When California officials announced this month that they would begin tracking virulent “superbug” infections in gyms, schools and other community settings, they billed it as a major advance in public health.
But the plan would capture just a fraction of drug-resistant infections, leaving the vast majority unreported to the state and unknown to the public, according to experts and consumer advocates.
Disease-tracking experts say California lags behind at least 15 other states that monitor such infections where they are most likely to occur: in hospitals and other healthcare facilities.
At least five states make infection reports public, so that consumers might be alerted to the institutions with infection-control problems. More than a dozen other states, including Oregon and Washington, have plans to publicly release such data in the near future.
The magnitude and cost of healthcare-related infections -- which are largely preventable -- are substantial. According to national estimates, one out of 22 hospital patients gets a drug-resistant infection and 99,000 patients die from them each year. In California hospitals alone, such infections cost the state $3.1 billion annually to treat, according to a recent estimate by the California Department of Health Care Services.
A variety of healthcare and consumer groups are pressuring California to provide more public oversight.
“You don’t know until you get there and then it’s too late,” said Suzan Shinazy, 49, a registered nurse in Newport Beach whose 66-year-old mother died at a private San Bernardino County hospital after contracting three infections while recovering from a heart attack.
“If the hospital’s refusing to clean up their rate of infection, the public should have an opportunity to go elsewhere,” Shinazy said.
The California Nurses Assn. agrees. The union is pushing for public reporting of infections in the state’s roughly 6,000 healthcare facilities, arguing that without public oversight, hospitals often cut costs by downsizing nurses and other infection-control staff.
“Infection control is about not keeping secrets. You can be a lot more effective if there’s disclosure about what’s going on,” said union lobbyist Donna Gerber. “The more the public knows, the more accountable hospitals are going to be.”
But many hospitals in California oppose reporting infection rates -- even privately -- to the state, saying that reporting would require extra staff and onerous paperwork.
“We’d have to hire so many data people to do it, that would take away from the staff hired to prevent the infections,” said Debby Rogers, a lobbyist with the California Hospital Assn. who serves on a state public health committee that advises on healthcare-associated infections.
Rogers said many hospital leaders resist the sort of public disclosure provided in such states as Pennsylvania and South Carolina. It would penalize facilities that treat the sickest patients who are most prone to infection, Rogers said, and wouldn’t give hospitals enough credit for the infections they prevent, unfairly damaging their reputations.
“Unless we risk-adjusted appropriately, it looks like that facility is providing bad care,” she said.
In 2004, Gov. Arnold Schwarzenegger vetoed legislation in California that would have required public reporting of hospital infection rates, saying that the state already provided enough oversight and that hospitals were making an effort to control infections. Two years later, the governor signed less stringent legislation sponsored by the hospital industry that required hospitals to publicly report infection-control policies.
To some patient advocates, that fell far short.
“The public doesn’t care about what processes you’re doing -- we want to know about the results,” said Carole Moss, a Riverside mother who started a patient advocacy group after her 15-year-old son died from a drug-resistant staph infection at an Orange County hospital. “Where can I take my mother when she has brain cancer that I know she’s not going to get worse? Where can my son get operated on that I know he’s not going to get worse?”
“Because I was not aware as a consumer,” said Moss, who now serves with Rogers on the state advisory committee, “I was not prepared to be an advocate for my son.”
This year, California legislators again have proposed requiring hospitals to screen for and report infections of methicillin-resistant staphylococcus aureus -- the virulent bacterial infection that killed Moss’ son -- but the hospital industry is criticizing the bill. The governor said through a spokeswoman that if infection rates are reported they should be “expressed in context.”
“The hospitals are the infection hot spots,” said the bill’s sponsor, Sen. Elaine Alquist (D-Santa Clara). “They’re not following hygienic procedures. These deaths are preventable, and whatever they’re doing is obviously not enough.”
Medical experts say healthcare facilities can prevent the spread of infections with low-cost, low-tech measures. These include ensuring staff disinfect their hands and use gloves or masks before treating patients.
In addition, hospital staff can test people before they’re admitted -- particularly the elderly and critically ill who are most at risk for infection. And they can isolate those infected and ensure that equipment used to treat them is not used on others.
California’s recent effort to track drug-resistant infections outside health facilities follows reports of outbreaks of severe staph infections presumably contracted in public places. Fear has been spreading among athletes, students and parents.
There is some basis for concern about these infections. Dr. Gil Chavez, California’s state epidemiologist, said they are especially virulent strains and less understood than those that crop up in hospitals.
Consumer advocates disagree. They argue that infections don’t stop at the hospital door, and that without mandatory reporting, the state can’t fully appreciate the virulence or full extent of staph infections.
About 85% of drug-resistant staph infection cases are contracted in healthcare facilities, according to statistics published in October’s Journal of the American Medical Assn. The same study showed that staph killed 19,000 people nationwide in 2005, most in healthcare facilities, making it potentially more deadly than HIV/AIDS in the United States.
Other states in the last two years have passed laws mandating that hospitals report their infection rates based on recommendations by some of the largest national epidemiology groups. The groups recommend that states report, using a CDC model, infections that stem from devices such as intravenous lines, ventilators and catheters, those that develop after surgical procedures and those that are drug resistant.
Late last year, the U.S. Department of Veterans Affairs began testing patients for drug-resistant staph infections, including those in California, upon admission, transfer and discharge.
In Pennsylvania, some hospitals are giving patients nose swabs upon admission to check for the infection so that special measures can be taken to keep severe staph infections from spreading.
Separately, that state requires its 168 hospitals to publicly report catheter-associated urinary tract infections, ventilator-associated pneumonia and central line-associated bloodstream infections. The most recent annual report, issued in 2006, showed that the problem was not small: 19,154 patients suffered healthcare-acquired infections, about a dozen out of every 1,000, and 2,478 died as a result.
Vigorous monitoring is needed because “you can’t prevent the spread of bacteria if you don’t know the source,” said Betsy McCaughey, former lieutenant governor of New York and chairman and founder of the New York City-based nonprofit Committee to Reduce Infection Deaths.
Testing and infection-control measures cost money, but supporters note that treatment for such infections costs far more. In Pennsylvania, hospital-acquired infections quadrupled patient treatment costs in 2005. But the University of Pittsburgh Medical Center reported that a $35,000 pilot infection-prevention program reduced its infection-related costs by more than $800,000.
Nine California hospitals recently used a new computer program to more quickly identify and treat at-risk patients, preventing an estimated 600 infections and saving $9 million in treatment costs, according to the Blue Shield of California Foundation, which sponsored the million-dollar pilot program.
Hospitals are facing increased financial pressure to monitor infection rates. Medicare, the federal medical insurance program for the elderly, announced last year that it plans to stop reimbursing hospitals for the cost of treating eight types of hospital-acquired infections.
The CDC has created an online system that has allowed about 300 hospitals to voluntarily report infection rates privately.
Several states, including Missouri, South Carolina, Vermont and Pennsylvania, used the system as a framework for their new mandatory public tracking of infections.