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SC hospitals required to disclose infection rates by Mary Helen Yarborough Public Relations Hospitals in South Carolina will be required to compile and publish infection rates due to enactment of a bipartisan measure that was pioneered by a New York politician.   The Hospital Infections Disclosure Act, signed by Gov. Mark Sanford on May 31, requires all hospitals and other inpatient care facilities to compile infection rates affecting in patients related to care and report the information to S.C. Department of Health and Environmental Control (DHEC) by Feb. 1, 2008. Public  reporting will begin the following year.   DHEC will publicize the data in annual reports, which also would include risk adjustments that might explain higher rates of infections to hospital patient populations. Infection rates will include those that occur in surgical sites, ventilator-associated pneumonia and central line-related intravenous blood stream infection.   At MUSC, infection rates have been well-documented for years, according to Beth Rhoton, R.N., an infection control practitioner in the medical director’s office. For a year, Rhoton worked with the S.C. Legislature in developing the bill, working with consumer groups and the Association for Professionals in Infection Control and Epidemiology.   “All stakeholders were involved in this process,” Rhoton said. “We met with DHEC and hospital associations."   The measure in South Carolina and other states was prompted by a campaign by former New York Lt. Gov. Elizabeth McCaughey, Ph.D., to force hospitals to disclose inpatient infection rates in an effort to reduce the number of health care associated infections and deaths from these infections. Similar laws have been passed by nine other states.   In South Carolina, an Upstate bipartisan push resulted in a fast-moving bill. Greenville senators Ralph Anderson (D) and Michael Fair (R) sponsored the bill.   The law amends the S.C. Code of Laws, 1976, by adding Article 20 to Chapter 7, Title 44 to enact the Hospital Infections Disclosure Act. As a condition of state licensure, this law requires hospitals to collect data and submit reports to DHEC on hospital acquired infection rates every six months. It also creates an advisory committee to assist DHEC in developing the methodology for data collection and analysis, to provide for patient privacy, and to provide for publication and availability of these reports to the public.   The law defines hospital as “a facility organized and administered to provide overnight or surgical  care or nursing care of illness, injury, or infirmity and may provide obstetrical care, and in which all diagnoses, treatment, or care is administered by or under the direction or persons currently licensed to practice medicine, surgery, or osteopathy and is licensed by DHEC as a hospital.” Such a facility may include  “residential treatment facilities for children and adolescents in need of mental health treatment which are physically a part of a licensed psychiatric hospital.” However, this definition does not include facilities that are licensed by the S.C. Department of Social Services.   Hospital-acquired infection is defined as a localized or systemic condition that:  results from adverse reaction to the presence of an infectious agent or agents or its toxin or toxins; and was not present or incubating at the time of admission to the hospital.   The law requires individual hospitals to collect data on hospital-acquired infection rates for the specific clinical procedures as recommended by the advisory committee and defined by the department, including the following categories: surgical site infections; ventilator associated pneumonia; central line-related blood stream infections; and other categories in addition to those listed above.   Hospitals must report completeness of certain selected infection control processes, as recommended by the advisory committee and defined by DHEC, according to accepted standard definitions.   Biannual reports must be submitted in a format and at a time as provided for by DHEC. Data in these reports must cover a period ending one month prior to submission of the report. These reports must be made available to the public at each hospital and through DHEC. The first report must be submitted before Feb. 1, 2008.   If the hospital is a division or subsidiary of another entity that owns or operates other hospitals, or related facilities, the report must be for the specific division or subsidiary and not for the other entity.    DHEC will appoint an advisory committee that must have an equal number of members representing all involved parties. The department shall seek recommendations for appointments to the advisory committee from organizations that represent the interests of hospitals, consumers, businesses, purchasers of health care services, physicians, and other professionals involved in the research and control of infections.   The advisory committee will assist DHEC in the development of the department’s methodology for collecting, analyzing, and disclosing the information collected under this article, including collection methods, formatting, and methods and means for release and dissemination of information.   In developing the methodology for collecting and analyzing the infection rate data, DHEC and the advisory committee will consider existing methodologies and systems for data collection, such as Centers for Disease Control's (CDC) National Healthcare Safety Network. Data collection and analysis methodology must be disclosed to the public prior to any public disclosure of hospital acquired infection rates.   DHEC and the advisory committee will regularly evaluate the quality and accuracy of hospital information reported under this article and the data collection, analysis, and dissemination methodologies.   DHEC also will require hospitals to collect data on hospital acquired infection rates in categories additional to those established in current standards.   The reports will be summarized in annual DHEC Web site postings and will first be published Feb. 1, 2009. DHEC may issue quarterly informational bulletins at its discretion, summarizing all or part of the information submitted in the hospital reports.   All reports issued by DHEC must be risk adjusted, which would take into account populations served, environmental conditions in areas where hospitals are located, as well as infectious disease concentrations in hospitalized populations.   The annual report must compare the risk-adjusted hospital-acquired infection rates for each individual hospital in the state. DHEC will make this comparison as easy as possible to comprehend. The report also must include an executive summary, written in plain language, which must include a discussion of findings, conclusions, and trends concerning the overall state of hospital acquired infections in the state, including a comparison to prior years.   DHEC also will publicize the report and its availability  to interested parties including, hospitals, health care providers, media organizations, health insurers, health maintenance organizations, purchasers of health insurance, consumer or patient advocacy groups, and individual consumers. The annual report must be made available to any person upon request and the department may charge a fee  not to exceed the actual cost of the copy of the report.   No hospital report or department disclosure may contain information identifying a patient, employee, or licensed health care professional in connection with a specific infection incident. SC joins nine other states As the newest state to require mandatory infection rates, South Carolina joins nine other states with laws or bills awaiting passage by their legislatures.   Tennessee, Vermont and Colorado have mandatory reporting bills that have passed the appropriate legislative bodies, and either await governors’ signature or are in conference committees.   States requiring mandatory reporting are: --Florida --Virginia --Maryland (to start reporting in 2007) --Connecticut (to start reporting in 2008) --New York --Pennsylvania --Illinois --Missouri --New Hampshire (to start reporting in 2007) --South Carolina (to start reporting in 2008) --Nevada (reports only to state) JCAHO reports high infection rates Despite the small number of infection-related sentinel event cases reported to the Joint Commission on Accreditation of Healthcare Organizations, the number of patients acquiring infections in the health care setting, as well as the number of patient deaths due to an acquired infection remains high. According to estimates from the CDC, each year nearly two million patients in the United States get an infection in hospitals, and about 90,000 of these patients die as a result of their infection. Infections are also a complication of care in other settings including long term care facilities, clinics and dialysis centers.   The CDC works in conjunction with approximately 315 hospitals throughout the United States to collect data for its National Nosocomial Infections Surveillance (NNIS) System. A cooperative effort begun in 1970, the system describes the epidemiology of nosocomial infections and antimicrobial resistance trends, and produces nosocomial infection rates to use for comparison purposes. (See NNIS report, December 2002, American Journal of Infection Control.) According to the Joint Commission database, only 10 infection-related reports have been reviewed under the sentinel event policy since its implementation in 1996.   Fifty-three patients were affected, of which 14 died. While the age of the patients afflicted varied, the vast majority were infants (29) and seniors (19), many of whom were immuno-suppressed. Settings included the newborn and pediatric intensive care units, long-term care facilities or units, general medical/surgical units, and endoscopy and obstetrics units.   The infecting organisms included HIV, Pseudomonas aeruginosa, E. coli, MRSA (methicillin resistant Staphylococcus aureus), salmonella, and Clostridium sordellii. The number of reported infection-related sentinel event cases represents an insufficient sample from which to draw any generalizable conclusions and recommendations.   Friday, June 9, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publication at 849-1778, ext. 201.