Studies conclude hospital-acquired infections are largely preventable

Hospital-acquired infections (HAIs) are common and avoidable, according to three recent studies. They result more from ineffective systems than human vulnerability—a situation that health professionals, including pharmacists, can correct. "HAIs result primarily from flawed processes of care and hygiene, not how sick patients are when they were admitted, which too many hospitals claim," said David Nash, M.D., chairman of the Department of Health Policy at Jefferson Medical College in Philadelphia.

Nash is editor of the American Journal of Medical Quality(AJMQ), which published a December supplement with reports about the studies. The studies' conclusions came in part from data in the first publicly revealed state survey about HAI frequency, published in November by the Pennsylvania Health Care Cost Containment Council (PHC4). That survey, reflecting data from 168 hospitals and 1.6 million patients, found that 19,154 patients contracted infections in Pennsylvania hospitals in 2005. It examined four types of HAIs: urinary tract infections associated with catheter use, infections from a central line inserted in large veins, ventilator-associated pneumonia, and infections at the site of incisions.

PHC4 officials reported that HAIs are expensive and dangerous. The average hospital stay in Pennsylvania was nearly 21 days for those with hospital-acquired infections, and five days for patients without them. The average hospital charge was $185,260 for patients with HAIs, compared with an average $31,389 incurred by other patients. Twelve percent of those patients who acquired infections died, compared with 2.3% of other patients.

Several states do issue hospital report cards, which track quality measures, but no other state besides Pennsylvania releases hospital-specific infection rates, according to Consumers Union. And, although about 16 states require that hospitals report HAIs to a state agency, no other state has issued a comprehensive report. "The [PHC4] report offers some good baseline data, although there may be some question on how current some of the data are," said Allen Vaida, Pharm.D., executive VP of the Institute for Safe Medication Practices. "What will be very important will be next year's data, to see what hospitals do with this information."

ASHP has long urged a multidisciplinary approach to reducing HAIs. "Hospital pharmacists can and should play a crucial role in the elimination of HAIs," said Kasey Thompson, Pharm.D., director of ASHP's Center on Patient Safety. "They should be involved in the patient safety committees developing hygiene protocols, in monitoring the proper use of antibiotics, and in evaluating the data collected in HAI reviews."

In one study published in AJMQ, researchers at Allegheny General Hospital in Pittsburgh found that age and severity of illness did not appear to be risk factors among 54 patients with ailments such as heart attacks and respiratory failure who contracted central line-associated bloodstream infections.

In the second study, researchers at Penn State College of Medicine in Hershey, Pa., examined the PHC4 data for more than 180,000 surgical patients. It found that although factors such as age, obesity, and diabetes are a factor in whether a patient was likely to develop a surgical wound infection, hospital practices such as hand-washing, the duration of surgeries, and traffic through the operating room played a greater role. Surgical site infections are the second most common cause of HAIs, after strep infections in intensive care units.

A third study, by researchers affiliated with Cardinal Health in Massachusetts, found that patients with HAIs stayed in the hospital longer, were more likely to die, and faced higher costs than patients with similar underlying illnesses who did not contract such infections. The severity of the effects of the infection could not be attributed to how sick the patient was on admission, the study found. According to the AJMQ article, "(t)he rise of multi-resistant pathogens has made HAI an even more urgent issue for hospitals than ever before. Despite an extensive knowledge of the mechanism of resistance, restrictions on antibiotic use, and development of formal control measures, multi-antibiotic drug resistance continues to rise."

It is in that arena that pharmacists can be especially useful, said Marianne Billeter, Pharm.D., a clinical pharmacy specialist who works in the infectious disease department of the Ochsner Clinic Foundation in New Orleans and is the pharmacist member of the Joint Commission's Infection Control Expert Panel.

"Pharmacists have a critical responsibility in monitoring the use of antibiotics by individual patients and their prescribing physicians, and in developing the protocols necessary to be certain proper prescribing practices are the hospital standard," Billeter said. "That means we have a very significant role to play in controlling hospital infections,"

"Hospital-acquired infections are not inevitable," said Marc P. Volavka, PHC4 executive director, "and they are not the result of being elderly or very sick. Every patient that enters a hospital in Pennsylvania and in this country is at risk for a hospital-acquired infection, and every health professional has a responsibility to try to eliminate HAIs."

The PHC4 report and AJMQ articles are available at