04 June 2010

The trend in hospital infections - good, bad, or too little data to know?

Some of you may have spotted an announcement last week from the Centers for Disease Control and Prevention about a release of data from the National Healthcare Safety Network (NHSN), a repository of hospital infection data. You can guess the big news in the report from its title,  "First State-Specific Healthcare-Associated Infections Summary Data Report": For the first time, database users are able to calculate healthcare-associated infections (let's call them HAIs for short) by state, as well as nationally.

Good news, you would think. And it is. According to the CDC's announcement (press release, press conference transcript), the national rate of one particular type of HAIs, central line associated bloodstream infections or CLABSIs (like it looks — pronounced "klab-sees") is down 18% from the previous 3 years. Taken together, all HAIs kill at least 100,000 Americans each year (an old number that is probably an underestimate) and cost at least $30 billion per year. CLABSIs are an important component of the spectrum of HAIs and may account for a third of all HAI deaths — so any reduction is a positive development.

And yet: The bigger news about this report, unfortunately, is that it lays bare how little we really know about HAIs, and how little progress has been made in preventing or even documenting them.

  • The report includes data from only 17 states
  • The data does not match state to state, so state rates cannot be compared
  • Participation in the NHSN by hospitals is voluntary (except in states that recently have passed mandatory reporting laws) and data is self-reported
  • Hospitals that report to the NHSN are not identified (in fact, unless state laws say otherwise, they are guaranteed anonymity)
  • The NHSN does not collect data on the most problematic HAI organisms, MRSA and C. difficile.
If you think for a moment about how incomplete this data is, and how much the data collection allows hospitals to avoid saying, then Dr. Peter Pronovost's remarks to the Association of Health Care Journalists in April begin to make sense. Pronovost is a MacArthur Fellow for his championship of evidence-based infection prevention, and said (sorry, no verbatim record that I know of, but I live-tweeted his speech) that if hospital infection reporting were truly transparent and truly accountable — right now, it's neither — the problem of HAIs would end tomorrow, because consumers would be so shocked that they would rise up and demand change.

The CDC says there will be additional data and a new comparison with this first snapshot within about 6 months. Again, that's all good news. But it's worth taking a deep look at this report to really understand how little we know — which will also help to explain why this problem so persistently fails to get better.

(NB: The CDC announcement and the relevant background were covered thoughtfully by my friends Dan DeNoon of WebMD and Barbara Feder Ostrov of Reportingonhealth.org, whose post, FWIW, quotes me.)

And, constant readers, an addendum: On Monday, I'll have big news to share about this blog. It's good news and I hope you'll support it. Stay tuned.

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