Infections at Hospitals Are Up Sharply

Reports of hospital-acquired infections have surged in Los Angeles County in the last 16 months, but public health officials refuse to name the facilities involved, saying the information is confidential.

Last year, public and private hospitals reported 31 outbreaks -- including stomach viruses, virulent skin infections and scabies mite infestations -- to the county Department of Health Services, compared with eight in 2003, new statistics show.

And in the first four months of this year, hospitals have tentatively logged 18 outbreaks, compared with seven in the same period last year. Most of these infections are not deadly, but they can complicate recovery for patients who are already seriously ill.

The health department pledged to improve public notification of hospital infections after a highly publicized outbreak of Legionnaire’s disease in 2002 at Good Samaritan Hospital just west of downtown Los Angeles. The Times reported that outbreak, which sickened at least six people, before the health department publicly disclosed it. Two of the patients died, though the hospital said the deaths did not stem from Legionnaire’s.

Since then, health officials have asked at least two hospitals to notify selected patients about outbreaks, but they haven’t issued a broader alert.

Concerns over hospitalacquired infections have grown locally and nationally, as research has shown that about 2 million patients are sickened in U.S. hospitals annually and that 90,000 die from the diseases.

Last year, the California Legislature passed a bill that would have created a public mechanism to track certain surgical-site infections, as well as those caused by intravenous central lines. Such infections result from common procedures that most hospitals perform.

Gov. Arnold Schwarzenegger vetoed the bill, saying voluntary efforts were working. Lawmakers are trying again this year.

“It’s one of the dirty little secrets of healthcare, and a shocking secret at that,” said state Sen. Jackie Speier (D-Hillsborough), the measure’s author. “There are some real serious risks associated with being hospitalized that we’ve got to be more serious about.”

Some groups, including Consumers Union, are pushing for greater disclosure of hospital infections nationwide. Since 2002, five states have enacted laws requiring public reporting of hospital-acquired infections.

“We’ve got a real problem on our hands, and it’s a public health problem, and they [health officials] have to be out in front being accountable to the people,” said Lisa McGiffert, director of Consumers Union’s Stop Hospital Infection Project.

Los Angeles County health officials said they did not know if the rise in reported infections represented a tangible increase or simply greater communication between public health personnel and hospitals.

“There’s no way we know the number of real outbreaks at any given time in 100 hospitals,” said Dr. Laurene Mascola, director of the county’s acute communicable disease control unit. “It’s just sort of cyclical. There’s not a consistent pattern.”

Citing state health regulations, the county has refused a request by The Times to identify hospitals reporting infections. Public health director Dr. Jonathan Fielding said such information would not be very meaningful for consumers, and his staff said they feared hospitals would stop reporting infections if they thought the information would become public. Also, he and his staff said, some hospitals define outbreaks differently from others because regulations do not provide clear guidance.

State hospital industry representatives say they don’t oppose disclosure of infection data by hospital, but they want to ensure that the comparisons are valid and that trial lawyers can’t use the information in lawsuits. They are trying to come up with a voluntary reporting system, although the effort has taken longer than expected.

“We have long since gotten beyond the point of saying, ‘No, there shouldn’t be any disclosure,’ ” said Jim Lott, executive vice president of the Hospital Assn. of Southern California. “We’re just trying to cross the Ts and dot the I’s so it’s done in a way where it doesn’t harm a hospital’s ability to provide care.”

The 18 outbreaks reported in Los Angeles County the first four months of this year sickened 196 patients, the health department said. The most common was scabies, an infestation of the skin with a microscopic mite, linked to five outbreaks and 92 cases.

Three outbreaks involved a painful staph skin infection not treatable with most common antibiotics, and another three involved an inflammation of the large intestine caused by the growth of the bacterium Clostridium difficile.

Drug-resistant staph infections have emerged as a common scourge in county jails and elsewhere. As with many infections, experts say the best way to avoid them is regular hand washing.

After the Legionnaire’s outbreak at Good Samaritan in 2002, the health department promised to take other aggressive steps to improve hospital reporting of infection outbreaks.

County health director Dr. Thomas Garthwaite pledged to pursue surprise inspections to ensure that hospitals were reporting infections, as required by existing state regulations. He also pledged to lobby the Legislature for tougher penalties for hospitals that failed to do so.

Garthwaite recently acknowledged that Fielding did not pursue either approach, preferring to collaborate with hospitals in identifying and reporting infections, not punish them.

Fielding said his division didn’t have the staff to visit hospitals to systematically check on their infection reporting. Still, he said, the county does more to help hospitals control infections than most other health agencies around the country. The county office that analyzes hospital infections has grown from 2.5 full-time employees to nine.

Speier, who wrote the hospital infection bill that was vetoed last year, said she was working on a version more acceptable to the governor. But she agreed that disclosure was important.

“Consumers need to have information, and I think you keep hospitals honest by making sure that there’s a form of disclosure,” she said.

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Increase in cases

The number of reported outbreaks at hospitals in Los Angeles County in 2004 reached the highest point since 1997. Below are the number of reported outbreaks for the last five years, as well as the number of patients affected.

*--* Year Number of outbreaks Number of cases 2000 20 103 2001 19 236 2002 26 273 2003 8 94 2004 31 275 2005* 18 196

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Source: Los Angeles County Department of Health Services* Through April