Hospital –Acquired Infections (HAI), or nosocomial infections, are infections that were not present on admission and first appear 48 hours after admission to a hospital/health care facility.  According to national statistics, approximately 5-10% of patients admitted to acute care hospitals and long term care facilities will develop an HAI. The Center for Disease Control (CDC) has determined that approximately 36% of these infections are preventable by following strict but commonplace standards when caring for patients.  Granted, most of these “at risk” patients are already immunosuppressed when they enter this facility; however even such simple measures such as frequent hand washing has been proven to prevent the spread of diseases.

 

Pennsylvania boldly went where no other state has gone before in requiring hospitals to report all infection data to a state agency called the Pennsylvania Health Care Cost Containment Council (aka, “PHC4).  A 98 page report was generated and the following graph depicts Lancaster General’s Infection data from 2006. How did LGH fare?

 

	Number of Cases	Infection Rate per 1,000 Cases	Mortality   Number	Percent	Average Length of Stay in Days   Mean	Median	Average Charge   Mean	Median
Lancaster General	32,219	NA	526	1.6	4.9	3.0	$23,110	$14,220
Cases with Infections	444	13.8	32	7.2	19.7	16	$100,149	$71,813
Urinary Tract	254	7.9	12	4.7	15.4	12	$69,164	$50,661
Pneumonia	26	0.8	3	11.5	17.8	16	$144,595	$136,304
Bloodstream	11	0.3	1	9.1	22.5	19	$126,356	$92,163
Surgical Site	37	3.3	1	2.7	21.8	20	$95,309	$72,630
Gastrointestinal	14	0.4	1	7.1	18.4	18.5	$77,605	$82,624
Other Infections	33	1.0	3	9.1	20.5	17	$122,105	$100,646
Multiple	69	2.1	11	15.9	34.3	33	$189,954	$162,344
Cases without Infections	31,412	NA	494	1.6	4.7	3	$22,034	$13,986

 

As seen in the graph, urinary tract infections (UTI) account for more than half of all infections.   

 

Aggregated data from the report entitled, “Hospital-Acquired Infections in Pennsylvania” states that:

 

 

As of January, 2008, Lancaster General Hospital/Women and Babies Hospital has been required by the State to issue letters to patients who developed an HAI (except asymptomatic UTI’s).  With these letters and the heightened awareness (one could say that healthcare is under the microscope), red flags are going up and litigation is on the rise.  Starting on October 1, 2008, the Center for Medicare and Medicaid Services (CMS) has ceased reimbursements for additional costs related to the following infections: catheter associated urinary tract infections, catheter associated bloodstream infections, mediastinitis (after open heart surgery), and surgical site infections after certain orthopedic procedures and bariatric surgery.

 

This list, however, is just the tip of the microscope.  It is anticipated that the list of non-reimbursable HAI’s will grow on a yearly basis.  LGH, as a top 100 hospital and leader in the healthcare industry, must set the standard by keeping these infections on the “microscopic level.”  The main reason for raising the bar on taking measure to decrease/prevent infections is to protect our patients who trust their healthcare needs to us.  In addition, we can also prevent litigation from infections that could have and should have been prevented.  Listed below are several practical preventative measures that we need to consider:

 

 

10/2008