October 28, 2004 |
2004-R-0801 | |
HOSPITAL-BASED INFECTIONS | ||
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By: John Kasprak, Senior Attorney | ||
You asked for information on hospital-based infections, including the number of such infections in Connecticut hospitals over the past few years, and steps being taken to address this issue.
SUMMARY
Some five to 10% of patients entering a hospital nationwide acquire an infection they did not have prior to admission. The estimated incidence is over 2 million cases per year, resulting in added expenditures to the health care system in excess of $ 2 billion. Hospital-based infections are estimated to more than double the mortality and morbidity risks of an admitted patient.
In Connecticut, the number of patient discharges assigned a primary diagnosis involving a hospital-acquired infection increased from 3,390 in 1999 to over 4,500 in 2003. The number of patient discharges assigned a primary or secondary diagnosis (or both) of a hospital-based infection increased from 8,822 to 10,809 over that same period.
Connecticut has recently passed legislation addressing the quality of health care in hospitals making the state Department of Public Health the lead agency.
BACKGROUND
Hospital-acquired infections (also known as nosocomial infections) are developed by between five and 10% of patients admitted to hospitals in the United States (over 2 million cases per year). Such infections are usually related to a procedure or treatment used to diagnose or treat the patient’s illness or injury. It is estimated that about 25% to 33% of these infections can be prevented by healthcare workers taking proper precautions when caring for patients.
Bacteria, viruses, fungi, or parasites can cause hospital-acquired infections. These microorganisms may already be present in the patient’s body or may come from the environment, contaminated hospital equipment, healthcare workers, or other patients. Most infections that become clinically evident after 48 hours of hospitalization are considered hospital-acquired. Infections that occur after the patient’s discharge from the hospital can be considered to have a nosocomial origin if the organisms were acquired during the hospital stay.
Viruses are the leading cause of nosocomial infections. During a hospital stay, patients may acquire viral respiratory infections in winter (e. g. influenza, parainfluenza, respiratory viruses) or enteroviral infections in the summer. Bacterial and fungal infections are less common. Most patients who are infected with nosocomial bacteria and fungal pathogens have a predisposition caused by invasive supportive measures such as intubation and the placement of intravascular lines and urinary catheters.
While all hospitalized patients are susceptible to contracting a nosocomial infection, some patients are at greater risk than others: young children, the elderly, and persons with compromised immune systems.
The National Nosocomial Infections Surveillance (NNIS) System of the Centers for Disease Control (CDC) undertook a survey from October 1986 to April 1998 of hospital-acquired infections. It ranked hospital wards according to their association with central-line bloodstream infections. The highest rates of infection occurred in the burn ICU, neonatal ICU, and pediatric ICU. NNIS has created a national nosocomial infections database used to (1) describe the epidemiology of nosocomial infections; (2) describe antimicrobial resistance trends; and (3) produce nosocomial infection rates to use for comparison purposes.
NNIS is the nation’s largest and oldest performance measurement system devoted to hospital-acquired infections. It began in 1970 as a cooperative effort between CDC and 62 participating hospitals and has grown to over 300 facilities today. Participation in the system is voluntary and limited to acute care general hospitals. By law, CDC assures participating hospitals that any information that would permit identification of any individual or institution will be held in strict confidence.
HOSPITAL-ACQUIRED INFECTIONS IN CONNECTICUT
We contacted the Office of Health Care Access (OHCA) for information on hospital-acquired infections in the state’s hospitals over the past five years. That information is provided in Table 1.
Table 1: Discharges Assigned at Least One Hospital Acquired Infections Diagnosis Code: FYs 1999 - 2003 | ||
# of Discharges | ||
Fiscal Year |
Primary Diagnoses1 |
Primary and/or Secondary Diagnoses2 |
FY 1999 |
3,390 |
8,822 |
FY 2000 |
3,572 |
9,273 |
FY 2001 |
3,800 |
9,799 |
FY 2002 |
4,180 |
10,431 |
FY 2003 |
4,587 |
10,809 |
Source: CT Office of Health Care Access Discharge Database | ||
1 Each discharge is assigned one primary diagnosis, therefore each occurrence of a code in this category is equivalent to a unique discharge. | ||
2 A discharge may have been assigned a primary diagnosis, a secondary diagnosis, a combination of the two or a combination of secondary diagnoses from the list of diagnoses. | ||
CONNECTICUT LEGISLATION ON QUALITY OF HEALTH CARE IN HOSPITALS AND OTHER FACILITIES
In 2002, the General Assembly passed legislation (PA 02-125, “An Act Creating a Program for Quality in Health Care”) that required DPH to establish a quality of care program for health care facilities. It required DPH to develop a health care quality performance measurement and reporting system applicable to the state’s hospitals. (Other health care facilities come under the quality program in later years. ) An important component of this quality program was the reporting of “adverse events” by hospitals and outpatient surgical facilities. (A detailed summary of PA 02-125 is attached as well as an April 2004 DPH report on “Quality of Care in Connecticut Hospitals. ”)
Public Act 04-164 made significant changes to the 2002 health care quality law by replacing the adverse event reporting system with a list of reportable events identified by the National Quality Forum or DPH. (A previous OLR Report, 2004-R-0532, discusses in detail the changes made by the 2004 legislation. )
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