|Lessons Learned From the New York Law Mandating Hospitals to Report on Infections |
By Sharon Moffatt, RN, BSN, MSN
Chief of Health Promotion and Disease Prevention
Association of State and Territorial Health Officials
As a significant cause of death, health care–associated infections (HAIs) are a critical challenge to public health in the United States. About 1 in 20 patients develops an infection while receiving care in U.S. hospitals. These infections result in up to $33 billion in excess medical costs every year.1 Despite these staggering statistics, HAIs are preventable through comprehensive strategies that involve public reporting, education, and prevention. Policies that support comprehensive programs are needed to reduce and eventually eliminate HAIs.
State health agencies play a central role in HAI prevention because they are responsible for protecting patients across the health care system and serve as a bridge between health care and the community. State health agencies may have authority to regulate and inspect facilities, collect and validate data on infections, and implement improvement programs, while protecting patients’ rights by maintaining the requisite level of privacy and confidentiality.
At least 28 states have enacted laws in the past decade to require that hospitals report infection data regularly to their State health agencies or other designated organizations.2 The most common HAIs addressed by these laws are central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections, and surgical site infections. These are the leading cost drivers, based on the severity of the infection and the intervention required to treat the infection. For example, CLABSIs are life threatening and may result in long stays in intensive care units.
New York was one of the first states to enact a comprehensive reporting law in 2005. The State health agency partnered with hospital representatives, consumer advocates, and State legislators, who recognized that HAIs were a problem both nationally and in New York. They drafted legislation to provide New Yorkers and other stakeholders with fair, accurate, and reliable data to guide decisions on where to receive care.3
However, public reporting alone is insufficient to sustain a decrease in HAI rates. The New York law authorized funds for the State health agency to support quality improvement projects at selected hospitals to improve their infection control programs. The agency also provided technical assistance to the hospitals, such as root cause analysis to facilitate HAI data reporting, and audited the accuracy of information submitted by the hospitals. Given the constantly changing hospital environment, the State health agency could also address the need to develop protocols for quality improvement and for ongoing review and reporting, to ensure sustained progress in reducing HAI rates.
Partnerships played an important role in the success of the legislation in reducing HAI rates and associated health care costs. For example, the State health agency collaborated with several hospitals on the quality improvement projects that it funded.
The comprehensive program increased staff adherence to hospital infection prevention and control programs, leading to significant reductions in targeted infections and cost savings. Since 2007, adult and pediatric CLABSI rates have decreased by 18 percent in New York after adjusting for type of intensive care unit. The State health agency estimated that the decline in surgical site infections between 2007 and 2010 generated between $7.9 million and $23.1 million in cost savings, while the decline in CLABSIs in adult, pediatric, and neonatal intensive care units has generated an additional $7.3 million to $29.4 million in savings.3
In interviews for a State policy report on HAIs1 issued by the Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention (CDC), stakeholders from New York attributed the success of the public reporting policies to the auditing of reported data and the initial pilot reporting program that allowed the state to refine the requirements and educate facilities on reporting. By raising awareness among hospital leadership and health care providers, the policies were also the catalyst for institutional and cultural change in facilities. This created the impetus for increasing dedicated infection control resources at the facility level.
States with dedicated financial support are better positioned to provide the technical assistance and oversight necessary to implement a comprehensive, well-staffed HAI prevention program. State health officials interviewed for the State policy report said that their HAI prevention efforts benefited from national funding provided by the American Recovery and Reinvestment Act of 2009. Yet the stakeholders expressed concern about the long-term sustainability of surveillance, reporting, and technical assistance. One way to address that challenge is to invest the money saved from reductions in HAI rates back into the State health programs that support efforts to prevent HAIs.
The experience with New York’s HAI public reporting law offers some important lessons. Public health officials and the health care community have a responsibility to inform policymakers about the benefits of such laws, especially as states face budget cuts and assess the value of public health programs. After seeing the associated cost savings and the improved quality of life of patients treated in hospitals with reduced HAI rates, policymakers may consider that information when deciding whether to implement similar laws in their own states or territories.
About the Author: Sharon Moffatt, RN, BSN, MSN, is the Chief of Health Promotion and Disease Prevention at the Association of State and Territorial Health Officials (ASTHO). ASTHO is the national nonprofit organization representing the public health agencies in U.S. states, territories, and the District of Columbia. ASTHO's members, the chief health officials of these jurisdictions, are dedicated to developing sound public health policy and ensuring excellence in State-based public health practice.
Disclosure Statement: Ms. Moffatt reported that ASTHO received a CDC grant for HAI and Winnable Battles. She reported no other financial or business/professional affiliations that are relevant to the work described in this commentary.
1Policies for Eliminating Healthcare-Associated Infections: Lessons from State Stakeholder Engagement, January 2012. Association of State and Territorial Health Officials and the Centers for Disease Control and Prevention. Available at: http://www.astho.org/Display/AssetDisplay.aspx?id=6786.
2Healthcare Associated Infection Reporting Laws. December 2008. Association of State and Territorial Health Officials. Available at: http://www.astho.org/uploadedFiles/Programs/Infectious_Disease/Healthcare-Associated_Infections/State%20HAI%20Reporting%20Laws%20122208.pdf (If you don't have the software to open this PDF, download free Adobe Acrobat Reader® software .).
3State-Mandated Tracking and Public Reporting Reduce Incidence and Costs of Common Hospital-Acquired Infections, Sept. 26, 2012. AHRQ Health Care Innovations Exchange. Available at: http://www.innovations.ahrq.gov/content.aspx?id=3686.
Original publication: September 26, 2012.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: January 23, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.