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Getting The Bugs Out
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"Where patients see hospital data that is discrepant," he said, "it's perfectly appropriate for the patient to ask the surgeon: 'Can you address this? Can you reassure me, if antibiotics are necessary, that I'm going to get them in a timely fashion?' "
Tapper, a hospital epidemiologist in New York who speaks for the Infectious Diseases Society of America, says any number of glitches can interfere with good practice. A surgical team may neglect to order a necessary drug, for example, or the drug may be ordered but not delivered on time. "To be effective, the drugs have to be given before the skin incision is made," he says.
Often, the problem is not that the drug gets forgotten but that it gets administered too soon and then excreted by the patient, says Dale Bratzler, principal clinical coordinator of the Oklahoma Foundation for Medical Quality.
Antibiotics, he says, "can't be started until the patient is rolling into or [already] in the operating room. Otherwise, there are just too many opportunities for [surgical] delay."
Practices surrounding the use of antibiotics aren't the only factors in preventing post-surgical infections. But the CMS database does not include such basic measures as doctors' hand hygiene. It also doesn't track the actual frequency of hospital-acquired infections, says Tammy Lundstrom, an infection-control specialist at Providence Hospital in Southfield, Mich. Laws recently passed in Maryland, Virginia and other states will require hospitals to track and publicly report certain kinds of infections.
CMS also recently announced that, beginning in 2009, it will stop reimbursing hospitals for the costs of treating certain hospital-acquired infections. That move is intended to put financial pressure on the institutions to improve their infection-control practices.
For now, the three CMS measures provide a partial window on how far some hospitals have to go. "These measures are indicators of how well the hospitals' infection-control programs are being implemented," McGiffert says. "But they don't tell us the results of those programs. The infection rates are what we're interested in." ¿
Ben Harder is the deputy health editor at U.S. News & World Report and usnews.com.
