It is the ultimate paradox of American health care: going to the hospital can kill you. Every year nearly two million hospital-acquired infections claim roughly 100,000 lives and add $45 billion in costs; that is as many lives and dollars as taken by AIDS, breast cancer and auto accidents combined. And with antibiotic resistance rising steadily, those numbers promise to climb even higher.
Even more staggering than the numbers is that most of these infections are preventable. The Institute of Medicine has long since determined that if hospital staff would make some minor adjustments to their routines—like washing their hands more—the problem could be significantly minimized.
Washington is now starting to crack down. On January 1 the Centers for Medicare & Medicaid Services (CMS) began requiring that all acute care facilities report the number of intensive care unit patients who develop bloodstream infections. Eventually the information will be made public, requirements will expand to include all types of hospital-acquired infections, and the level of Medicare reimbursement will be tied to how effective hospitals are at reducing infection rates.
Some medical centers have already taken the initiative and started making changes. A handful “have virtually eliminated some forms of infection that other hospitals still think are inevitable,” said Donald M. Berwick, who heads the CMS, in congressional testimony last year.
One of them is Claxton-Hepburn Medical Center, a rural hospital with a 10-bed intensive care unit in Ogdensburg, N.Y. It has nearly wiped out ventilator-associated pneumonia (VAP)—a hospital-acquired infection that occurs in 25 percent of all people who require mechanical ventilation—just by making a handful of changes to its protocol. Instead of laying patients flat, nurses keep them elevated at a 30-degree angle, which studies show is better for the lungs and does not, as previously thought, increase the risk of bedsores. Rather than leaving patients sedated, doctors now wean them from sedatives once a day to test their progress—another trick proved to reduce the length of stay. Nurses also take care to brush patients’ teeth every day and to clean their mouths and gums every few hours because oral infections often spread to the lungs. In the five years that followed the adoption of these practices, not a single case of VAP emerged.
Claxton-Hepburn is not the only hospital with success stories to share. In fact, dozens of New York–based hospitals—including ones much larger than Claxton-Hepburn—managed to cut their VAP rates in half by employing similar methods. And in Michigan 103 intensive care units eliminated catheter-related bloodstream infections during an 18-month study; hospital workers credited evidence-based practices and simple checklists. With solutions that cost less than the penalties, more hospitals are sure to follow Claxton-Hepburn’s lead.
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