In the first report of its kind, CDC officials said yesterday that central line-associated bloodstream infections dropped by 18% overall in 17 states that have mandatory reporting laws in the first six months of 2009 compared with the previous three years.
These catheter-related infections kill 31,000 hospitalized patients a year.
"The bottom line is the 18% reduction shows that care in hospitals is getting safer, but we know there is more work to be done," said Arjun Srinivasan, MD, director for Healthcare Associated Infections Preventions Program for the Centers for Disease Control and Prevention.
Peter Pronovost, MD, medical director of the Center for Innovations in Quality Patient Care at Johns Hopkins University, added that the report's release "marks a turning point in transparency and accountability for healthcare" with the published results. "Central line associated bloodstream infections are the polio campaign for the 21st century."
Pronovost is well-regarded for his five-step checklist, a sterile procedure by which providers avoid contaminating lines leading into patients' bloodstreams. The checklist also empowers observers who notice a misstep to call a stop to the line insertion process.
The report included information from 1,538 facilities in 17 states: Colorado, Connecticut, Delaware, Illinois, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Oklahoma, Oregon, Pennsylvania, South Carolina, Tennessee, Vermont, Virginia and Washington. Only Tennessee and Maryland had infection ratios above expectations. The rest had fewer than expected.
The report used information from the CDC's National Healthcare Safety Network but did not compare rates by specific hospitals. However, officials said they expect to include information submitted by hospitals in every state in future reports, to be released every six months.
"At that point we can judge progress over time and determine whether or not central line associated bloodstream prevention efforts are driving infections down," Srinivasan said.
Rachel Stricof of the Council of State and Territorial Epidemiologists, said previous statistics on these infections were not as reliable. "For the first time, the states, the public, and federal partners are able to review data from a much more representative group of hospitals within states and across the country.
In a statement, Health and Human Services Secretary Kathleen Sebelius said this type of bloodstream infection not only causes death in hospitalized patients, but costs $2.7 billion in added costs to the healthcare system. "We will also continue to expand healthcare data for policymakers, providers, and consumers so they can all make the most informed health decisions possible," she said.
"This administration is firmly committed to promoting transparency in our healthcare system so we can know what's working, what's not, and how we can do better."
Officials for the Association for Professionals in Infection Control and Epidemiology (APIC) said in a statement that the data "provide a solid benchmark against which future efforts can be measured and represent the quality of data that are needed for the prevention of healthcare-associated infections."
Many hospitals already have seen that these infections "can be reduced to zero, and that in many instances 'zero' can be maintained" in a way that not only conserves healthcare resources, but reduces lengths of stay and associated costs.
However, the association added, some healthcare institutions still lag behind those in states with mandatory reporting requirements. Preventing infections requires hospital leadership commitment, adequate resources, a culture of patient safety, and a sufficiently trained staff to lead interventions.
Central line associated bloodstream infections occur when catheters, generally placed into the large blood vessels of the neck either to administer medications or monitor patient status, become infected. They are often used in seriously ill patients who already have diminished immune systems or multiple diseases that make it even more difficult for them to fight infection.
Mandatory reporting is seen as one effective way to increase hospital resources and attention in the issue. When the report was done, 17 states had laws requiring CLABSI reporting to health agencies.
"Over the last two years, we've seen the number of states requiring mandatory reporting move from 13 to 20 to 27," said Don Wright, MD, HHS deputy assistant secretary for healthcare quality. "We expect the trend will continue to encourage public reporting at the state level."