- 20 states have laws requiring public reporting of infection rates.
- 3 states have laws requiring public reporting of infection information, but not specifically rates (CA, OK, RI).
- 2 states have laws requiring confidential reporting of infection rates (NE, NV).
- 1 state has a voluntary law requiring public reporting of infection information (AR).
- All other states except WY, AZ, MT, ND have considered hospital infection reporting laws, but have not yet passed legislation.
Colorado (2006) Article 3, Part 6
The Colorado Hospital-Acquired Infection Disclosure statute requires hospitals, ambulatory surgical centers and dialysis centers to report incidents of hospital-acquired infections to the CDC to be analyzed and risk adjusted. The Colorado Department of Public Health and Environment will use that information to issue facility-specific infection rates to the public. An advisory committee, including consumer representatives, will assist the department. Requires the person collecting the infection data for facilities with more than 50 beds to be certified in infection control. Requires physicians who diagnose a hospital-acquired infection upon follow-up with patients to report those infections to the facility in which the reportable procedure was done. These reports are to be included in the facility report to the Department. The first report will include infection rates for cardiac and orthopedic surgical site infections and central line-related blood stream infections. The advisory committee can recommend additional measures later. The first annual comparative report will be issued in January 2008.
Connecticut (2006)
The Connecticut Act Concerning Hospital Acquired Infections requires hospitals to report infections to the Connecticut Department of Health. A committee, which includes consumer representatives, will advise the department on specifics regarding the types of outcome and process measures to be collected, as well as how these are to be collected and reported. The department will then make hospital-specific infection information available to the public. The first report is to be issued by October 2008.
Florida (2004)
Law passed in 2004. Implementation by the Agency for Health Care Administration; committee of stakeholders organized to develop implementation plan. The Florida law is generally a directive to collect and report on hospital-acquired infections. They have chosen a phased in process, which enabled them to almost meet their legislative deadlines.
First hospital-specific report in the US issued in November 2005 using the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicators (PSI) scale. [produced along with a comprehensive report of other quality indicators, such as mortality rates connected to specific procedures] They found significant variations among hospitals. The report compares hospitals by grouping in categories the rate of infection was as expected, lower than expected, or higher than expected. They also included a rate, which they claim cannot be used to compare hospitals, but reflects each hospital's unique population. Their plan is to report the CMS SIP process measures next (actually have the current year's information on their site now; but many hospitals did not report), then hospital infection rates using the CDC NHSN collection and analysis process.
The Patient Safety Indicators include several infection-related measures: Infections due to medical care (serious infections usually from the use of an IV or catheter) and postoperative sepsis (serious blood stream infection following surgery). Also includes decubitus ulcers (bed sores), iatrogenic pneumothorax (collapsed lung due to medical care or surgery), postoperative hip fracture (in adults who entered the hospital for something other than a hip fracture), and post operative pulmonary embolism or deep vein thrombosis (serious blood clots in deep veins/arteries; the most common cause of death for patients who spend a long time in the hospital).
This tool culls out likely hospital-acquired infections using administrative data. This is controversial because, according to most hospitals, these billing forms are an inaccurate reflection of the patient's condition and care received. Typically these documents are coded by clerks, not health care professionals, who take the information from the medical records.
The advantage of using administrative information is that it is in electronic form, supplies a record for almost every patient, and typically contains information that can be used to risk adjust and assess the patient?s condition and treatment in the hospital.
To access hospital information, go to reports about Florida hospitals, and follow the instructions to get information about "Hospitals" and "Complication/infection rates."
Illinois (2003)
The Illinois reporting law initially passed in 2003, but there were several changes that were made by the 2005 legislature that pared down the reporting. The new law requires two or more infection measures to be reported as determined by the state Department of Public Health to include process or outcome measures relating to surgical site infections and ventilator-associated pneumonia, and central vascular bloodstream infection rates in designated critical care units. The measures are to be based on those developed by national quality organizations and agencies. Reporting is to occur quarterly, with the annual report due on December 31 of each year; presumably the first report will be available in early 2007. These reports will include selected hospital-acquired infection rates (surgical site infections, ventilator-associated pneumonia, central line blood stream infections), using the CDC National Healthcare Safety Network methods. The bill also required reporting of nurse staffing ratios.
Maryland (2006)
Requires the Maryland Health Care Commission to include hospital-acquired infection information in the existing reporting system on hospital quality. The information is to be presented in a manner that will allow comparisons among hospitals. Both versions of the hospital infection reporting bills passed; the Senate version went into law without the Governor's signature and the House bill was vetoed by the Governor as duplicative.
Minnesota (2007) (Scroll to line 400.8: Hospital Information Reporting Disclosure.)
Missouri (2004)
Missouri's law passed in 2004. It requires hospitals to report risk adjusted rates for surgical site infections, ventilator-associated pneumonia and central line-related bloodstream infections; it allows other categories of infections to be added by rule later. The initial report will be on bloodstream infections, then six months later, surgical infections for total hip replacements, CABG and abdominal hysterectomies. The first report will be issued at the end of 2006.
Missouri Report: Central line blood stream infections in intensive care units.
New Jersey (2007)
Chapter No. 196. The Commissioner of Health and Senior Services, in consultation with the Quality Improvement Advisory Committee shall stablish standard methods for identifying and reporting health care facility-associated infections; identify the major site categories for which infections shall be reported, taking into account the categories most likely to improve the delivery and outcome of health care in the State; and specify the methodology for presenting the data to the public, including procedures to adjust for differences in case mix and severity of infections among hospitals.
New York (2005)
Law passed in 2005. This bill was significant in that the hospital associations worked with consumer organizations and supported the public reporting required in this bill. The bill allows for a long implementation period (2 years) and is unique in that it requires the first year?s data collection to be considered a "pilot" with no hospital-specific information revealed. However, the data can be released without identifying the hospitals, e.g., aggregate statewide data or hospital level information without the hospital name, which would enable the state to look at the variations among hospitals or in various regions of the state.
The initial report will include surgical site infections, central line related blood stream infections, and ventilator associated pneumonia in critical care units. Allows for the health department to require additional reporting after consulting with technical experts.
This "pilot" idea is basically what happened in PA. They couldn't get good enough data to release it with confidence, so they released the aggregate number of infections and analyzed the information further. The National Conference of Insurance Legislators (NCOIL) just adopted this as their model act.
New Hampshire (2006)
Requires hospitals to report their infection rates as well as measures they use to prevent infections. The first report's outcome measures will include the rate of central line related blood stream infections; ventilator associated pneumonia and surgical site infections; the rate at which the hospital uses certain processes to prevent these types of infections will also be included. The reports will be issued by the Department of Health and Human Services, which will consult technical experts. The department has the authority to add to these reports in the future. The law's effective date is July 2007; annual reports will be issued June 1 of each year. The first report should be out in June 2008, however, in June 2007 the NH Ways and Means Committee only budgeted $1 for reporting, so public reporting will be delayed at least until 2009 as they do budget votes every two years. The bill sponsors' requested $138,000 dollars to fund the program.
Ohio (2006)
Creates a hospital measures advisory council that will recommend how the state will collect and report hospital quality measures, including hospital-acquired infection measures. The law specifically calls for the council to consult with consumers, nurses, and infection control professionals on infection reporting. The law requires various price and performance data to be collected from hospitals beginning in 2007 and reported to the public on a website within 90 days of receiving the information from the hospitals. The director of health must adopt rules that will include ?measures that examine infections? as well as other measures of quality of care.
Pennsylvania (2004) Section 6(f)(3)(vi) and Section 7(a)(1)(i)
Under a general law on hospital quality, the Pennsylvania Health Care Cost Containment Council (PHC4) was given the authority to collect and report hospital-acquired infection rates. PHC4 now has published three reports, based on 2004 data and the first nine months of 2005. This was the first attempt to collect hospital-acquired infection for publication in the US. The PHC4 issued two reports in 2005; the latest one found that 76% of PA hospital infections were paid for my Medicare and Medicaid. The agency is using the administrative billing information as a counter check to the infections being reporting by the hospitals and found serous underreporting. It identified 16 hospitals that failed to provide accurate information in the first year and reporting has improved in the second year (for 2005 data).
The following links will take you to the reports:
Public Report: Hospital-specific patient infection rates, mortality and cost in Pennsylvania (11/06)
Hospital-acquired infections, March 2006
Reducing Hospital-acquired Infections, The Business Case
Hospital-acquired infections, July 2005
MRSA in Pennsylvania Hospitals ? August 2006
South Carolina (2006) Article 20
Requires hospitals in the state to report the rate at which their patients develop surgical site infections, ventilator assisted pneumonia, and central line bloodstream infections to the Department of Health and Environmental Control by February 2008. A committee, which includes consumer representation, will advise the Department on the methodology for collecting, analyzing and disclosing the information. The department has the authority to add measures in the future. The first annual report will be issued by February 2009.
Tennessee (2006)
The Department of Health will publish on their website infeciton rates for central line associated blood stream infections in intensive care units. The reports will be updated every six months with the most recent four quarters of data. The department will report only aggregate statewide CABG surgical infection rates. Data will be reported through the CDC National Healthcare Safety Network (NHSN). A task force will advise the department on infection reporting system and as national consesus standards are developed it may recommend additional reporting measures.
Virginia (2005)
Law passed in 2005. The bill is a simple mandate for acute care hospitals to report nosocomial infection rates through the CDC National Health Safety Network. No advisory committees, no specifics on what will be collected or how the board of health will specify details. Information is to be available to the public upon request which is not advised, web based reports are the best way to go. The bill is not effective until July, 2008.
Vermont (2006)
In late 2005 a state committee recommended that the state report certain hospital-acquired infection information and the state's health agency (Health Care Administration) went right to work on those recommendations after getting approval from key stakeholders and legislators in early 2006. Meanwhile a bill was filed to put the mandatory reporting into law; the language from that bill was eventually added to an omnibus health care bill (SB310) which passed. A work group, including consumer representatives, will advise the agency. The first report, to be issued in the Summer of 2006, will include the rates at which hospitals use procedures that prevent surgical site infections. Hospitals are also required to complete the LeapFrog survey on hand washing and numerous other patient safety and quality-of-care measures will be included about each VT hospital. Subsequent reports are expected to include infection rates.
Washington (2007)
Requires hospitals in the state to disclose the rate at which patients acquire certain infections during treatment. Washington hospitals must begin to collect data on certain health care associated infections and report it to the state. The law will be phased in so that hospitals first will be required to collect data on central-line associated bloodstream infections in intensive care units (beginning July 1, 2008), then ventilator-associated pneumonia
(beginning January 1, 2009), and then surgical site infections for certain procedures (beginning January 1,
2010). By December 1, 2009, and every December 1 in future years, the Department of Health will publish a
report on its web site that compares the health care associated infection rates at individual hospitals in the
state using the date reported in the previous calendar year.
STATES WITH LAWS REQUIRIING PUBLIC REPORTING OF INFECTION INFORMATION, BUT NOT SPECIFICALLY RATES
California (2006)
This law requires hospitals to have policies in place to prevent infections, which will be checked by the Department of Health Services once every three years after 2009. The public will not know whether the hospitals are actually following their procedures. It requires public reporting based on the CDC?s "Guidance to Public Reporting," but only includes process measures, relating to the rate at which prevention practices are used. The reporting requirements do not include the Guidance "outcome" measures, such as hospital infection rates, which would reveal whether hospital policies are actually reducing infections. The limited public reporting in this bill is to be done at some unspecified time (on or after Jan. 1, 2008) which is a year after we expect the same process measures to be available on the federal "Hospital Compare" website.
Oklahoma (2006)
Establishes advisory council with authority to recommend and approve reporting of ventilator-associated pneumonia and device-related blood stream infections in acute care intensive care units.
Rhode Island (2006) Chapter 23-17.17-6
Does not specifically mandate public reporting but requires an existing hospital quality steering committee to consider adding measures associated with hospital-acquired infections, in consultation with experts, to the state's hospital quality of care reports. These reports are issued in January of each year.
STATES WITH STUDIES ABOUT HOSPITAL-ACQUIRED INFECTION REPORTING
Alaska (2006)
The Alaska Legislature adopted a resolution to create a task force to develop recommendations for hospitals to disclose their infection rates, to be presented in the form of legislation in 2007.
Georgia (2006)
The Georgia Senate created the Health Care Standards Commission for Prevention of Hospital Acquired Infections. Members include legislators, representatives of the hospital and medical community, and one researcher, but no public members. The commission will study safety standards, best practices, infection rates and causes.
New Mexico (2007)
Establishes a task force to conduct a review of health care acquired infection studies in the U.S. Report on the feasibility of infection surveillance in NM no later than November 1, 2007.
Texas (2005)
The Texas Legislature created a committee to develop recommendations for reporting hospital-acquired infection information to the public. The committee will issue a report in the Fall of 2006 for action during the state?s 2007 legislative session.
CONFIDENTIAL HOSPITAL INFECTION REPORTING TO STATE AGENCIES
Nebraska & Nevada
In 2005, these states passed laws mandating collection of hospital infection information but not to share with the public.
The Nebraska law requires health care providers to track and report hospital infections as an aggregate number to the health department.
Nevada requires certain medical facilities to report hospital-acquired infections as sentinel events to the Health Division of the Department of Human Resources.
Prepared by
Lisa McGiffert
www.StopHospitalInfections.org
Consumers Union
506 West 14th, Ste. A
Austin, Texas 78701
512-477-4431 ext 115
512-477-8934 (fax)
lmcgiffert@consumer.org