Kentucky voices: State reporting on hospital infections lax, dangerous

Imagine a flu epidemic wiping out almost half the people in Dawson Springs, hometown of Gov. Steve Beshear. That's how many Kentuckians are predicted to die each year — 1,390 — not from flu, but from hospital-acquired infections.

Another 23,800 Kentuckians are expected to get sick from HAIs, equal to almost the entire population of Nicholasville.

The Centers for Disease Control and Prevention reports that 1 in 20 hospitalized patients nationally, or 1.7 million people, develop these infections each year, causing just under 100,000 deaths. Each death is incalculable. The additional cost of treatment is about $43,000.

But "with focused efforts," says the CDC's director, Dr. Thomas Frieden, "these once formidable infections can be greatly reduced ... leading to a new normal for health care-associated infections as rare, unacceptable events."

Public reporting is an essential component of controlling health care-acquired infections. Twenty-seven states, but not Kentucky, have laws requiring public reporting.

The CDC, Society for Healthcare Epidemiology of America and the Association for Professionals in Infection Control and Epidemiology all support public reporting. State-level reporting must play an important role in federal efforts to prevent HAIs.

As with any epidemic, the state Department of Public Health must lead the way. No less than 100 percent facility participation is acceptable. In August, WKYT reported that 39 of Kentucky's nearly 100 hospitals were participating in CUSP, a program for preventing Methicillin-resistant Staphylcoccus aureus or MRSA. This participation level is unacceptable, and I hope has since increased.

The state has received a CDC grant to augment its HAI prevention efforts. Dec. 31 was the grant's deadline for establishing a state advisory council, defining prevention targets, conducting a needs assessment and establishing an evaluation process.

I fear these goals, which represent a first step, will meet with significant resistance and may also have been overly optimistic. In Kentucky, only outbreaks, not individual HAIs, are required to be reported. But the state has yet to define an outbreak, The Courier-Journal reported Dec. 23.

Only four outbreaks were reported by Kentucky hospitals from Oct. 1, 2009 to Sept. 31, 2010. No hospital outbreaks of the potentially lethal bacteria MRSA and C. difficile were reported.

One might conclude from this that MRSA and C. diff., the two most common causes of health care-acquired infections, are not a problem in Kentucky. But that is not the case, according to other data.

In a 2008 report in the American Journal of Infection Control, Kentucky had the sixth highest rate of C. diff. infections in hospitals. Kentucky is one of the top four states with more than 60 percent of the cultured Staph being MRSA, according to the Center for Disease Dynamics, Economics & Policy.

The MRSA statistic is of outpatient cultures and is a testament to how pervasive this epidemic is in our communities. It also underlines the importance of health department oversight and the need for universal MRSA screening of all patients admitted to a hospital.

I am concerned about how effective the federal grant will be in decreasing HAIs when there are no hospital reports of C. diff and MRSA, the two most common bacteria.

A state trying to control an epidemic without defining an outbreak is nothing short of depressing. As other states are issuing their infection reports to the public, Kentuckians are endangered by the lack of reporting, public or otherwise, and inhibited health department oversight.

The cost of public reporting is small. A CDC grant is already paying for start-up costs. In addition, the CDC operates a standardized national reporting system which can be utilized free of charge to collect data and prevent duplicative reporting by institutions.

We need to stop placing all the fault for Kentucky's poor health statistics on Kentuckians and realize that a significant part of the problem rests with our health care delivery system.

If Norton Healthcare and St. Joseph Health System can implement public reporting, the rest of the state's hospitals can, too. Our universities need to be leaders in this effort. And hospitals are not only morally responsible for their own institution but also for promoting good practices across the entire state.

The primary responsibility of the governing body of a non-profit hospital is to the community, not the institution.

I fear more money will be spent to lobby and defeat public reporting of HAIs in Kentucky than the program would cost.