Infection report program funded

Three years after the state Legislature passed a law requiring hospitals to report the number of infections patients acquire during medical care, a federal grant will give the state the funding needed to get the program off the ground.

The state was awarded nearly $760,000 from the federal stimulus program and will use the money to hire staff to manage the reporting program and audit the numbers submitted by hospitals.

Under the legislation, hospitals are required to report every time patients develop infections in surgical sites, in central lines and in their lungs after the use of a respirator. Hospitals must also report how often they comply with infection-prevention measures: the use of antibiotics before surgery, compliance with best possible procedures for inserting central lines and the rate at which hospital employees receive seasonal flu vaccinations.

The legislation also requires the state to publish the numbers to the public.

Advocates say public disclosure of hospital-acquired infections is critical in holding health care institutions accountable for their errors and will help patients make the best decisions about where to seek their health care.

"I think this is a huge victory for health care consumers and really for the general public," said Lori Nerbonne, a founder of New Hampshire Patient Voices. Nerbonne, whose mother died from a hospital-acquired infection, advocated for the passage of the bill and has pushed legislators to ensure the program is funded.

National studies estimate that as many as 100,000 patients die annually of infections caught in hospitals, more than car accidents, breast cancer or AIDS.

Though the legislation passed years ago, the state only began asking hospitals to report the data earlier this year. And it has requested a more limited data set than that spelled out in the bill. Hospitals are not being asked to report pneumonia cases, and they are only being asked to report infections related to three types of surgery: knee surgeries, cardiac bypass surgeries and colon surgeries.

Beth Daly, a state epidemiologist, said the state waited to ask for data until it had developed a workable reporting system. It has requested more limited information because there are no clearly established federal guidelines on how to define the other infections, she said.

"We decided to start with some that are easier to track than others since this is our first year," she said.

Daly said the federal money will make a big difference in bringing the information to the public. Currently, the state has no employees devoted to the program, and the grant will allow it to hire one full-time worker to manage the data.

This year, the Legislature approved a bill that would allow the state to fund a staff person by levying a fee on hospitals. Daly said the state does plan to develop a fee structure but said the federal money will allow the state to hire an analyst faster.

The funds will also allow the state to audit the results submitted by hospitals. That validation, Daly said, will allow the public to feel confident that every hospital is reporting on the same types of cases. Until that process begins, however, the state will not release the kind of hospital-identified data required by the law. Early reports will provide some state-wide numbers of infections and prevention measures. By next June, the state may present some anonymous hospital-by-hospital numbers.

"We don't have any intention of releasing hospital-specific data until we are able to do audits and make sure everyone is using the same data," Daly said.

In the meantime, hospitals are still endeavoring to use a new web-based system to report all of their cases to the state. At Concord Hospital, which uses electronic medical records for much of its patient care, reporting the data has become fairly seamless, said Anne Diefendorf, the hospital's director of quality performance.

But, she said, the mere act of measuring and reporting the incidence of infection and prevention measures has helped hospital employees stay vigilant.

"Unless you measure and monitor it, you really don't know how you are doing," she said.

Money from the grant will also help the state train hospital staff and fund some existing programs that have been shown to improve infection control.

Among those is one sponsored by the state's Healthcare Quality Assurance Commission, designed to encourage medical professionals to wash their hands. Though hand washing is among the simplest and least expensive ways to reduce the spread of disease, national surveys have found that doctors and nurses only wash their hands about 70 percent of the time they should.

The "high five for hand hygiene" program uses posters and ever-changing computer screen savers to prompt good hand hygiene.

"When you walk into a hospital, that's what you're going to see about every screen," said Rachel Rowe, of the Foundation for Healthy Communities.