Health Care - Associated Infections

Health care-Associated Infections (HAIs) are infections that patients can get after having medical or surgical treatments. These infections can happen when needles and tubes are inserted through a person's skin, which is the natural protection against bacteria and other organisms. Insertion of needles and devices provides a pathway for bacteria and other organisms to enter the blood stream and lungs. Patients in the intensive care unit (ICU) have the highest risk of HAIs because of the number of procedures they undergo and the seriousness of their health problems. HAIs can aggravate a patient's illness and lengthen the stay in the hospital. They also can be passed on to other individuals.

The Guidance on Public Reporting of Health Care-Associated Infections, published by the Health Care Infection Control Practices Advisory Committee in 2005, says that in hospitals alone, HAIs account for an estimated 2 million infections, 90,000 deaths, and $4.5 billion dollars in extra healthcare costs each year. Hospitals and other healthcare facilities have policies and rules designed to minimize the occurrence of HAIs. Despite this, it is not possible to prevent all HAIs.

In 2004 the Missouri General Assembly passed a law requiring hospitals and ambulatory surgery centers (ASCs) to provide information to the Missouri Department of Health and Senior Services (DHSS) about HAIs in their facilities. Facilities are required to report central line-associated bloodstream (CLAB) infections, specific surgical site infections (SSIs), and ventilator-associated pneumonia's (VAPs). The law also requires the DHSS to make this information available to the public.

Hospitals began reporting CLAB infections in July 2005. Each month hospitals report the number of CLAB infections in selected ICUs. Collection of data on SSIs from hospitals and ASCs began in January 2006.

Facilities report CLAB infections by the type of ICU involved (medical/surgical, coronary, medical, surgical, pediatric, neonatal). Reporting by ICU type allows for a fairer comparison between hospitals. It takes into account differences in the types of patients ICUs treat and the different risks for infection. SSIs are reported by procedure and the infection rates are adjusted to take into account differences in patient risk for infection due to factors such as the length of the surgery, the type of surgical wound for that procedure, and the patient's physical condition. Surgical procedures selected for SSI reporting are serious, are performed in a variety of facilities, and tend to be associated with HAIs. These procedures include abdominal hysterectomy, coronary artery bypass and hip repair procedures performed in hospitals, and breast and hernia procedures performed in ASCs.

Reporting of VAPs has been postponed.  Because hospitals do not use a standard method of diagnosing VAPs, the infection control panel, with input from an expert panel, convened to study the infection control issue, recommended that a process measure, HOB elevation, be reported instead.  The risk of contracting a VAP is substantially reduced for patients on ventilators if they have their heads elevated at least 30 degrees.  This measure has been included in a group of VAP measures endorsed by the Joint Commission on Accreditation of Healthcare Organizations.  At the request of the DHSS, Missouri hospitals began voluntarily reporting HOB elevation in November 2007.  Reporting is done for four ICUs—medical, surgical, medical/surgical and coronary—plus all other ICUs combined.

In October 2010, the DHSS added historical data to the website.  After reaching the main page for Missouri Healthcare Associated Infection Reporting, visitors can link to a table where they can select either hospitals or ASCs.  For the selected facility, users can view numerators, denominators and rates for CLABSIs, SSIs and HOB elevation.  Currently displayed are data for 2006-2009.  As each calendar year of data becomes complete, it will be added to this table.

This information about HAIs gives consumers access to important information about healthcare facilities in their area and across the state. Of course this information should be only one of the pieces of information a consumer uses to choose a healthcare facility. Consumers should consider the experience of the facility staff, the advice of their physician, and all other factors that are unique to his or her situation, in addition to the infection data reported on this website. Facilities vary in the types of patients they treat, and a facility that treats severely ill patients will naturally be at higher risk for HAIs. We have used procedures recommended by the Centers for Disease Control and Prevention (CDC) to adjust the infection rates so consumers can get an even picture across facilities. However, when reviewing the numbers people should keep in mind that these procedures are not perfect. Also, viewers should note any comments and/or explanations provided by a facility regarding its data.