Some ICPs skeptical laws improve patient safety

While hailed as a patient measure, some question whether mandatory infection-rate disclosure laws will create "data graveyards" that will drain scarce resources from infection control programs.

"Merely collecting information and reporting it will not affect the public, the consumer, the individual patient," said Carlene Muto, MD, hospital epidemiologist at the University of Pittsburgh Medical Center. "What you need to do is take the information, transform it into actionable data, feed it back to the clinicians, and then figure what needs to be done to correct it. What has been done [with the infection-rate disclosure law] in Pennsylvania is merely asking us for the data — asking us for so much data that we wouldn’t have time to do the other important steps, which will really effect the point of patient care."

Muto was among many ICPs at a recent meeting in Atlanta that questioned whether increasingly popular infection-rate disclosure laws will have a positive impact on patient safety.

Four states (Pennsylvania, Illinois, Florida, and Missouri) have passed infection-rate disclosure laws, and 20 other states throughout the country have bills introduced for their 2005 legislative sessions.

The primary advocacy group behind the laws is the Consumers Union, the Washington, DC-based publisher of Consumer Reports. Lisa McGiffert, Consumers Union senior policy analyst and director of the infection-rate disclosure campaign, got a polite but somewhat chilly reception from an audience that consisted primarily of ICPs.

"The public doesn’t know the extent of the problem and the possibilities to fix it," she said. "There has been an incredible amount of secrecy around this issue, and we hope to stop that. We want people to be aware because we think the consuming public can have a role in bringing about change. It’s a no-brainer. All evidence indicates that hospital infections can be significantly reduced by adherence to policies already in place and by adopting new protocols," McGiffert noted.

"I am a patient safety advocate," Muto pointed out. "We have reduced our bloodstream infections 70% systemwide. It can be done. But please ask us how do it and get us involved. Don’t merely say, You need to do it.’ Let us tell you. We are little tired of being accused of the secrecy issue. We have never been asked for our help."

Too late for beta testing?

There are no data that indicate publicly reporting infection rates will reduce infections or increase patient safety, reminded William Scheckler, MD, hospital epidemiologist at St. Mary’s Hospital in Madison, WI. In the absence of such data, he suggested that it would make sense to use the states that have passed laws as "beta test sites" before more states adopt legislation.

"There is no evidence that public reporting works," McGiffert conceded. "We are aware of that, but I have to tell you that the genie is kind of out of the bottle right now. There are many states that see this as a problem, and they want to do something about it. I feel we are not going to know if this is going to change behavior until we start doing it."

The Consumers Union might have a greater impact on infection control by lobbying against funding cuts that are undermining sentinel surveillance programs at the Centers for Disease Control and Prevention, Scheckler added. By the same token, patient safety advocates should apply pressure to hospital administrators to fully fund infection control programs to meet new standards by the Joint Commission on Accreditation of Healthcare Organizations, he urged. "The Joint Commissions’ 2005 [infection control standards] talk about making sure the CEOs of hospitals provide enough quality-trained infection control professionals and hospital epidemiologists. I would like to see [Consumers Union] get behind that."

The Consumers Union is open to the possibility of making infection control resources a public disclosure issue, but is less than enamored of the Joint Commission, McGiffert responded. "My biggest beef about JCAHO is that they have a lot of information that the public can’t see," she said. "They have a lot of information that is not hospital specific. That’s what we want to see. We don’t want to see aggregate information; we want to see hospital-specific information."

Infection control is a "fundamental part of health care" and cannot be shirked due to funding woes, she added. "[How about] reporting how many resources a hospital puts into infection control and how many infection control professionals they have in their hospital.

"Would that be a good indicator? I think it might be. We are open to talking about what it is that identifies a hospital that does a good job on infection control. What we hope will come out of this work is that there will be more support for what infection control professionals do. They will rise in status in the hospital as a fundamental part of that hospital," McGiffert pointed out.

Risk adjustment of infection-rate data may be the most expensive component of the disclosure laws, but it is an area both ICPs and consumer advocates agree is critical if comparisons between hospitals are to be made.

"We feel that risk adjustment is essential in the process, and would not support legislation that does not include it in some way," McGiffert said. "Most of the legislators I have talked to have come to understand risk adjustment. I think they do accept that. All of the laws so far include some risk adjustment."

ICPs should become involved in any legislative effort in their state and make sure it is crafted accordingly, she added.

"Our philosophy is we want the legislation to be a framework," McGiffert continued. "You do not want too much detail in your legislation. Believe me, you do not want legislators writing in the law how to risk adjust. You want to have an advisory committee of stakeholders and experts help develop that so that it can change as systems change."

No hiding or spotlighting

Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association (AHA), said the AHA is open to the disclosure concept but has several concerns.

"We are very interested in sharing our data with the public," she told the attendees. "We really want the public to know what we are doing to work for them, to make them safer, to provide higher of quality of care. That said, [the question] is how to do that credibly and in a way that is understandable to them."

There are myriad questions about how the data will be gathered, who can see it and when, Foster said. "But the most important thing — the thing we all agree on in this room — is the goal for public reporting is to make patients safer when they are receiving health care.

"I’ve seen a lot of data collection enterprises in my years as a health care professional that resulted in data reporting but not useful information in the way [Muto] was talking about. We don’t need another data graveyard. We have plenty of them, quite honestly, data going in but no resources available to do the analysis, to turn it into real information," she explained.

The data-reporting process can neither be about "hiding real problems" nor "spotlight opportunities," she added. "I have worked in hospitals that proudly hung their "100 Best Hospitals" banner in the lobby. I am sure that hospitals will look forward to hanging banners in their lobby about their infection rates. This is not about a victory for any particular organization."

Ultimately, the Consumers Union hopes to be a catalyst for change for a system that has conceded too much for too long in the area of hospital-acquired infections, McGiffert said.

"If you think we can not end infections, I challenge you to think about the infections we can prevent," she said. "It is possible to prevent an infection in the most immunocompromised person. It is possible. You don’t expect every single one of them to get an infection. Let’s start with actions that can move us toward zero and measure our progress there."

There is indeed the possibility that consumer advocates could form a formidable — if initially awkward — partnership with ICPs. After all, the goal of reducing infections is shared by both. A frank perspective on the issue was offered by Karen Patton, an ICP from Nashville, TN, who chose not to name her facility in going to the microphone to address the audience as the meeting neared conclusion.

"The thought hit me that maybe our biggest fear of public reporting is the fact that we know that there are things out there that we haven’t been successful in accomplishing — our peers washing their hands, use of barriers, correct antibiotics," she said.

"Maybe that fear is one of the things that has got us so mobilized about public reporting. Maybe this is the thing that needs to happen so that we can meet our goals as infection control practitioners," Patton adds.