In
June 2005, at the very end of the session, both houses
of the New York 's
State legislature passed bills that would require every
acute care hospital to track and then report to the state
certain types of hospital-acquired infections. Surgical
wound infections, those associated with central blood
lines and other types of infections are thought to cause
at least 100,000 preventable deaths each year across the
country. In New York
as many as 7,000 patients may be dying in New
York hospitals because of lapses
in infection control.
The
Center for Medical Consumers played a leading role in
both writing the legislation and brokering support from
a diverse group of organizations, most importantly the
state's two major hospital trade associations, the Health
Care Association of New York State and the Greater New
York Hospital Association. Also working to secure passage
of the bill were a number of consumer and patient groups,
including Consumers Union, NYPIRG, StateWide Senior Action
and AARP. The NYS Business Council, the major health workers
union SEIU 1199 and the NYS Nurses Association all joined
in the effort as well.
New
York 's new law would initially
require the reporting of wound infections after surgery
and infections resulting from the insertion of a central
venous line. The tracking will focus on patients in critical
care units, such as ICU's, where the majority of hospital-acquired
infections occur. Over time the health department can
expand the types of infections to be reported.
The
first year of reporting will be a so-called “pilot phase”
and hospital names will not be identified. It is hoped
that what is learned during this anonymous test period
will allow the health department and hospitals to overcome
problems that have beset other reporting systems, such
as vast underreporting and confusion over what is to be
reported.
The
importance of assuring that the information collected
by the state is accurate and complete cannot be overstated.
Otherwise public reporting runs the risk of being highly
inaccurate and misleading—a “lose-lose” situation for
everyone involved in such efforts. For example, is a hospital
with low rates of infection really controlling infections
or simply not reporting them. To deal with the problem
of underreporting, the law requires the health department
to create an auditing system to assure accuracy and keep
the playing field level.
After
the initial pilot year every individual hospital will
be identified in an annual report of hospital-acquired
infection rates available on the department of health
Web site. While the Department of Health asked for and
got some delay in implementation of the program, the legislation's
supporters believe that, in fact, hospitals will not delay
their efforts to control infections. In anticipation of
the public reporting system coming on line it is likely
that most hospitals will want to make strides in infection
control as soon as possible. Adding to the incentive to
begin work immediately is the fact that a majority of
New York State hospitals have signed on to a national,
voluntary patient safety improvement effort, the 100,000
Lives Campaign , a large part of which involves improvements
in infection control over the next eighteen months. (
http://www.ihi.org/IHI/Programs/Campaign/
)
After
New York 's Governor, George Pataki, signed the bill into
law New York joined a handful of other states that have
mandated similar requirements. However no state has yet
to publish a report of their hospital's infection rates.
And twice as many states have seen proposed laws to require
hospital infection reporting either defeated in their
legislatures or vetoed over the last few years. If you
are interested in working to get similar legislation in
your state, visit the web site of Consumers Union http://www.consumersunion.org
and click on “Stop Hospital Infections.”
Arthur
A. Levin, MPH, Center for Medical Consumers ©, July
2005
