Hospital infection rates go unreported to public

WRAL investigates what's being done in the General Assembly to make hospital infection rates readily available and why some say having them available to the public has unintended consequences.

Posted 10:07 p.m. Mar 18, 2009 — Updated 1:50 p.m. Oct 12, 2011

BENSON, N.C. — Living on 54 acres outside Benson, Frances Lee doesn't take any of the credit for the success of Max Lee Farms.

There are blueberries, blackberries, raspberries, peaches and flowers – as far as the eye can see when they are in season. Her husband, Max Lee, was responsible.

"Nothing could make him happier than to say, 'I've got to plow the lower field,'" Lee recalled.

The two met a day after she graduated high school. They married in 1958 and had four children, who in turn have had 10 grandchildren. In September, the couple celebrated their 50th wedding anniversary.

Her husband, Lee says, worked the fields practically every day, until November, when he was diagnosed with lung cancer.

In early December, Max Lee underwent surgery to remove a portion of his lung. Initially, his wife says, it went well.

"We thought he was coming home," Frances Lee said. "'Oh, he'll be home for Christmas,' we said."

He never left the hospital, however. At age 79, he died the day after Christmas. According to his death certificate, he died of the bacterial infections methicillin-resistant staphylococcus aureus and sepsis.

"You go to a hospital to get better – you think. Then, this happens," Lee said.

According to the federal Centers for Disease Control and Prevention, approximately 90,000 patients like Max Lee die each year in the United States from hospital-acquired infections – more deaths than those from breast cancer and AIDS combined. More than 2 million patients develop an infection during their stay.

"It's about 5 percent of all hospital admissions," said Dr. Jeff Engel, North Carolina's state health director.

Five percent, Engel said, is "disturbingly high" because 30 percent to 70 percent of hospital infections are preventable.

MRSA, for example, is a leading cause of potentially life-threatening bloodstream infections and surgical-site infections. According to a 2007 CDC report, it was responsible for an estimated 94,000 life-threatening infections and 18,650 deaths in 2005.

About 85 percent of those infections could be traced to a hospital stay or some other health care exposure, according to the report. Two-thirds of those occurred among people who were no longer hospitalized.

Nationally, studies show the rate of all hospital-acquired infections is down. Locally, it is unclear, because North Carolina is one of 24 states that do not require hospitals to report or make that information public.

Rex Healthcare, WakeMed and the hospitals in the Duke University Health System indicate rates have dropped, although they declined to provide times or specific numbers. (View statements from the hospitals.) UNC Health Care did not respond to WRAL News' request for the rates.

Rep. Lucy Allen, D-Franklin, is sponsoring House Bill 296, which would require all hospitals to track, report and make the information public. The statewide program would cost approximately $1.2 million in the first two years to develop and implement.

The measure, she says, will save lives.

"Oh, definitely, it's a patient-safety issue," she said.

Engel does not think a mandated statewide program is worth the investment. He believes each hospital needs to track the data, but says it should be up to the hospital to decide what to report and to whom.

"All I can say is that there's no evidence that when those reports are published for the public's consumption that they work to reduce rates in hospitals," he said.

He says there are unintended consequences of a mandatory surveillance and reporting system because there are no standards for tracking infections. Each hospital has its own.

If one hospital does a better job at tracking its infections, it might be perceived as having a higher rate of infections than a hospital that tracks its infections a different way.

Don Dalton, a spokesman for the North Carolina Hospital Association, says that creating a uniform system in which hospitals can track and monitor infections can help eliminate many hospital-acquired infections.

The association established a voluntary reporting system in December to develop a methodology and training program so that data are consistent among hospitals.

He says 66 of the 105 member hospitals participate in the program. If Allen's bill, as it stands now, becomes law, it would become mandatory for every hospital in the state beginning July 1.

Dalton says that when hospitals are required to provide the results to everyone, doctors share best practices and patients are better informed.

Engel also says that a reporting system doesn't take into consideration how risks vary from hospital to hospital. The types of patients and procedures at hospitals could keep them from wanting to perform procedures or treat patients if infection is a possibility.

Allen disagrees. She thinks doctors would work harder.

"I don't think many doctors would keep from doing a procedure that was necessary to save a person's life because of that possibility," she said.

Dalton says the public needs access to the information to have another piece on which to judge the quality of care in hospitals in the state. He also believes that when patients become more involved in their care, their quality of care is going to improve.

"The ultimate goal is to eliminate hospital-acquired infections," he said.

At Max Lee Farms, Frances Lee says her son now takes care of the crops. And she is helping foster support for Allen's bill.

She says she devotes most of her energy to telling people her story and hopes that hospital infection rates will be disclosed. She believes the price of not doing so is far too great.

"Not a day passes I don't cry, think about him," Lee said. "I accept that it's over. But I'm saying: 'Does it have to happen to somebody else?'"

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