Jim Carroll stood at his bathroom sink with yellow fluid oozing down his leg. It was 10 days after his knee surgery at Annie Penn Hospital in Reidsville in late 2008.
He was supposed to be recovering. But instead, he suffered high fevers and, later, violent shaking spells multiple times a day. For months, the infection persisted against antibiotics.
"I was at a point where I was ready to give up," said Carroll, 51, of Reidsville. He battled the infection for months, under went additional surgeries, and is still not 100 percent.
Like Carroll, an estimated 1.7 million people in the United States acquire infections annually during or after treatment in a health care facility, according to the Centers for Disease Control and Prevention. About 99,000 people die each year from health care-acquired infections.
These infections add as much as $33 billion in excess health care costs each year, according to the U.S. Department of Health and Human Services. They have become America's leading cause of death from infectious disease.
As the national health care reform debate continues, hospitals have taken steps to reduce infection rates. One of those steps - infections reporting - allows hospitals to share best practices and view rates in perspective. In more than two dozen states, public reporting of infection data allows patients to choose hospitals, just as they might shop for any other service.
But that information is not readily available for all hospitals in North Carolina.
"North Carolina has been talking about public reporting for a long time, and there certainly has been activity, but mostly discussing and studying the issue," said Lisa McGiffert, campaign director for the Consumers Union Safe Patient Project, which advocates to end hospital infections and medical mistakes. "From my perspective, the people in North Carolina have been waiting since 2005 for something to be done at the state level to inform them about their hospitals' infection rates. And they're still waiting."
That activity was brought to the forefront when a legislative committee was established in 2007 to study hospital infections. As a result, a bill was introduced in the N.C. House in 2009. It would have appropriated $1.1 million for the next two fiscal years to develop and implement a mandatory statewide surveillance and reporting system. But the appropriations bill was lost in committee - pushed aside by the recession and other pressing needs, according to legislators and health officials.
"Sometimes we just don't have any more money," said Rep. Martha Alexander, D-Mecklenburg, who sponsored the bill. "It's not that it's a bad idea. We just can't do it all, and you finally have to make a decision."
Prospects for reporting
The federal government may push North Carolina toward mandatory reporting. The health care overhaul bills that passed the U.S. House and Senate both reference a reporting system that would include health care-associated infections. But the provisions may not remain a part of a final bill.
In the meantime, some North Carolina hospitals are participating in voluntary reporting systems, such as the N.C. System for Hospital Infections Measurement and the CDC's National Healthcare Safety Network.
The CDC's network is used by more than 2,000 hospitals nationwide and in 19 states that mandate its use. Many states opt for this option because it is free and uniform, and the information is easily accessible to the public.
The N.C. Hospital Association initiated a system last year to collect voluntary and confidential information on infections that result from major surgeries.
But out of 135 North Carolina member hospitals, a little more than half - 72 - have signed up. And like the CDC's National Healthcare Safety Network, the hospital association system was created to give feedback to participating hospitals, not the public.
Don Dalton, an N.C. Hospital Association spokesman, said public reporting is not mandated in North Carolina because the state isn't ready. The state recognizes that to put out inaccurate and insufficient data would potentially be as harmful to the public as it could be beneficial, he said.
"The first and most important issue is to improve patient care," Dalton said. "Secondarily, you want to provide the public with quality information on where to get that care. Until reports can reflect a quality of reporting and surveillance, then they would not be beneficial."
Dalton, as well as legislators and other health care officials, said he thinks North Carolina hospitals will be required to report hospital infection rates to the state government soon, possibly within the next two years.
"Our goal frankly is to get hospitals ready for mandatory reporting of health care-acquired infections," Dalton said.
Standards for reporting
Some officials are concerned that rates will not be accurate and standardized. As a result, the public will be given a distorted view of occurrences of hospital infections.
"Patients should know all they can know about the quality of care provided by the hospital they choose," said Kathryn Johnson, vice president of risk management, accreditation and regulatory affairs at UNC Health Care. "Everyone benefits from transparency, but meaningful comparative statistics are hard to get."
William A. Rutala, a professor of infectious disease at UNC-Chapel Hill and director of Hospital Epidemiology and Occupational Health at UNC Health Care, said three criteria must be met with mandatory public reporting:
First, Rutala said, all hospitals must use the same definitions for acquired infections so that reporting is consistent.
Additionally, all hospitals must seek infections with the same vigor and resources, so a hospital that deploys a large infection control team isn't penalized for its vigilance in detecting and reporting infections.
Finally, Rutala said, rates must be risk adjusted. Academic centers such as UNC Hospitals or Duke University Medical Center have patient populations that are sicker and more health-compromised, he said. The older the patient and the more compromised the patient's immune system is, the more likely the patient is to get an infection in the hospital.
"Public reporting is a big jump from where we are currently," Rutala said. "All that we have in our literature suggests that hospitals are not using the same definitions, and our efforts to identify them, although conscientiously performed, are not good."
Good relations
Rep. Lucy Allen, D-Franklin/Halifax/Nash, said publicizing infection rates raises public awareness and prompts hospitals to attack the problem. Hospitals can cut infection rates with good hand and mouth hygiene, room cleaning, bacteria isolation, skin antisepsis and protective wear.
"[Hospitals] will not neglect things like that," Allen said. "They want good public relations, and they want patients to come."
Some hospitals, including UNC Hospitals and Wake Med, survey infections already. UNC Hospitals reports its numbers to the state hospital association, Rutala said. Wake Med shares its numbers with the CDC, the state hospital association and VHA Inc., a national alliance of healthcare organizations.
How that information might be used by the public, however, remains unknown. Carroll didn't seriously consider the possibility that he might pick up an infection in the hospital.
"You sign the waiver form that says infection is a possibility, but I've had so many surgeries and I've never had a problem," he said. "I went into the knee replacement knowing I needed to have it, being told I needed to have it, and knowing it was the next step."
He said he probably would not have gone online to check infection rates before his knee surgery. Now, however, he'll talk more with his doctor about possible negative results.
"Doctors are wonderful healers, but the public has to be more conscious of the risks involved," he said.
