Pending Mandatory Reporting of HAIs in Hospitals: Dealing With a Prehistoric Enemy

Pending Mandatory Reporting of HAIs in Hospitals: Dealing With a Prehistoric Enemy
Freedom From the Chain of Septic Flow

ByThomas L. Kovach

One of the first living creatures onEarth was a microorganism in the ocean. Ever since the dawn of time, they havemanaged to exist, replicate, mutate and flow into a septic flow chain. Today,they exist in our hospitals and claim lineage to Precambrian Time, long beforemost other creatures evolved. Hence, microorganisms as living creatures havebeen around for millions of years. Recent state and federal legislation havemade it clear, as have agencies such as the Association for Professionals inInfection Control (APIC) and the Consumers Union (CU) have stated that we have aproblem with healthcare-acquired infections (HAIs) within the very system whosepurpose is to preserve life and heal the patient.

The Centers for Disease Control and Prevention (CDC) reportsthat HAIs cause 90,000-plus patients to die of the total 2 million patients peryear that contract these infections. This mortality figure is more than thecombined total number of deaths attributed to AIDS, breast cancer and motorvehicle accidents. A serious bloodstream infection can add almost $60,000 to apatients bill.

The CDC has compiled statistics on HAIs through its NationalNosocomial Infection Surveillance System (NNIS). Currently, the rate of HAIs isestimated to be between 5 percent and 19 percent of all hospital inpatientstays. At that level, one can only assume that this problem issignificant to warrant state and federal legislation and guidelines. Thissituation has triggered existing and proposed laws by state legislatures andCongress. Various pieces of legislation require hospitals to follow thesegeneral guidelines:

• Monitor, report and set up data guidelines, and publish adata stream on current HAI rates to state health authorities

• Begin programsto educate staff about HAIs

• Initiate total and effective infection controland handwashing compliance programs

• Implement standardized HAIdata-reporting procedures

As many as 40 state legislatures have proposed or havealready enacted some or all of these elements into law. Many states already havesome version of the aforementioned three elements. We note that Senate Bill 1279in Missouri is often cited as a model for other proposed legislation andregulations. The Missouri Nosocomial Infection Control Act is available for the public to review.¹

APIC has recently issued a position paper on mandatoryreporting of HAIs. In sum, this March 14, 2005 position paper cites thefollowing 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 federallegislators, accreditation agencies, CDC, and federal and state regulatoryagencies is essential to effective mandatory reporting²

CU is also quite specific in four of its main recommendations:

• Hospitals shall collect data on nosocomial infections andinclude surgical site, ventilator associated pneumonia, central line bloodstreaminfections, and urinary tract infections

• HAIs shall be systemic to thepatient and not found at the time of admission

• Hospitals shall submitquarterly reports to a central health authority and make public at the hospitaland the central health authority

• The director of the department shallappoint an advisory committee and include all elements of the healthcarecommunity; the advisory committee shall evaluate and devise new methodologiessuch 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 mostother states are engaged in the process of passing laws regarding mandatoryreporting of HAIs, while other entities are joining in the interest in promotingmandatory 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 Yorkphysicians suggest that cutting infections could help in the funding ofMedicaid 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 andimplementing mandatory HAIS reporting systems

• Create multi-disciplinaryadvisory panels, including persons with expertise in the prevention and controlof 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 tohide and remain undetectable to the human eye; they also have the ability tocontinue to evolve and survive as other species do. We have to accept thatmicroorganisms will always be hidden from the eyes of hospital staff. Due totheir small microscopic size, microorganisms have the ability to hitch a ride onhospital surfaces or on healthcare workers hands. We know that microorganismscan multiply from one to more than a million in just eight short hours on mostsurfaces, including the hands of the caregiver. This situation should send astrong signal to hospitals to maintain an effective infection control program toguard against potential cross-contamination.

ThomasL. Kovach is president of Kovach & Associates Inc. and chairman of the boardof The Kovach Foundation of Chesterfield, Mo. The Kovach Foundations missionis to lower nosocomial infections, and to expedite and implement mandatoryreporting of nosocomial infections data to state health authorities. Kovach has25 years of experience in the infection control, skin care and disinfectionindustries.

References:

1.Missouri Senate Bill 1279 (2004)

2.Association forProfessionals In Infection Control. APIC Position on Mandatory Reporting ofHealthcare-Associated Infections. (March 14, 2005).

3. The Committee to Reduce Infection Deaths (RID). HospitalInfections Adding to Medicaid Woes. March 10, 2005 press release. Position paper at: www.hospitalinfectionrates.org/

4. Centersfor Disease Control and Prevention. Recommendations of the Healthcare InfectionControl Practices Advisory Committee (HICPAC) Guidance on Public Reporting ofHealthcare-Acquired Infections: Recommendations of the Healthcare Infection Control PracticesAdvisory Committee. (Feb. 28, 2005).