Information is New Tool in Fight Against Hospital Infections

By KIM BREEN / The Dallas Morning News - LAWRENCE JENKINS/Special Contributor

Four days after Carla Mullins' seemingly routine heart procedure, she awoke at her Hurst home with a 105-degree temperature and excruciating pain in her back and feet.

'I don't think people are aware of what goes on in hospitals,' said Carla Mullins of Hurst, who got an infection that made her feet black after a 2003 heart procedure. The effects linger. She spent the next month at a Tarrant County hospital's ICU fighting a blood infection that turned her feet black and nearly killed her. She had to quit her job, couldn't walk for three years and expects to be taking pain medication for the rest of her life. It never occurred to Ms. Mullins, 68, that she would leave the hospital after stent surgery in 2003 sicker than when she arrived.

"I don't think people are aware of what goes on in hospitals," she said. "I was very naïve. I just trusted everybody and everything."

An estimated 99,000 people die each year in the United States from infections they contract in hospitals, according to the Centers for Disease Control and Prevention. About 2 million such infections happen each year, at a cost of at least $4.5 billion. With an estimated 5 percent of people hospitalized contracting at least one infection, that translates to about 130,000 Texas cases each year.

On Wednesday, the Texas House passed legislation already approved in the Senate to make hospital infection rates public – a move to bring a historically secret problem to light. Growing attention to health-care-related infections has sparked similar legislative action across the country.

"People need to know when they're ill and going into the hospital that they're not going to leave with an illness that they picked up when they were there," said Sen. Jane Nelson, R-Lewisville, who sponsored the bill.

Consumer advocates and health professionals say the upcoming data, if reported fairly and consistently, will drive innovation and better communication among hospitals.

Hospitals have access to national data on infections for benchmarks, but the new reporting would be the first time area hospitals could compare numbers. It also would give prospective patients the opportunity to shop around and research hospitals.

Most medium-size and large hospitals already collect most if not all of the required infection-rate data, though it will take work to compile it in the right way once all the rules are set. "We stay on top of it all of the time to see if we're having problems," said Shirley Shores, director of infection control at Parkland Memorial Hospital.

Patients in the Dallas area should expect to see more measures to stop the spread of so-called superbugs when they check into the hospital, such as nasal swabs used to test for increasingly troublesome and potentially deadly bacteria – methicillin-resistant Staphylococcus aureus, or MRSA.

"Just having this law in place is going to lead to improvement," said Lisa McGiffert, director of the Stop Hospital Infections project for Consumers Union, which has been pushing nationally for legislation. "For the first time, hospitals will see how they compare. That is a huge motivator." Many see it as a first step.

Bob Beeley, a first responder for a fire department near Houston, had knee surgery in 2005 after twisting his ankle while attending to an accident victim. He checked into the hospital for minor day surgery "disgustingly healthy," but days later his knee swelled and turned red. He said he contracted an MRSA infection at the hospital. The infection spread, and he spent the day after Christmas on an operating table and two weeks in the hospital. "There was a time in the hospital when I was almost a goner," he said. When he went home, he had to treat himself with intravenous antibiotics three times a day for six months.

Beyond reporting infection rates, Mr. Beeley said the system needs improved financial accountability. He said his health bills have piled up because of someone else's mistake. The cost has reached well into six figures, of which he is responsible for at least 20 percent after insurance. "The dollars that I'm out of pocket are nothing compared to what it did to my family," he said. "I know that people make mistakes. My theory is if I make a mistake, I expect to pay for it."

The law would require hospitals to report rates of several infections, including some bloodstream infections as well as surgical site infections from procedures including colon, hip and knee surgeries and hysterectomies. Infections used to be seen as inevitable in hospitals, but no longer, experts said. "There's a whole move nationally from our profession of zero tolerance," said Ms. Shores of Parkland. "Don't make excuses, don't accept that you're no worse than you were last year or worse than anybody else. Continually try to improve."

At Hospital Corporation of America hospitals, which include Denton Regional Medical Center, Medical City Dallas Hospital and Medical Center of Plano, posters urge patients to take ownership of the oldest – and most important – infection prevention tactic.

The posters feature a germy green hand. "Stopping MRSA is in your hands." The hospitals are urging patients and visitors to wash their hands, and to ask caregivers to do the same. "Our goal is to eradicate preventable health care associated infections," said Dr. Jonathan Perlin, chief medical officer for HCA. Compulsive hand washing is part of a five-pronged campaign that kicked off in January. Studies have shown routine hand washing in hospitals happens far too infrequently, Dr. Perlin said. Aside from the posters, hand sanitizers in HCA hospitals are everywhere.

The hospital system has also ventured into a more modern infection prevention tool – screening high - risk patients for MRSA. At Methodist Health System hospitals, including Methodist Dallas Medical Center and Methodist Charlton Medical Center, high-risk patients are screened for several organisms, including MRSA. Most hospitals consider patients who are coming from nursing homes or who have been hospitalized recently among those at a high risk for MRSA and other bacteria.

"We're finding anywhere from 20 to 30 percent of patients we're doing cultures on are positive for organisms," said Virginia Davis, vice president of quality services for Methodist Health System. "At least half had no history of them." The testing began at Charlton more than a year ago and has led to a "marked decrease in the rate of health-care-associated infections," she said. Ms. Davis said so-called surveillance costs extra, but so do hospital-acquired infections, which lead to longer hospital stays: "It's a cost avoidance, but we're doing it because it's the right thing for the patient."

At Texas Health Resources hospitals, including Presbyterian Hospital of Dallas, a group of 10 employees spends a week inspecting hospitals every 12 to 18 months for safety in 10 areas, including infection control. They monitor hand washing, and when a patient is in isolation, they watch to see if employees wear the right gowns before stepping into the room. They check to see if intravenous lines are changed in time to prevent bloodstream infections.

Dr. Michael Deegan, chief clinical and quality officer for THR, said technological improvements for infection prevention will likely follow the legislation. "When people measure things and are transparent about it, it tends to lead to improvement." Presbyterian Hospital of Dallas currently has a pilot program for screening intensive care unit patients for MRSA.

Making the information public creates a business incentive to decrease infection rates, Ms. Shores said. But pride among health-care workers also will play a large part for motivation. Many patients do not have unlimited choices when it comes to hospital care, she said. "But it can help the consumer make choices," Ms. Shores said. "I think it makes the consumer more educated. I think it makes them ask questions." Ms. Davis noted that patients can log on to the U.S. Department of Health and Human Services Web site,, to compare the way hospitals care for heart attack patients.

Comparing data in Texas before and after public reporting shows remarkable improvement, she said, adding that she thinks the same will happen with infection rates.

"After they start seeing what others are doing ... they want to start learning from each other," she said. "It forces an escalation of shared best practices."