Legislative panel must support more hospital reporting of infection outbreaks

Dr. Kevin Kavanagh of Somerset is board chairman of Health Watch USA.
Dr. Kevin Kavanagh of Somerset is board chairman of Health Watch USA.

A recent report by the Robert Wood Johnson Foundation ranked Kentucky in the lowest tier of states for preparedness to protect citizens from infectious disease.

This study comes on the heels of reports that in India the almost untreatable deadly bacteria CRE has become totally untreatable. You have had an option of taking a very toxic antibiotic and risking catastrophic kidney failure, soon you might not even have that option.

Kentucky could stand much improvement in this area. Despite years of assurances from the health care industry that all is well, we learned in October that Kentucky has the third-highest rate among the 50 states of bloodstream infections caused by the deadly Staph bacteria MRSA.

Our state is also behind in preventing infections of deep vascular treatment lines, having a rate worse than the national average. And no state is doing well controlling the deadly G.I. bacteria C. Difficile.

Unfortunately, one of the lessons learned from the United States' fumbling response to Ebola is that we are not as prepared as we should be to address infectious outbreaks. Patient safety regulations are all too few. and standards leave too much leeway. As aptly stated by National Nurses United, multiple choice is not a standard.

This is a problem of our entire health care system. Correcting it will take the coordinated effort of all types of facilities. It is not just a hospital problem, for hospitals make up less than 20 percent of health care facilities. Any occurrence of these dangerous organisms in one facility can place all facilities in a region at risk.

In many cases, it is not clear what exactly needs to be done. Comprehensive data are lacking on the types of infections and how often they occur. Also, more information is needed on what initiatives high-performing facilities are using.

The search-and-destroy method for controlling these bacteria has been clouded in a fog of poorly executed studies. It is imperative that we know what is happening and where, so effective action can take place.

After all, shouldn't you know if there was an outbreak of an untreatable bacteria in a nursing home or hospital? Or the rate of MRSA at a facility where you were considering having an elective procedure?

Once made public, the problems can be corrected quickly in many cases. and the facility becomes safer than it was hiding under its veil of secrecy.

In other cases, high infection rates are due to a large number of bacterial carriers coming from the community. However, both situations can pose a danger to patients.

Gov. Steve Beshear's administration has wisely responded by developing a regulation that will make Kentuckians safer through greater transparency of infection rates and other data. It gives the Kentucky Department for Public Health timely access to hospital data which are submitted to the U.S. Centers for Disease Control and Prevention. The CDC has access to data but no authority. It is only advisory and can take action only if invited.

The state, on the other hand, has a wide range of options for intervening when patients or the public is at risk. The regulation also better defines an outbreak and when to report, correcting a problem that many think led to the underreporting of CRE outbreaks.

Most importantly, the regulation requires laboratory reporting from specimens submitted from all types of facilities. This reporting is fully computerized so as not to place a significant burden on a facility. Reporting will include both MRSA and C. Difficile.

I wish I could tell you that all will be well and Kentucky soon will emerge at the top of a desired list, but more needs to be done along with much-needed support given to the state and local health departments.

As a first step, it's imperative to approve the regulation, which comes before the legislature's Administrative Regulation Review Subcommittee today. I strongly encourage our legislators to support this effort.