Congressional committee chair calls for action against hospital infections

Waxman cited statistics that, with 100,000 deaths per year, healthcare-associated infections are the equivalent of the sixth leading cause of death, something he said is particularly disturbing because many infections are preventable with simple, inexpensive measures.

A GAO report done for the committee said HHS has not adequately prioritized the 1,200 practices in 13 guidelines on hospital infections from the Centers for Disease Control & Prevention. GAO recommended that prioritization be done to aid decisions including which practices should be part of the Centers of Medicare and Medicaid Services' conditions of participation for hospitals. GAO noted that only a few of the guidelines are required by CMS or by accrediting organizations' standards. GAO asserted that those organizations should not be expected to require more of the recommended practices until they are prioritized. CDC has sorted the practices according to the strength of the evidence, but other factors to be considered might include costs or organizational obstacles, it said.

Testifying at the hearing, GAO's healthcare director Cynthia Bascetta said, "Our belief is that HHS could be doing a much better job bringing to bear" the expertise from CDC, CMS, and the Agency for Healthcare Research and Quality in order to influence hospitals to take the needed measures.

A key part of the Congressional hearing was on Michigan quality programs. A project reported in the New England Journal of Medicine eliminated catheter-related bloodstream infections in half of 127 intensive-care units and reduced it significantly in others. Peter Pronovost, M.D., Ph.D., assistant professor of the Johns Hopkins Department of Anesthesiology and Critical Care Medicine, who directed the project, explained that it was based on simple interventions such as a checklist for doctors, distilled from CDC's recommended practices.

John Labriola, director of William Beaumont Hospital, Royal Oak, Mich., told the committee that, among other actions on infections, his hospital added several professionals to the intensive-care area, including a pharmacist to address medication appropriateness, compatibility, and discuss evidence-based treatment regarding therapy.

The hospital, he said, has "experienced a 53% reduction in bloodstream infections and a 44% decline in ventilator-related lower respiratory tract infections in 2007 when compared to 2006. Through hospital-wide efforts, infections associated with peripherally inserted central catheters also decreased from 1.8% to 1.4% (a 22% drop)."

Asked by Waxman how many lives could be saved if all hospitals used the checklist from the Michigan quality project, Pronovost said there are 28,000 deaths and a cost of between $2 billion and $3 billion a year for catheter-related infections. Waxman told the hearing, "I know that no hospital wants to be inundated with all sorts of checklists. Let's coordinate what is essential, successful, and doable."

THE AUTHOR is a writer based in the Washington, D.C., area.