Studies: Hospitals Could Do More to Avoid Infections

By Christopher Lee
Washington Post Staff Writer
Tuesday, November 21, 2006

Infections acquired in hospitals, which take a heavy toll on patients, arise mainly from poor hygiene in hospital procedures, not from how sick patients were when they were admitted, according to three new studies.

The studies, published yesterday in the American Journal of Medical Quality, provide new evidence for experts who argue that hospitals could prevent many of the growing number of infections that afflict patients nationwide, cost billions of dollars to treat and are responsible for thousands of deaths each year.

"It's the process, not the patients," said David B. Nash, the journal's editor and chairman of the Department of Health Policy at Thomas Jefferson University in Philadelphia. "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."

Rather than accepting some infections as unavoidable, Nash said, health professionals should do more to promote hand-washing among medical staff, take greater care in donning gowns and other infection-preventing clothing during medical procedures, reduce traffic in and out of operating rooms, isolate patients when necessary and use antibiotics more selectively.

The government can do more to educate the public and encourage hospitals to report infections, Nash said. And patients should speak up more, even asking doctors and nurses, "Did you wash your hands?" before being treated.

Hospital officials agree, said Nancy Foster, vice president for quality and patient safety at the American Hospital Association, which represents more than 4,800 hospitals and health-care systems nationwide.

"The new wave of research is showing that our previous expectations around what was preventable underestimated what we could actually achieve," Foster said. "We can prevent more infections than we thought before. Lots of hospitals are striving to get to zero" infections.

Preventing infections is a "delicate balancing act," she said, because simple measures such as greater antibiotic use would simply speed up the evolution of drug-resistant germs. "It's really the germs that are the bad guys here," she said.

Previous studies have shown that patients with hospital-acquired infections spend many more days in the hospital, undergo more extensive procedures and are more likely to die than patients who do not contract them. The problem has been the subject of congressional hearings and reports by the federal Institute of Medicine.

Solid national estimates are not available. But in Pennsylvania, the first state to collect such data, 19,154 patients contracted an infection in hospitals last year, up from 11,668 in 2004, according to a survey released last week by the Pennsylvania Health Care Cost Containment Council. The council, a state agency, said some of the increase was because of better reporting by hospitals.

The average hospital stay in Pennsylvania was nearly 21 days for those with hospital-acquired infections, and five days for patients without them. The average hospital charge was $185,260 for those with infections, nearly six times the $31,389 incurred by others. Twelve percent of patients who acquired infections died, compared with 2.3 percent of other patients.

The Pennsylvania survey, involving 168 hospitals and 1.6 million patients, examined four types of hospital-acquired infection: urinary tract infections associated with catheter use, infections from a central line inserted in large veins, ventilator-associated pneumonia, and infections at the site of incisions.

In one study released yesterday, researchers at Allegheny General Hospital in Pittsburgh found that age and severity of illness did not appear to be risk factors among 54 patients with ailments such as heart attacks and respiratory failure who contracted central line-associated bloodstream infections during the three-year period that was reviewed. On average, the hospital lost $26,839 caring for each patient, illustrating that there are financial advantages to reducing infections, the study found.

A second study, by researchers affiliated with provider Cardinal Health Inc. in Massachusetts, found that patients with hospital-acquired infections stayed in the hospital longer, were more likely to die and faced higher costs than patients with similar underlying illnesses who did not contract such infections. The severity of the effects of the infection could not be attributed to how sick the patient was on admission, the study found.

The third study, led by Christopher S. Hollenbeak, a professor of surgery at Penn State College of Medicine in Hershey, Pa., examined Pennsylvania's data for more than 180,000 surgical patients. It found that, while factors such as age and obesity, and conditions such as diabetes helped determine whether a patient was likely to develop a surgical wound infection, hospital practices such as hand-washing, the duration of surgeries and traffic through the operating room played a greater role.

"Hospital-acquired infections . . . should not be viewed as inevitable," said Marc P. Volavka, executive director of the Pennsylvania agency. "They are not just about the very elderly or the very sick. The simple fact is that every patient that enters a hospital in Pennsylvania and in this country is at risk for a hospital-acquired infection."

© 2006 The Washington Post Company