Bill calls for hospitals to disclose infections

Friday, April 7, 2006

Maryland hospitals must disclose their rate of patient infections under a bill passed unanimously by both the Senate and House.

The bill, if signed by Gov. Robert L. Ehrlich (R), could force hospitals to improve hygiene efforts and limit hospital-acquired infections, which have reached pandemic proportions across the nation, says its chief sponsor, Del. Shane E. Pendergrass (D-Dist.13) of Columbia.

Ehrlich spokesman Henry Fawell said Thursday the governor hasn’t taken a position on the legislation.

Beginning July 1, the state’s 47 acute-care hospitals would be required to report data on hospital-acquired infections through a system of health-service ‘‘report cards” that have been collected and compiled by the Maryland Health Care Commission since 2002.

The data, including relative risks and potential costs of hospital infections, would be available to health insurance companies, employers, patients and providers in annual commission reports as early as next year. Violators face delicensure or fines of up to $1,000 per day per violation.

The bill ‘‘causes the hospitals to compete with other and make things better and improve the rates of infections from elective surgeries,” Pendergrass said. ‘‘It is very good that we made this happen.”

Bruce Kozlowski, the commission’s deputy director for performance and benefits, agreed, saying, ‘‘It is definitely a national problem that everyone is very, very sensitive to. Our charge is to provide information for use by consumers in making informed choices.”

Experts agree that hospital-acquired infections are an especially thorny problem because antibiotic-resistant bacteria — which are often carried on skin and in nostrils — become potentially deadly when entering wounds, surgery incisions or needle penetrations.

As many as 2 million people in the United States contract infections in hospitals each year, resulting in an estimated 90,000 deaths, according to the Centers for Disease Control and Prevention in Atlanta. The CDC says its estimates are not very firm because reporting data from the nation’s hospitals and nursing care facilities have not been widely available.

Last week, health officials in Pennsylvania, the first state to require disclosure of hospital infections, in 2004, reported that the problem is larger and costlier than originally estimated. Nearly 14,000 hospital-acquired infections in that state during the first nine months of 2005 resulted in extra hospital charges of $2.3 billion and 227,000 additional hospital days, according a new report by the Pennsylvania Health Care Cost Containment Council.

Several other states have recently passed laws to collect hospital infection data, but the Maryland bill is the first in the nation to reference new CDC guidelines, according to Libby Fuss, legislative representative for the Baltimore chapter of the Association for Professionals in Infection Control and Epidemiology and an infection-control nurse at the University of Maryland Medical Center.

‘‘We felt like this bill is a good approach,” Fuss said. ‘‘It does not prescribe exactly what [kind of infections] is covered. It leaves oversight up to [the state health commission] and recommends it follow the CDC guidelines” for defining and describing infections and epidemics.

Kozlowski said the disclosure data will have wide applications in businesses and in homes.

‘‘In the reality of the reporting, we need to step back and keep in mind that no matter how much data we put out, there are circumstances when we as consumers are not necessarily decision-makers,” he said. ‘‘It could have to do with who our employer is, in the context of what plan we are in. It could be where my physician happens to have privileges. It could be geographic, who is closest. There are many other variables that are not related to clinical outcomes.”

The early data from Pennsylvania, though troubling, are also encouraging to Dr. William Minogue, director of the Maryland Patient Safety Center.

‘‘Some hospitals in Pennsylvania have now gone months with no infections,” said Minogue, a former senior vice president for medical affairs at Bethesda’s Suburban Hospital. ‘‘We know that it is doable.”

Minogue supports the disclosure measure.

‘‘This bill says to the [state health commission], it is time to make infections part of the record,” he said.

Through the state commission’s report cards and the hospitals’ collaborative arrangements with other hospitals, both in-state and nationally, Maryland has been ‘‘changing the culture” of common hospital activities, Minogue said.

They have lowered infection rates by implementing faster treatment of pneumonia and sepsis and shortening the time between a patient’s admission and treatment., he said. He said he expects hospitals to respond well to the disclosure requirements because ‘‘they are already sharing wonderfully, being completely wide open. They are learning from one another.”

Screening measure killed

Earlier this session, the Senate Finance Committee voted 8-3 to give an unfavorable recommendation to, and essentially kill, a separate bill that would have required 69 Maryland hospitals and 240 nursing homes to screen all incoming patients for antibiotic-resistant bacteria.

The hospital industry lobbied against the bill, arguing it would be too expensive. But preventing an illness through screening would save money in the long run, said Sen. Lisa A. Gladden, (D-Dist.41) Baltimore, who said she plans to reintroduce the measure next year.