Healing hospitals

July 25, 2005

TOO MANY AMERICANS are getting needlessly sicker once they enter the hospital; far too many are dying.

Requiring hospitals to report infections acquired while in care is a big first step toward taming the problem some call the deadliest in modern medicine.

Each year, 90,000 of the 2 million people who contract infections in the hospital die from them, estimates the Centers for Disease Control and Prevention. Precise numbers have been hard to come by. A handful of states have started requiring hospitals to report the number of patients who acquire hospital-based infections; Maryland is in its first year collecting such data from just its 47 acute-care hospitals.

This month, Pennsylvania became the first state to issue a report: 12,000 patients contracted infections during their hospital stay in 2004, and at least 1,500 died preventable deaths. The state considers the number low because not all hospitals reported correctly or at all and because hospitals billed for 115,631 infections. At any rate, infections in the thousands are unacceptable.

Using the hospital-reported figures, these infections cost insurers $2 billion. Good care would be cheaper, and in most cases wouldn't be that difficult.

Ensuring that staff wash their hands and their work areas more often and follow careful procedures for patients who need to use ventilators and catheters and those preparing for surgery would do the trick in most cases, health care experts say. But many hospitals have a way to go. In one study, only 61 percent of doctors washed their hands before attending to a patient - and that was when they knew someone was watching. If they thought no one was watching, only 44 percent of doctors washed, according to the University of Geneva study.

Maryland's hospitals may well show better compared with the rest of the nation; some already are shoring up infection barriers. Intensive care units at the University of Maryland, Johns Hopkins and other nearby hospitals together studied ways to cut the death rate from sepsis, found simple fixes and implemented them. The death rate has fallen from 26 percent of sepsis patients at Hopkins in late 2003 to 20 percent now. By combining the sterile sheeting, cleansers and other tools for inserting intravenous lines into chest veins onto one cart - and setting and enforcing proper procedures - Hopkins has cut the rate of catheter infections nearly to zero; such infections kill 28,000 patients a year nationally, according to the CDC.

The state's first report, due next spring, also will be a work in progress. Once it irons out the kinks, Maryland should expand the reporting requirement to all hospitals. Patients count on hospitals to cure them, not make them sicker.

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