States Attack Hospital-Acquired Infections

Published June 1, 2007

When people enter a hospital for treatment, they typically expect to leave it either cured or doing much better. But according to the U.S. Centers for Disease Control and Prevention (CDC), 2 million patients contract hospital-acquired infections each year–and 90,000 of them die as a result.

Even more problematic is that 70 percent of the bacteria that cause the infections are resistant to at least one of the medications typically used to treat them.

Antibiotic Resistance

In March, the CDC released a report identifying dialysis patients as being especially susceptible to methicillin-resistant staphylococcus aureus (MRSA) infections. Though in healthy patients the infection tends not to have symptoms, it can cause deep tissue infections in minor cuts and lead to fatal pneumonia. Doctors also believe it further undermines the health of sick patients.

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As a result, 13 states to date this year have considered bills requiring hospitals to disclose infection rates to the public. Fourteen others have passed such laws over the past four years. (See tables 1 and 2.)

According to the CDC, MRSA is involved in approximately 90,400 of the 2 million hospital-acquired infections contracted each year. The general population reflects an incidence rate of 0.2 to 0.4 cases per 1,000 people, according to the CDC.

MRSA is the leading bacterial cause of hospital-acquired infections. It is particularly deadly because it causes staph infections, which are very resistant to typical antibiotics and first-line antimicrobial agents in health care settings, the CDC notes.

Poor Hygiene

The majority of hospital-acquired infections are caused by hospital staff members’ poor hygiene practices: Lack of hand-washing, inadequate cleaning of facilities and devices, and incorrect insertion of IVs and catheters can all transmit bacteria.

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Lisa McGiffert, director of the Stop Hospital Infections campaign of the New York-based advocacy group Consumers Union, says hospital-acquired infections remain highly prevalent because health care facilities have taken a lackadaisical approach to the issue.

“My sense is that hospital-acquired infections have not been addressed due to the belief by experts and hospital professionals that the infections could not be stopped and were inevitable,” McGiffert explained. “The standard for years was to treat it with an antibiotic and send the patient[s] on their way. That tactic has become more and more ineffective because we now have bugs that are highly resistant to treatment.”

Hospitals that have targeted infections have already seen some success in reducing them. According to the December 28, 2006 issue of The New England Journal of Medicine, Michigan’s ICU project–which accounts for 85 percent of the state’s intensive-care unit beds–reduced rates of catheter-related central-line bloodstream infections by 66 percent over the course of 18 months.

The confidential infection reporting project also achieved median rates of zero infections per 1,000 catheter days. The national average is 5.2 infections per 1,000 catheter days.

Cost Considerations

The cost of requiring hospital-acquired infection reports has been an area of contention for several states considering such legislation.

However, McGiffert notes, treatment of MRSA infections costs as much as $4.2 billion annually, according to a report published in the December 2006 issue of the American Journal of Infection Control–an amount far greater than the long-term cost of prevention strategies.

“The question has always been, ‘Do the hospitals lose money or make money on these infections?'” McGiffert noted. “Hospital officials have to realize these infections pose a financial risk to them. … The cost in lives is enormous, but the cost of the infections is also really significant for the insurers and providers of health care.”

In March 2002 the CDC launched its Campaign to Prevent Antimicrobial Resistance in Healthcare Settings. At press time the agency had not yet called for nationwide reporting or practice mandates.

Aricka Flowers ([email protected]) writes from Chicago.

For more information …

“Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Dialysis Patients–United States, 2005,” Centers for Disease Control and Prevention, Morbidity and Mortality Weekly Report, March 9, 2007,

“Designing a Program to Eliminate MRSA Transmission, Part I: Making the Clinical Case,” by Carlene A. Muto, American Journal of Infection Control, December 6, 2006,

“An Intervention to Decrease Catheter-Related Bloodstream Infections in the ICU,” by Peter Pronovost, M.D., Ph.D., et al., The New England Journal of Medicine, December 28, 2006,