Massachusetts to Act on Nosocomial Infections

Massachusetts is trying to tackle the problem of hospital-acquired ('nosocomial') infections by adding $1 million dollars in funding to track and monitor hospital compliance with infection control measures. As I've discussed before, nosocomial infections are a huge problem, and may account for roughly a quarter of all hospital costs. From the Boston Globe:

State officials plan to increase scrutiny of hospital-acquired infections in Massachusetts as a way to significantly lower their frequency, and they hope to require all hospitals to report their infection rates to the state by next year.

A new health insurance law calls for mandatory education for healthcare workers and penalties for employees and facilities that don't comply with infection prevention measures, which health officials are developing....

Because hospitals are not required currently to report hospital-acquired infections to public health agencies, researchers don't know how often they occur. But patient safety and public health specialists estimate that nationally hundreds of thousands of hospital patients a year contract infections. Bacteria spread down tubes, also called central lines or catheters, placed in their veins to deliver medicine or in their lungs to help them breathe, and through incisions made during surgery.

The federal Centers for Disease Control and Prevention estimates that each year patients contract 250,000 infections from catheters alone, infections that kill between 12 percent and 25 percent of patients who get them and cost about $25,000 each to treat. A small Massachusetts study published in 2002 suggested that 13 percent of 1,953 cardiac bypass patients suffered infections at the site of their surgery, including ones detected after patients were discharged.

Aside from the risk to patients and the cost to the healthcare system, another reason for the industry's growing focus on the problem is the increasing proportion of hospital infections that are resistant to common antibiotics, which makes them more dangerous and difficult to treat. At the same time, specialists believe that many infections are preventable with proper sterilization techniques and timely administration of antibiotics and more judicious use of catheters and ventilators....

The department [of Public Health] has authority to discipline hospitals for poor infection-control practices, but health officials generally know about problems only if they get a complaint, which Dreyer said they rarely do.

"For a long time, there's been a sense that hospital-acquired infections are inevitable and the cost of doing business," Dreyer said. "Partly because of the patient safety movement, people don't think that's the right way of looking at them anymore. They're no more the cost of doing business than wrong-side surgery."

This shift in thinking has been reinforced as some hospitals have shown it's possible to reduce infection rates to near zero by focusing more on prevention. Michigan hospitals that rigorously implemented infection-control procedures, such as doctors and nurses washing their hands and cleaning patients' skin with an antibacterial agent before inserting intravenous lines, reduced catheter-related blood stream infections in intensive-care patients from an average of 7.7 per 1,000 days of catheter usage to 1.4 per 1,000 days a year and a half later, researchers reported in the New England Journal of Medicine last month.

I've seen the program Massachusetts wants to implement. I hope the consultants they hired are good, because the state RFP ('request for proposals') was very vaguely worded (I don't really have much confidence in the state oversight; I heard a lot of buzz words and not much in the way of specifics). Nonetheless, if this works, it will save many lives, and, hopefully, be a model for the rest of the country.