventable underestimated what we could actually achieve," Foster said (Washington Post, 11/21).

Broadcast Coverage
PBS' "NewsHour With Jim Lehrer" on Monday included an interview with Shannon(Suarez, "NewsHour With Jim Lehrer," PBS, 11/20).

Audio of the segment is available online.