Pending Mandatory Reporting of HAIs in Hospitals: Dealing With a Prehistoric Enemy
Freedom From the Chain of Septic Flow
By Thomas L. Kovach
One of the first living creatures on Earth was a microorganism in the ocean. Ever since the dawn of time, they have managed to exist, replicate, mutate and flow into a septic flow chain. Today, they exist in our hospitals and claim lineage to Precambrian Time, long before most other creatures evolved. Hence, microorganisms as living creatures have been around for millions of years. Recent state and federal legislation have made it clear, as have agencies such as the Association for Professionals in Infection Control (APIC) and the Consumers Union (CU) have stated that we have a problem with healthcare-acquired infections (HAIs) within the very system whose purpose is to preserve life and heal the patient.
The Centers for Disease Control and Prevention (CDC) reports that HAIs cause 90,000-plus patients to die of the total 2 million patients per year that contract these infections. This mortality figure is more than the combined total number of deaths attributed to AIDS, breast cancer and motor vehicle accidents. A serious bloodstream infection can add almost $60,000 to a patients bill.
The CDC has compiled statistics on HAIs through its National Nosocomial Infection Surveillance System (NNIS). Currently, the rate of HAIs is estimated to be between 5 percent and 19 percent of all hospital inpatient stays. At that level, one can only assume that this problem is significant to warrant state and federal legislation and guidelines. This situation has triggered existing and proposed laws by state legislatures and Congress. Various pieces of legislation require hospitals to follow these general guidelines:
- Monitor, report and set up data guidelines, and publish a data stream on current HAI rates to state health authorities
- Begin programs to educate staff about HAIs
- Initiate total and effective infection control and handwashing compliance programs
- Implement standardized HAI data-reporting procedures
As many as 40 state legislatures have proposed or have already enacted some or all of these elements into law. Many states already have some version of the aforementioned three elements. We note that Senate Bill 1279 in Missouri is often cited as a model for other proposed legislation and regulations. The Missouri Nosocomial Infection Control Act is available for the public to review.1
APIC has recently issued a position paper on mandatory reporting of HAIs. In sum, this March 14, 2005 position paper cites the following issues:
- The desire of the consumer to have HAIs made public
- There is no standardized method of collecting, comparing and reporting HAIs
- Cooperation between consumers, state health departments, state and federal legislators, accreditation agencies, CDC, and federal and state regulatory agencies is essential to effective mandatory reporting2
CU is also quite specific in four of its main recommendations:
- Hospitals shall collect data on nosocomial infections and include surgical site, ventilator associated pneumonia, central line bloodstream infections, and urinary tract infections
- HAIs shall be systemic to the patient and not found at the time of admission
- Hospitals shall submit quarterly reports to a central health authority and make public at the hospital and the central health authority
- The director of the department shall appoint an advisory committee and include all elements of the healthcare community; the advisory committee shall evaluate and devise new methodologies such as CDCs NNIS and adopt a methodology that is standard to reporting HAIs
In cooperation with the CDCs NNIS or its successor unit, Congress and most other states are engaged in the process of passing laws regarding mandatory reporting of HAIs, while other entities are joining in the interest in promoting mandatory reporting regulations. The Centers for Medicare & Medicaid (CMS) and CU have suggested guidelines or a model hospital infections disclosure act, while The Committee to Reduce Infection Death (RID) and leading New York physicians suggest that cutting infections could help in the funding of Medicaid patients and overall in short-term general hospitals in New York.3
The Healthcare Infection Control Practices Advisory Committee (HICPAC) recommends the following guidelines:
- Use established surveillance methods when designing and implementing mandatory HAIS reporting systems
- Create multi-disciplinary advisory panels, including persons with expertise in the prevention and control of HAIs to monitor the planning and oversight of HAIs public reporting systems
- Choose appropriate process and outcome measures based on facility type and phase in measures to allow time for facilities to adapt and to permit ongoing evaluation of data validity
- Provide regular and confidential feedback of performance data4
Since the beginning of time, tiny microorganisms continue to hide and remain undetectable to the human eye; they also have the ability to continue to evolve and survive as other species do. We have to accept that microorganisms will always be hidden from the eyes of hospital staff. Due to their small microscopic size, microorganisms have the ability to hitch a ride on hospital surfaces or on healthcare workers hands. We know that microorganisms can multiply from one to more than a million in just eight short hours on most surfaces, including the hands of the caregiver. This situation should send a strong signal to hospitals to maintain an effective infection control program to guard against potential cross-contamination.
Thomas L. Kovach is president of Kovach & Associates Inc. and chairman of the board of The Kovach Foundation of Chesterfield, Mo. The Kovach Foundations mission is to lower nosocomial infections, and to expedite and implement mandatory reporting of nosocomial infections data to state health authorities. Kovach has 25 years of experience in the infection control, skin care and disinfection industries.
1.Missouri Senate Bill 1279 (2004)
2.Association for Professionals In Infection Control. APIC Position on Mandatory Reporting of Healthcare-Associated Infections. (March 14, 2005).
3. The Committee to Reduce Infection Deaths (RID). Hospital Infections Adding to Medicaid Woes. March 10, 2005 press release. Position paper at: www.hospitalinfectionrates.org/
4. Centers for Disease Control and Prevention. Recommendations of the Healthcare Infection Control Practices Advisory Committee (HICPAC) Guidance on Public Reporting of Healthcare-Acquired Infections: Recommendations of the Healthcare Infection Control Practices Advisory Committee. (Feb. 28, 2005).