More Action Needed on Hospital Infections

A nonpartisan congressional report released this week states that the U.S. government could do more to force hospitals to prevent infections that are killing up to 99,000 people annually. As part of the report’s recommendations, regulators could consider mandating certain core standards, such as hand washing, for which the government could tie reimbursements. It is believed that by setting priorities for those measures which work best, some of the $5 billion in extra costs resulting from <"">hospital infections could be stayed, the Government Accountability Office report said.

The report criticized the U.S. Department of Health and Human Services (HHS) for not coordinating data across agencies and not requiring hospitals to apply recommended practices. “HHS is not exploiting its leverage to reduce or eliminate hospital acquired infections,” Cynthia Bascetta, director for health issues at the Government Accountability Office told a U.S. House of Representative committee hearing on Wednesday. “We concluded that leadership from the secretary is required.” Experts feel mandating proven practices would be relatively inexpensive; however, health care practitioners would need payment incentives and guidance from regulators and accrediting agencies on the best practices. Meanwhile, Medicare, just expanded the list of hospital-acquired conditions for which it would cut funding. Medicare, the state-federal health insurance plan, spends almost $400 billion on care for about 44 million elderly and disabled people.

Don Wright, a public health official at HHS, acknowledged efforts are needed to improve coordination among agencies saying, “HHS recognizes more work and leadership is necessary to enhance patient safety in this regard.” According to experts, U.S. health care system providers tend to be paid on a fee-for-service basis, which, by its very nature, rewards excess care. “Unfortunately in some ways we get what we pay for,” Leah Binder, the chief executive at the Leapfrog Group, a nonprofit that represents employers. “We pay the same even when errors occur that jeopardize a patient’s health or life; indeed we pay more for poor performance,” said Binder, a former hospital executive.

Peter Pronovost, head of the Quality and Safety Research Group at Johns Hopkins University, told the panel that another problem is the ongoing concern with “trendy” new drugs and technologies and not infection prevention and correct patient care. For instance, last year alone, 94,000 Americans developed MRSA—methicillin-resistant S. aureus; most were infected in healthcare facilities and 19,000 died. The Centers for Disease Control (CDC) says drug-resistant infections in hospitals must be fought with multiple strategies: Better hospital hygiene, enhanced cleaning, and testing. A handful of U.S. hospitals routinely screen and test for MRSA and have found it to be very effective, with one study showing a 50-percent infection reduction. Three states and the Veterans Administration have also ordered MRSA screenings. But the CDC says that testing alone is not sufficient and will not order screenings. The overarching feeling is that the CDC is discounting significant and growing evidence indicating that aggressive hospital testing could significantly cut down the spread of hospital-generated MRSA. Given that the epidemic started with hospital-generated MRSA and with nearly 100,000 MRSA cases last year—20% ending in death—this seems a legitimate course of action.

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