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| It’s Enough to Make You Sick! |
| by Senator Richard T. Moore |
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September 1, 2006...When any of us is admitted to the hospital for illness or needed surgery, we expect that we will receive quality care and that our visit to the hospital will make us better. Too many patients contract infections while in the hospital that can make them even sicker, or even die. One of the less publicized, but nevertheless critical, provisions of the new Massachusetts Health Care Reform law is the appropriation of $1million to establish a Statewide Infection Control program at the Department of Public Health. This program will not only save lives, it is a key component of the state’s effort to contain health costs so that our effort to provide universal health coverage remains affordable and sustainable. The International Society for Infectious Diseases, notes that about 5 to 10% of patients admitted to acute care hospitals in developed countries acquire an infection which was not present or incubating on admission. Infections that occur among hospitalized patients and become manifest only after 48 hours of stay are called "nosocomial," or hospital-acquired infections (HAI). These infections too often result in death, and nearly always add to costs expected from the patient’s underlying disease or surgery alone – and they are almost always preventable! Surgical site infections (SSIs), the second most common cause of hospital acquired infection after urinary tract infections, cause approximately 17% of all hospital-acquired infections and lead to increased costs and worse patient outcomes in hospital inpatients The Centers for Disease Control and Prevention (CDC) estimates that approximately 500,000 SSIs occur annually in the United States. Costs and outcomes secondary to SSIs can vary by location and surgery type. Infections in cardiac surgery have been estimated to add from $16,053.53 to $73,700 to the cost of care after adjustments are made for preexisting illnesses and conditions, and these increased costs are likely attributable to excess hospital and intensive care unit stays. Overall, SSIs may result in $30 billion in direct and indirect medical costs each year. With the current trends favoring a shortened postoperative hospital stay, outpatient surgery, and same-day surgery, more SSIs are occurring after discharge from the hospital and, therefore, beyond the reach of most hospital infection control surveillance programs. Of all surgical procedures, 75% are now estimated to occur in the outpatient or ambulatory setting, and for those that do occur in the inpatient setting, postoperative length of stay is decreasing. An estimated 47% to 84% of SSIs occur after discharge; most of these are managed entirely in the outpatient setting. Complete cost-benefit analyses provide estimates of all costs of hospital acquired infections that are saved by effective programs, including physicians’ fees and costs to the patient for time off work. In addition, computation of these costs should include salary and overhead of the infection-control staff and the cost of patient-care practices (e.g., hand washing costs) to prevent cross-infection. It is clear that an effective statewide infection control program could save the Massachusetts health care system hundreds of millions of dollars and many lives. As required by the Massachusetts Health Reform law, the Department of Public Health has begun to establish its Statewide Infection Control Program. In order to provide the leadership necessary to achieve the goal of reducing the rate of hospital acquired infections, the Department has established a steering committing comprised of the Directors of the Division of Health Care Quality, the Bureau of Communicable Disease Control, and the Betsy Lehman Center for Patient Safety. Under the guidance of the steering committee, a panel of experts from different clinical specialties, professional associations, hospitals, and academia has been recruited to oversee each phase of the new program. This expert panel will undertake and extensive examination of best practices in infection control. The Department’s steering committee and expert panel is now in the process of: 1. Identifying which type of infections to monitor; 2. Determining the lowest rate of infections that can be reasonably achieved; 3. Collecting and analyzing data on predetermined infections, associate patient demographics, cost of treating Hospital Acquired Infections, and the cost of repeated hospitalizations; 4. Reporting this data to DPH and the public; 5. Designing a surveillance system for early detection of infectious disease patterns and of resistant and emerging infections; 6. Educating hospital staff at all levels of their organization; and 7. Deciding on the meaning of compliance and non-compliance. Once this information is assembled, the Department of Public Health will solicit proposals from vendors working in the field of infection prevention and control. This organizational structure should enable the DPH to move forward in designing and implementing a process that will lead to a higher quality of medical care for the people of the Commonwealth. |
