You asked for information on hospital-acquired infections in Connecticut hospitals over the past few years and recent actions taken to address this issue. (This report updates a previous OLR report on the topic, 2004-R-0801).

HOSPITAL-ACQUIRED INFECTIONS IN CONNECTICUT

We contacted the Office of Health Care Access (OHCA) for information on hospital-acquired infections over the past three years. That information is provided in Table 1, which indicates hospital discharges assigned at least one hospital-acquired infection diagnosis code.

Table 1: Hospital- Acquired Infections as Primary and Secondary Diagnoses: FYs 2004-2006

Source: CT Office of Health Care Access (OHCA) Acute Care 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 This category enumerates the number of times the diagnosis was assigned as a secondary diagnosis; a discharge could have a combination of the included diagnoses.

NB: Financial incentives influence how hospitals select and order diagnosis codes. For example, E-codes are not used for payment, therefore hospitals may or may not enter these codes in their data or codes may have been deleted during data management processes. Secondly, variations in coding practices between hospitals may affect the volume of reported hospital acquired infection; hospitals may either under-report or not report hospital-acquired infection to the OHCA discharge database. Finally, the included codes do not indicate if complications were a result of a current or previous discharge, and in some cases where the infection occurred.

RECENT ACTIONS

Legislation

In 2006, the General Assembly passed PA 06-142, “An Act Concerning Hospital Acquired Infections. ” The act created an 11-member “Committee on Healthcare Associated Infections,” responsible for developing, operating, and monitoring a mandatory reporting system for healthcare associated infections (“HAI”). The act defines an HAI as any localized or systemic conditions resulting from an adverse reaction to the presence of an infectious agent or its toxin that (1) occurs in a patient in a healthcare setting; (2) was not found present or incubating at the time of admission unless the infection was related to a previous admission to the same setting; and (3) if the setting is a hospital, meets the criteria for a specific infection site, as defined by the National Centers for Disease Control and Prevention (CDC).

The act requires the Department of Public Health (DPH) to implement the committee's recommendations concerning a mandatory reporting system for infections and standardized data reporting measures. It required the committee, by April 1, 2007, to (1) advise DPH on the development, implementation, operation, and monitoring of a mandatory system for reporting HAIs; (2) identify, evaluate, and recommend to DPH appropriate standardized measures; and (3) identify, evaluate, and recommend to DPH appropriate ways of increasing public awareness about effective measures to reduce the spread of infections.

The act requires DPH, by October 1, 2007 and within available appropriations, to implement the committee's recommendations.

Committee Report and Recommendations

The Committee on Healthcare Associated Infections issued a report on April 1, 2007 (attached). Its recommendations are as follows:

1. Connecticut should utilize the reporting system established by the CDC's National Healthcare Safety Network (NHSN).

2. Connecticut should initially begin collecting data on the NHSN module that tracks data relative to central line-associated blood stream infections (CLABSIs) in patients in intensive care units. After hospitals are collecting and reporting this data in a standardized manner, additional modules should be added to the system as appropriate.

3. The Connecticut program should be designed to go beyond the collection and reporting of data. It is essential that the data collected be used to implement evidence-based prevention methods.

4. HAI-related education is a critical element to the success of a statewide HAI reporting and prevention system, and education initiatives should begin well before public reporting of HAI information derived from the reporting system.

5. The implementation and success of the recommended reporting system and education initiatives require an immediate and ongoing state funding commitment.

6. The committee should continue to advise in the development and implementation of the recommended reporting system and education initiatives.

7. DPH needs $ 250,000 to implement these recommendations. An additional $ 55,000 is necessary to implement the recommendations of the education subcommittee.

8. Additional resources are necessary for Connecticut's hospitals to implement the collection, reporting, and prevention recommendations.

Status of Recommendations

DPH reports that it has just issued an RFP for the committee's education-related recommendations. DPH also is in the process of hiring additional staff for these activities (a mid-level epidemiologist and two infection control positions. )

In regard to the reporting of HAIs, the Connecticut Hospital Association (CHA) is conducting training sessions with hospital staff on the NHSN/CDC reporting system, according to DPH. Hospitals are expected to be “hooked up” to the reporting system by November 1. And by January 1, 2008, hospitals will be reporting to NHSN/CDC information on infections.

DPH must report to the Public Health Committee, by October 1, 2008 and annually afterwards, on the information collected by DPH through the mandatory reporting system.

JK: ro