Infection control Rates, as far as the public is concerned, has always been protected as privileged and confidential information. It isn’t as if we are trying to hide anything, but the difficulty of presenting data to the public that can reasonably compare one facility to another has always been an issue. Due to scathing media reports and consumer groups carrying the banner of patient safety, the demand for infection data has increased with the speed of light. We will have to be up front with our rates.
Laws requiring healthcare acquired infection rate disclosures have been passed in Illinois and Pennsylvania and are under discussion in a number of states. The CDC is working on a guidance document on rate infections disclosure issues. The Association for Professionals in Infection control and Epidemiology issued a position paper on the subject saying that crude or overall infections rates, not adjusted for risk, are misleading. So, once again, the question comes up. What are we hiding?
The answer is nothing. So what’s the problem with telling the infection rates? There’s the problem. If hospital A has an infection rate of 9.5 and B has a rate of 3.5, one sounds better than the other. But what are you comparing. Number one, 9.5 what? 9.5% of overall patients, 9.5 infections per patient admissions, per 100 patient days, per 1000 patient days? How do the patients compare? How do the hospitals compare? What if hospital A only treats high-risk, low income patients and B treats referral only, low risk, high income patients? Would the comparison be fair? Maybe hospital A statistics include surgery rates and B doesn’t have a surgical department. What if A takes nursing home patients and B doesn’t?
All of these issues have the potential for clouding the statistics. Even if you supposedly compare apples to apples, oranges to oranges, there are still risk stratification issues that need to be considered. If you narrow the reported infections to surgical infections, what are the surgeries? Are the patient populations equally at risk for complications? This is why statistics have to be taken with a grain or ten of salt. Know what’s being compared.
Ideally, before a state demands statistics, they will allow the states to look at what they are surveying and what kind of definitions need to be in place before data collection is done, so that all hospitals are able to compare comparable data. This is the area where consumers and infection control professionals far apart. Infection control professionals are always thinking in terms of like populations and risk categories for patients. Consumers may think that a higher number automatically means poor care.
One big danger seen by many if a mandatory reporting law is enacted is that hospitals may not be inclined to look at the higher risk areas because it could make them look bad. Consumers want to see every infection that occurs be tracked and reported. The cost to hospitals in man hours alone could sky-rocket healthcare cost. If someone does a really good job of surveillance, reports everything carefully and they lose patients and are threatened financially, they would be inclined to do a less thorough job next time instead of being penalized for doing an excellent job.
What does all this mean to nurses? Why do I care? It’s just numbers. Well, it means hospitals could lose business due to Infection Reports if the public is not appropriately educated to understand what’s being reported. If a hospital loses business, staffing is often decreased as a cost savings. Would your job be on the line? As nurses we need to be able to speak to hospital infections and make sure we don’t start unfounded rumors. We also need to be able to help other people interpret what they read. Journalism loves high profile, scare-tactics kind of stories. We have to be a voice of reason in a high-stress world.
When it becomes Up Close and Personal at your hospital, can you be one of the voices for reason? Find out how you are doing. Give out accurate information if you’re asked. Statements like "Dr.______ patients always have infections." are not helpful. Don’t be the rumor monger for your hospital, be the person who makes everything better. Always remember that the consumer is more knowledgeable than ever. Everyone’s eyes are on healthcare and that won’t change. We just have to continue to do the best job we can as our industry turns into a fish bowl and more and more of quality issues become public knowledge.