Bill would let public know more about hospital infections

JEFFERSON CITY, Mo. -- Experts estimate that one person in 20 picks up an infection during a hospital stay. Some legislators say the public deserves to know how often -- and where -- hospital-acquired infections occur in Missouri.

Bills pending in the legislature would require hospitals to report such information to state health officials, who would compile the data and make it available to the public.

Supporters say the reports would help consumers make more informed decisions and force hospitals to take appropriate steps -- with simple steps like proper hand-washing -- or risk losing business.

"When you go into the hospital you expect to get well. You don't expect to get a life-threatening infection," said sponsoring Rep. Rob Schaaf, R-St. Joseph, who is a physician. "Sometimes market pressure is the best way to effect change."

Will that work?

"I think public awareness is part of the resolution," said Dr. Gregg Laiben, medical director of Missouri Pro, a nonprofit group hired by the federal government to help Missouri hospitals and doctors improve health care. "That is a strong driver for process change and behavior change within hospitals."

The federal Centers for Disease Control and Prevention estimates that each year nearly 2 million patients in the United States get infections in hospitals, and about 90,000 of these patients die as a result of their infections.

Under the legislation by Schaaf and Sen. Sarah Steelman, R-Rolla, the state Department of Health and Senior Services would be required to develop guidelines and then gather data on the type and number of infections in hospitals and other health care facilities.

Two versions passedBoth the House and Senate have passed versions of the legislation, and the sponsors believe there is a good chance it will receive final approval before the session ends May 14.

The Missouri Hospital Association initially had concerns about the proposal but now supports it.

Lobbyist Daniel Landon said the association wanted to be sure that hospitals' patient demographics are considered and that every facility reports data using the same criteria. Otherwise, he said, those that aggressively report cases could appear to have a bigger problem than those that slack off on monitoring staph and other infections.

"It is very easy with infection control for the worst hospitals to look like the best and the best to look like the worst," Landon said.

Under the latest draft of the bill, the first public report would be due by the end of 2006.

The state health department reported that 12,430 Missouri residents hospitalized in 2002, the latest year for which figures were available, had a staph infection.

But the department's figures do not differentiate between how many people had an infection before entering the hospital and how many acquired it as a patient. That, supporters say, is precisely the reason the legislation is needed.

The health department said staph infections were mentioned on 225 death certificates in 2002, although not always as the main cause of death.

Along with the public reporting requirements, the bill has other patient safety measures. It protects internal hospital infection control officers from retribution if they report problems and gives them power to stop any practice they deem harmful.

The legislation establishes an advisory panel whose duties include recommending steps to cut down on hospital infections. And it requires that hospital staff be monitored -- at least sometimes without their knowledge -- to ensure they follow good practices such as washing their hands between patient visits.

Hospitals that do not cooperate could lose their licenses or state funding.

Health care organizations say another factor in reducing infections is how soon, and how often, antibiotics are administered to patients who undergo surgery. If they are given antibiotics quickly, but not for longer than 24 hours, patients respond better, Missouri Pro found.

Steelman cited statistics estimating that surgical-site infections cost about $57,000 per patient, mostly because their hospital stays are extended.

If just 1 percent to 2 percent of the state's hospitalized Medicaid patients contracted an infection in 2000, Steelman estimated, it would have cost $49 million to $97 million in federal and state dollars.

Schaaf called infections "a giant problem."

"Almost everybody you meet ... knows somebody who's gotten a bad infection at a hospital," he said. "My bill will save many millions of dollars to the state and thousands of lives over time."