Hospitals offered business plan to deal with resistant infections

Each case can cost $10,000 to $30,000

The paper, ‘‘Raising standards while watching the bottom line: making a business case for infection control,” offers ways for hospitals to estimate the economic impact of hospital-acquired infections. Its goal is to provide hospitals with tools ‘‘to create an outcome study of infections and new control measures.”

It was commissioned by the Society for Healthcare Epidemiology of America and published in its journal, Infection Control and Hospital Epidemiology.

Humans are a natural reservoir for Staphylococcus aureus bacteria, with the bacteria living in the skin and nose far more often than causing actual infections. However, in the past two decades, a new strain, methicillin-resistant S. aureus, or MRSA, which withstands antibiotic treatment, has steadily increased in hospitals.

Hospitals, including Holy Cross, Montgomery General, Suburban and Adventist HealthCare facilities, and state agencies have worked to screen high-risk patients, including all headed to an intensive care unit. Washington Adventist Hospital in Takoma Park reports that one of its three ICUs has shown no ventilator-related cases of hospital-acquired pneumonia in the past year, for example.

But MRSA and other drug-resistant bugs are still becoming more prevalent in communities and in some hospitals.

MRSA was limited mainly to large urban medical centers at rates of 5 percent to 10 percent in the mid-1980s, according to the Centers for Disease Control and Prevention. By the 1990s, rates in smaller, community hospitals had increased to 20 percent and up to 40 percent in some large urban hospitals.

Part of the problem is that a relatively unfavorable return on investment is apparently deterring large pharmaceutical companies from developing treatments for infections, according to Dr. Richard P. Wenzel, chairman of internal medicine at Virginia Commonwealth University and president of the International Society for Infectious Diseases.

Perencevich traces the origin of the problem to three decades ago, when then-U.S. Surgeon General William H. Stewart told Congress that science had conquered infectious diseases.

More than 2 millioncases a year

The new task force states that each additional hospital-acquired infection, whether MRSA or any of a host of others, costs from $10,000 to $30,000. There are more than 2 million cases annually, with more than 100,000 hospital patient deaths, according to CDC. More Americans now die from MRSA than from AIDS-related diseases.

‘‘We wanted to help the hospitals learn how to interpret the literature” on control studies, Perencevich said.

Hospitals get no direct reimbursement for hospital-acquired infections from the Centers for Medicare and Medicaid Services, he said. Maryland, though, unlike other states, can negotiate with that federal agency on an individual case basis.

The agency ‘‘will pay thousands for a kidney transplant but not $5 for an infection,” he said.

The agency classifies hospital-acquired infections as unexpected events and will tighten its rules further in 2008 toward not reimbursing hospitals to treat the infections, as an incentive for prevention and to not reward poor care.

More gowns, masks, gloves

Susan Glover, vice president and chief quality and integrity officer at Adventist HealthCare in Rockville, welcomed the task force business plan.

‘‘We have looked at ways to reduce some of the waste that we have, that is lack of efficiencies that are then translated to waste,‘‘ Glover said.

Added costs to deal with infections include not only more tests, but more gowns, masks and gloves, she said. ‘‘But the real business case is it’s just the right thing to do.”

Donna Limmert, a registered nurse and infection control officer at the Baltimore Washington Medical Center in Glen Burnie, welcomes the attention now being paid to MRSA.

‘‘We have recognized that it is an increasing problem and it is a huge amount of work in infection control,” Limmert said. ‘‘Now with the outcry, the public helps to put the focus on the problem.”

The legislature has twice failed to pass bills requiring hospitals to conduct tighter monitoring and report of MRSA cases to the agency that regulates them. The nonprofit Maryland Hospital Association opposes such legislation and prefers to let hospitals self-regulate with the help of its support network.

Expected soon are recommendations from an independent advisory committee of physicians and infection control officials, appointed by the Maryland Health Care Commission.

Glover, who is also a board member of the Maryland Patient Safety Center, said the recommendations may not be necessary because ‘‘in a lot of ways, Maryland has been very proactive.”