Hospital, Infect Me Not

Patients in hospitals should not end up worse off than when they were admitted because of an infection acquired during treatment. Yet thousands of people are stricken this way in Massachusetts and across the nation. Hospitals know their infection rates, and it's about time they made them public, to inform prospective patients of the risk and to put the staff on notice that they need to do better to prevent the spread of germs.

A report by a special investigative committee funded by the Legislature recommends that the state mandate reporting of infections in three common procedures: hip replacements, knee replacements, and the insertion of "central line" catheters, which can remain in patients for weeks to deliver chemotherapy or liquid food. Hospitals would report rates of other less common procedures to the Department of Public Health, but not have to release the information to the public.

Karen Nelson, RN, vice president of the Massachusetts Hospital Association, likes the idea, but inquiries to hospitals in Boston suggest a certain reluctance. For instance, Boston Medical Center said in a statement: "Until a standardized mechanism for reporting these rates is agreed upon, any information released to the public by an institution would not provide an accurate method of comparison." John Auerbach, the state commissioner of public health, would like to wait six to nine months before releasing comparative data, while DPH and the hospitals work out a strategy to reduce infections.

There's no need to delay. Since December Paul Levy, chief executive of Beth Israel Deaconess Medical Center, has been publicizing his hospital's rates of central line infections, dating back to October 2005. Combined with an intensive internal education campaign, it has caused the infection rate to drop significantly. BI-Deaconess follows a standard set by the US Centers for Disease Control and Prevention. That ought to be an adequate model for the other hospitals in the state.

The Department of Public Health set up the special committee as part of the Health Reform Law approved in 2006. Legislators wanted expanded access to health insurance to be accompanied by improvements in healthcare quality. Compared to the difficulties of providing coverage to the uninsured, publication of the comparative data is a simple matter.

Next month the Legislature's Committee on Health Care Finance will be examining a bill to require better reporting as part of a package of health quality improvements. If DPH and the hospitals don't release the data on the three infection rates soon -- say, by Jan. 1 -- the Legislature would be justified in imposing a mandate, so that Massachusetts residents can compare how well hospitals fight infections before they cross the threshold as patients.

© Copyright 2007 Globe Newspaper Company.
Boston Globe
August 12, 2007