Tuesday, November 21, 2006

Editorial-Pennsylvania's Infection Reporting

Here is an open letter to the editor about the mandatory reporting of HAI's in Pennsylvania hospitals. It accurately reflects our feelings on the issue:


Pennsylvania has a rich history of trail blazing in healthcare. The first medical school in America opened in our state in 1765. The first medical school for female students opened here as well, in 1850.

Building on this history of innovation, Pennsylvania is the first state to mandate thorough public reporting of hospital acquired infections (HAIs) for all hospitals within the Commonwealth. Now that the first year’s worth of results are published, hospital officials are justifiably concerned that people will misinterpret the information. As a person who works with hospitals in Pennsylvania to reduce HAIs, I understand their unease.

Under the current reporting rules:

-some honest hospitals that scrutinize and report all HAIs may face an unfavorable comparison with hospitals that are not as diligent in their reporting.

-the types of infections that hospitals were mandated to track changed during the year; these rule changes may’ve caused errors and confusion.

-mortality rates are skewed for hospitals that provide palliative care for terminally ill patients who, by request, do not seek aggressive interventions.

In the hospitals’ defense, defining the source of an infection can be elusive.

Difficulty in finding an infection’s source is reflected in a study published in the November 2006 issue of the American Journal of Infection Control. Researchers reviewed medical reports of more than 1,500 outbreaks of HAIs. In 37% of the outbreaks no source could be identified.

Where does this leave Pennsylvania healthcare consumers? The answer is that we are in a better position than any other state to monitor and improve the quality of medical care. Here are some things to keep in mind as you review the new statistics on HAIs:

-knowledge is power! Some measure of quality is better than none. HAI statistics are certain to evolve with time and become clearer and fairer.

-HAI rates are just one indicator of quality. Speak to your physician, or better yet, speak to a nurse who works in a hospital you’re considering for a procedure. Another great source of hospital information is available on the web through the Joint Commission on Accreditation of Healthcare Organizations (www.jointcommission.org).

-all healthcare is local. Many effective hygiene techniques occur right inside your hospital room. Thanks to HAI awareness, you can prevent infections by insisting on rigorous adherence to hand washing procedures (don’t be shy about asking physicians, nurses and visitors to wash their hands).

In Pennsylvania we should be proud that we are able to gather and view information on HAIs. In many other states political pressure has prevented citizens from having access to this important data. We must be aware that infection control is dynamic—numbers can only tell part of the story. But at least we are telling the story here in Pennsylvania and we are beginning a dialogue on how to break the chain of pathogen transmission within hospitals.

Once again Pennsylvania is a pioneer in healthcare.