So which statistic are we to believe: 122,300 lives saved or 87% of hospitals failing to adopt well-established practices to prevent nosocomial infections?
For about the hundredth time, a reportthis one from the Leapfrog Grouphas called into question whether the majority of the hospital industry is doing anything more than providing lip service when it comes to preventing medical errors and creating a culture of patient safety. The employer groups review of infection-control practices at 1,256 hospitals found that just 13% are following all of Leapfrogs recommendations for preventing hospital-acquired infections and only a quarter of hospitals have adopted all 27 National Quality Forum-backed safety practices.
If news releases could only heal people, we could call off healthcare reform. We have had quality reporting initiatives to government, an array of private sector programs and more than 3,000 hospitals signing on to the Institute for Healthcare Improvements 100,000 Lives Campaign and its successor, the 5 Million Lives Campaign. And yet, other than some self-congratulatory news conferences, there is just not enough evidence of improvement and not enough saved lives.
The Leapfrog report stated hospitals are trailing in five areas: aspiration- and ventilator-associated pneumonia; central venous catheter-related bloodstream infections; surgical site infections; vaccination of staff members against flu; and hand hygiene.
Hmm. Sounds familiar. Here are the stated aims of the two Lives campaigns: preventing catheter-related central-line infections; preventing surgical site infections; preventing ventilator-associated pneumonia; reducing methicillin-resistant Staphylococcus aureus (MRSA) infections. Each of those goals has specific, well-established practices associated with it, but Leapfrog found that only about a third of hospitals even have a handwashing policy.
In reacting to the Leapfrog report for our Sept. 17 cover story, industry officials came up with contradictory excuses. Onefrom the American Hospital Association and an official at Emory Healthcare in Atlantais that there are too many infection-control programs, each with differing emphases. With no single strategy to follow, they said, hospitals are left without a coherent message on how to solve the infection problem. The other, advanced by the California Hospital Association, is that you have to be cautious about mandated, one-size-fits-all approaches. Theres not just one solution for such a complex set of problems, we were told.
Yes, there are too many quality projects out there, and they do have significant variations. One could even see how a government mandate to follow one set of practices might have some unintended consequences. However, to suggest that either situation means you simply throw up your hands while thousands of people get sick and die is tantamount to malpractice. For instance, surgical infections result from poor adherence to protocols established many years ago. Actions such as using a gloved hand contaminated during surgery to make a phone call are all too common.
As most hospitals dither, government is stepping in with its heavy hand. The CMS promises not to pay for certain medical errors, including some nosocomial infections. Illinois recently passed legislation mandating that all patients entering intensive-care units be screened for MRSA. Pennsylvania, which already mandates reporting of infection data, has done the same. It also will require hospitals, nursing homes and day-surgery centers to have state-approved infection-control plans in place.
The CMS action is undoubtedly just the first step toward federal laws and regulations aimed at reining in all forms of preventable medical errors. Reviewing the presidential candidates reform plans, you see many references to doing just that. Given that the hospital industry has thrown in the sponge on self-policing, it is time for mandates.