Las Vegas Sun

October 30, 2014

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Do No Harm:

We’re the ones who are in there. Our lives are entrusted to them.’

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Leila Navidi

State Sen. Shirley Breeden sponsored legislation last year that mandated stricter reporting of hospital-acquired infections. The bill passed, but the hospital lobby blocked the requirement that infections be identified by individual facilities.

State Sen. Shirley Breeden understands the patient suffering caused by hospital-acquired infections.

While she was in Carson City last year championing a bill to require stricter reporting of such cases, her father was battling a Methicillin-resistant Staphylococcus aureus, or MRSA, infection he contracted in a Las Vegas hospital.

The bill passed, but Breeden is disappointed it won’t lead to the transparency needed to make hospitals’ reports meaningful for the public.

When Breeden, a Henderson Democrat, met with lobbyists in March 2009 to discuss Senate Bill 319, they told her they would block any legislation that allowed infections to be identified by individual facilities, she said.

To get lobbyists for physicians and hospitals to support reporting by hospitals, she had to promise the information would not be made public.

Friday, the State Board of Health is slated to adopt those regulations for the new law.

But Nevada health officials are inviting hospitals to voluntarily disclose their infection numbers.

It’s “really sad” when doctors and hospitals don’t want people to know about the quality of care, Breeden said. “We’re the ones who are in there. Our lives are entrusted to them.”

A Las Vegas Sun investigation found 2,010 instances in 2008 and 2009 in which patients were infected in one of the 13 acute-care area hospitals by the lethal bacterium MRSA or Clostridium difficile, or C. diff. The bacteria are often called “superbugs” because they are resistant to many antibiotics.

Two hundred thirty-nine of the infected patients died, the Sun found, although it’s impossible to tell from the hospital billing records examined by the Sun how or whether the infections factored in the patients’ deaths.

The Sun’s report is the first time the number of MRSA or C. diff infections at individual Las Vegas hospitals has been reported.

The regulations stemming from SB319 would require hospitals to report MRSA cases, certain surgical site infections and bloodstream infections related to central-line catheters — flexible tubes used to inject medicine deep into the body — to the National Healthcare Safety Network, a program run by the Centers for Disease Control and Prevention.

The Nevada State Health Division originally proposed facility-specific reporting, but that was rejected by the Legislative Council Bureau because the language in Breeden’s bill does not specifically mandate it.

Still, the Health Division isn’t giving up. On Monday, agency officials sent a letter to hospital administrators asking for permission to report the information for their respective facilities. Hospitals that want their infections to be made public can give the state permission to report them, said Marla McDade Williams, deputy administrator of the division.

Hospitals have fought facility-specific reporting of infections since 2002, when the Legislature passed a law requiring the reporting of sentinel events — injuries and infections that take place in hospitals. But since the Sun published the first story in its investigative series, “Do No Harm: Hospital Care in Las Vegas,” St. Rose Dominican Hospitals and University Medical Center have agreed to publish all their quality-of-care information, including hospital-acquired infections. Other hospitals have refused.

The Sun contacted the 13 acute-care hospitals in Las Vegas to ask them how they would respond to the state’s request for permission to publicly report the infections they report to the CDC.

St. Rose and UMC officials said they will give permission to the state to publish the information. North Vista Hospital officials said they will consider the state’s request. Sunrise Hospital and Medical Center said it “will comply with state and federal reporting requirements” — meaning they will not be transparent to the public. No other hospital responded.

Breeden applauded the hospitals that are being transparent, and said consumers may wonder if the others are “hiding something.”

The resistance to public reporting of infections is a nationwide issue, and data collection methods are so haphazard, even within the federal government, that it’s unclear whether anyone understands the scope of the problem.

Maryn McKenna, author of “Superbug: The Fatal Menace of MRSA,” said hospitals nationally know how many patients are infected within their walls but they keep the information from the public.

“The reporting we require from the health care system is not transparent or accountable,” McKenna said.

The National Healthcare Safety Network allows hospitals to report infections with the assurance that the information will remain anonymous, McKenna said.

State laws vary in terms of the types of data gathered and the level of transparency, she said, and many states’ efforts are hampered by budget problems. The result is that consumers can’t tell where they might be at risk, where outbreaks are occurring or how to do comparison shopping, McKenna said.

The problem exists because the various reporting systems have been developed independently and do not mesh together to become useful, she said. And it’s all been created under the influence of political lobbying, she added.

“There is a profound influence exerted by the hospital industry, the medical industry and the professional associations,” McKenna said. “They do exert influence on the legislative process.”

Dr. Bill Jarvis, who worked for the CDC for 23 years and led its hospital-infection program, said he questions the reliability of data reported to the National Healthcare Safety Network.

Good infection reporting is paradoxical, Jarvis said. If a hospital wants to look better when compared with others, it might disband its infection-control program so fewer are identified.

In years past, the National Healthcare Safety Network had strict requirements for hospitals that reported infections, Jarvis said: Each had to have a dedicated infection-control program, proper staffing and administrative support. This helped ensure the quality of the data being reported, he said.

Since many states have adopted the CDC’s network as their de facto reporting mechanism, as Nevada has, the number of hospitals using the network has jumped from about 400 to more than 2,600. That has muddied the quality of the information, Jarvis said.

Meanwhile, there is no process to validate the data, he said.

“It’s basically left up to the states to determine if they want to verify (the data),” Jarvis said.

Breeden is disappointed that the information reported by Nevada hospitals to the CDC network will not be made public, but she’s not giving up. Legislators will make health care a primary focus of the 2011 session, she said, and will take up public reporting of infections.

“We will win in the long run,” she said.

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