Report: Hospital-Acquired Infections

In Tuesday's article "Data Show Scourge of Hospital Infections" (Post, July 13), Washington Post staff writer Ceci Connolly reports:

"Nearly 12,000 Pennsylvanians contracted infections during a hospital stay in 2004, costing an extra $2 billion in care and at least 1,500 preventable deaths, according to state figures released yesterday that officials say represent a conservative measure of one of the deadliest problems in modern medicine.

"As the first state to collect data on hospital-acquired infections, Pennsylvania has put hard numbers on a troubling phenomenon that until now has only been estimated. Even so, the true infection rate and cost is probably much higher, the report's authors said, because of underreporting by many hospitals. The actual tally could be as high as 115,000 infections, based on billing claims the hospitals submitted to insurers, the report said."

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Connolly was online Wednesday, July 13, at 3 p.m. ET to answer your questions about the report issued in Pennsylvania on hospital-acquired infections.

A transcript follows.

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Washington, D.C.: Now that this report has come out, what happens next? How can this be prevented in the future? Anything determined yet?

Ceci Connolly: Experts have come up with many ways to reduce hospital-acquired infections. The Leapfrog Group, a coalition of progressive employers, has come up with a list of the top 30 steps for reducing preventable infections.

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Arlington, Va.: What are, or could be, the broader implications of the Pennsylvania report for the rest of the country?

Ceci Connolly: To use a cliche, the Pennsylvania report is probably just the tip of the iceberg. There is no reason to think Pennsylvania is an anomaly. It is simply the first state to collect and publish hard numbers. Several other states are expected to follow suit soon.

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Bethesda, Md.: How can a citizen of Maryland encourage the Legislature to require Maryland hospitals to report hospital acquired infections?

Thanks

Ceci Connolly: There are any number of ways to convey your thoughts to lawmakers. Letters to the editor and letters to the politicians are two. A visit in person to your representative's office is also quite effective. And sometimes you can become involved with a group that shares your views and is actively engaged in lobbying for change.

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Washington, D.C.: Did you find the ICU and NICU areas to be safer than the other areas of the hospital in terms of acquiring these infections? I'm assuming because it is Intensive Care, Hospital staff might follow procedures more closely. Were equipment, rooms, etc tested to find the most contaminated areas?

Ceci Connolly: I can only answer anecdotally from my experience reporting other medical stories. While it is true the ICU and NICU are vigilant about possible infection, the use of machines poses certain infection risks. Patients on ventilators or catheters, for instance, stand a higher chance of contracting infection. Although again, in those cases, there are some good steps that can be taken to dramatically reduce those risks.

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Washington, D.C.: What kinds of infections and what were the main ways people were acquiring them?

Ceci Connolly: The Pennsylvania report analyzed infections in 4 broad categories: bloodstream, surgical, pneumonia and urinary tract infections via catheters. There are myriad ways to pick up an infection in a hospital. One of the most common -- and easily preventable -- if infection spread due to improper or lack of handwashing. This can come from a nurse or doctor to a patient or from one part of a patient's body to another.

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Washington, Va.: Can a correlation be made between these kinds of errors causing the infections with the nursing shortage and the use of less-trained staff?

Ceci Connolly: There is not concrete data on that, however many in the industry will tell you that staff shortages can cause personnel to cut corners or simply be rushed. On the other hand, medical errors, including preventable hospital-acquired infections, have been a problem for much longer than the most recent nursing shortage.

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Other groups?: Are there any other groups besides The Leapfrog Group that do similar work? Thanks.

Ceci Connolly: The American Health Quality Association is another organization focused on these issues, so is the Institute for Healthcare Improvement, based in Boston.

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Washington, D.C.: If it's determined that a person has a hospital-acquired infection, how is that treated generally? Are insurances handling this as any other infection?

Ceci Connolly: I'm not sure I completely understand the question. From an insurance perspective, these infections would be treated and paid for. In terms of the information reported on claims forms, many, but not all, will indicate how the infection was acquired.

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Virginia: Are these infections causing many deaths? Any documented so far? If so, are they only being documented in Pennsylvania so far? Thanks.

Ceci Connolly: Yes, these infections do cause deaths. The Pennsylvania data found that the 12,000 reported hospital-acquired infections caused 1700 deaths, of which 1500 were preventable. If you take a look at today's story, the report's authors use that to extrapolate some national numbers. In addition the Centers for Disease Control and Prevention has estimated 90,000 people die each year because of hospital-acquired infections.

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Aberdeen, Md.: What can someone that is going to undergo future surgery do to protect themselves from these infections? Take extra vitamin C?

Ceci Connolly: Well I'm a big fan of vitamin C but I think it will take more than that. The experts say do not be afraid to ask everyone you encounter in the hospital if they have washed their hands. If your surgery involves a catheter or breathing tube, experts suggest spending as little time as possible hooked up to the contraptions because those areas are at higher risk of infection. You can also ask the hospital to see its policies on infection control (if they have them!)

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Anonymous: When did research for this report begin?

Ceci Connolly: The Pennsylvania data was collected throughout 2004. The agency has been in business for a few decades but this was the first year it was able to get this information from hospitals. The effort is continuing in 2005.

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Washington, D.C.: In your experience covering the medical community, how widespread do you think this problem is and are there reports of this happening in other parts of the world?

Ceci Connolly: All of the experts say this is a widespread, serious problem. The CDC estimates that 2 million patients contract an infection in U.S. hospitals each year. It is costing consumers billions of dollars.

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Arlington, Va.: If you're using a catheter or breathing tube, how would you spend as little time as possible hooked up to the contraptions and why are these areas at higher risk for contamination? Thanks for the clarification.

Ceci Connolly: I am not a physician, but as I understand, any open area on the body is more susceptible to infection. Dr. Westley, who is quoted in today's story, suggests that most patients on a breathing tube attempt to spend even just a few minutes each day breathing on their own. This will help speed the recovery process. With respect to catheters, doctors have told me that some hospitals are just slow when it comes to removing them. I guess my advice would be to ask plenty of questions.

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Arlington, Va.: Are there many lawsuits pending in Pennsylvania because of all this?

Ceci Connolly: I don't know about lawsuits, but that is a great suggestion. I will pursue that and perhaps have another story to report soon. Thanks!

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Anonymous: Have you heard how the general medical community is responding to this report? What about specifically in Pennsylvania ... do you think this will end up being a catalyst for change?

Ceci Connolly: Many people hope that this sort of concrete data can be a first step toward pushing for change. It will probably take individual patients and employers (who often pay for health care) to pressure for sweeping change.

The reaction by hospitals has been mixed. Some are defensive, some embrace the safety movement and many are in between the two.

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Ceci Connolly: I'd like to thank all of you who emailed and/or read today's story. I have to write another story for tomorrow's paper but please feel free to pass your tips of health care stories along.

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