In September 1999, Dr. Neil Novin decided to have his hip replaced so he could keep playing tennis.
Within days of the surgery, his hip was badly infected with nasty, antibiotic-resistant bacteria known as MRSA. Although there is no way to be sure, Novin, a 76-year-old surgeon, is convinced that the source was likely something or someone he'd come in contact with at the hospital.
Since then, Novin, who lives in Pikesville, has had 11 more operations on his hip. He will almost certainly never play tennis again.
Two million Americans a year contract an infection while in the hospital, and about 90,000 die, according to the latest data from the federal Centers for Disease Control and Prevention in Atlanta. Some critics say hospitals aren't doing enough to prevent infections and are urging more action.
Some health and consumer groups are pushing for laws that compel hospitals to report infection rates and improve safety measures. Six states have passed reporting laws. Maryland could become the seventh within weeks; a bill making its way through the General Assembly would require all of the state's 50 hospitals to share with authorities - and the public - information about infections among patients.
Hospital groups say members are working hard on the problem, and they generally prefer voluntary steps to deal with it.
Proponents say the bill would encourage hospitals to reduce infection rates and help patients decide which hospitals are safest.
"When you make information public, people make better choices," says Del. Shane E. Pendergrass, the Howard County Democrat who sponsored the House version.
The measure would require hospitals to report infection data annually to the Maryland Health Care Commission, which would post the information on its Web site.
And last week, the Senate Finance Committee held a hearing on another bill that goes even further. This measure, sponsored by Sen. Paula C. Hollinger, chairwoman of the Education, Health and Environmental Affairs Committee, would require hospitals to test many incoming patients for infections and isolate those who come up positive.
Some national experts say hospitals haven't done enough to control what epidemiologist Dr. William Jarvis termed a "huge, huge problem."
"The standard of care in this country is to treat an infection after it occurs, not to prevent it," said Jarvis, a specialist in infection control who worked at the CDC for more than two decades. "That's ridiculous."
The Maryland Hospital Association, which supports the reporting bill, opposes the Hollinger measure.
"We absolutely support the concept of working to reduce hospital-associated infections," said Beverly Miller, senior vice president. "But it's premature," she said, for the state to set hospital procedures for infection control.
She said the law had the potential to "distract" hospitals from current safety work and noted that the Maryland Health Care Commission started last year a Patient Safety Center that focuses on reducing hospital-acquired infections.
The problem of hospital-acquired infections has worsened in large part because of the proliferation of antibiotic-resistant germs.
"I think what is most out of control is the infections that are antibiotic-resistant," said Dr. Barry Farr, an infectious disease specialist at the University of Virginia.
After decades of antibiotic use - and overuse - bacteria have responded by mutating into forms that can resist the medicine.
Changing hospital demographics are also to blame. As less seriously ill patients increasingly are treated with home therapy or outpatient care, hospitals are catering to the sickest. It is these patients who are most vulnerable to hospital-acquired infections.
Experts agree that the most common antibiotic-resistant infection is methicillin-resistant staphylococcus aureus, or MRSA. It can resist many antibiotics, making it difficult to treat. The bacteria can cause a range of symptoms, including fever, neurological problems and organ failure. It can kill older patients, along with those who are sick or have weakened immune systems.
Over the past 30 years, it has spread to nearly every hospital in the country, according to Farr and other experts. In 1980, CDC figures showed that 2 percent of hospital-acquired staph infections were MRSA; by 2003 the rate was about 60 percent.
"MRSA is a terrible thing," Novin said. His infection appears to be gone now, but it is hard to tell: The bacteria can lie dormant for years and then flare unexpectedly. MRSA is particularly hard to track and eradicate because many people harbor it without symptoms. Often it is only after it gets into a wound that it wreaks havoc.
A spokeswoman for Union Memorial Hospital, where Novin first underwent surgery, acknowledged that he contracted an infection but said that because he received treatment at another hospital as well, it is not clear that he was infected while at Union Memorial. She said Union Memorial constantly reviews safety strategy to minimize infection risk.