Sunshine not only fights infection—sunshine laws push data out of the shadows into the public arena, where it belongs. So let's salute yesterday's release of the second annual "Hospital-Acquired Infections in Pennsylvania." It's a 98-page report on how well in 2006 the state's 165 acute-care hospitals, each one named, kept patients from being infected while being treated within hospital walls. It is illuminating, if you'll excuse one more sunshine reference.
- More than 3,700 patients with hospital-acquired infections died in 2006. Hospital-infected patients died at a rate nearly six times that of uninfected patients—about 1 in 8, compared with 1 in 50.
- Urinary tract infections were by far the stickiest problem, yet it is well known that the UTI rate would drop if urinary catheters were simply removed as soon as they were no longer medically necessary.
- Aside from the human toll, the financial impact of hospital-acquired infections is horrendous. At one hospital, the average charge for treating its 111 UTI patients was $450,000 per case. Another hospital rang up more than $1.25 million for each patient who developed pneumonia while on a ventilator and $1.4 million per patient with multiple infections.
Publishing a report such as this is a courageous act. Kudos to the Pennsylvania lawmakers who voted to require hospitals to turn over infection data to a state agency called the Pennsylvania Health Care Cost Containment Council—PHC4, as it's called—and Marc Volavka, who as director of the council snapped at legislators' heels for years to make them appreciate the need for public reporting. Volavka stepped down a couple of weeks ago. His forceful passion will be missed.
Leafing through the report and fizzing indignantly about the performance of some of the hospitals, I was overheard by Bernadine Healy, my next-office physician colleague (a former medical school dean and director of the National Institutes of Health). She reminded me that there could well be reasons for a number that seems outrageous. A hospital might treat a disproportionate number of patients vulnerable to infection because of HIV or old age, for instance. The data are important and impressive, she said, but the primary purpose is to alert a hospital with high numbers that something may be badly amiss. "Before jumping to conclusions, you need to drill down into the data," she said. "Investigate. Find out what's going on."
She is right, of course. In the report, the PHC4 notes that the art of collecting and reporting hospital-acquired infections is far from perfected. "[T]he most important use of the report is to measure individual hospital performance over time and as a tool to ask physicians and hospital representatives informed questions about infection control and prevention," the report cautions, "rather than to compare hospitals to each other." I'll accept that. It's sober, responsible, and measured.
Then why aren't more states following Pennsylvania's lead? "Stand up and be counted" works for data and for politicians, too.