Six years after the New York Department of Health started publishing hospital-acquired infection data as part of a public transparency agenda, the rates of most infections are trending downward, and benefiting health and financial outcomes.
With data on hospital-acquired infections (HAIs) published on individual facilities, the sixth annual report shows a 53 percent decrease in central-line bloodstream infections since 2007, when the program began, a 14 percent decline in infections associated with colon surgery, and 23 percent decline in infections associated with cardiac bypass surgery.
New York's experience lends some evidence to a correlation Canadian researchers, writing in PLOS Medicine, found in Ontario: a "significant reduction" in hospital Clostridium difficile infection rates after the introduction of mandatory public reporting.
Whether or not there's a "sunshine effect" incentivizing New York hospitals to be more proactive now that the media, lawmakers and patients can scrutinize their records, New York Health Commissioner Nirav Shah, MD, said the data should be available, for one thing, and that it's showing positive trends.
"Patients deserve the peace-of-mind of knowing the hospital they receive treatment from utilizes best practices to protect their safety," Shah, who's been leading statewide reform efforts across a number of public healthcare programs, said in a prepared statement.
In 2012, New York's statewide average rates were 5.1 infections per 100 procedures for colon surgery; 2.2 per 100 procedures for abdominal hysterectomy surgery; 2.1 per 100 procedures for coronary bypass surgery; and 1.1 per 100 procedures for hip replacement or revisions. For central bloodline infections, the statewide average was 1.2 per 1,000 line days.
Those central bloodline infection rates are 28 percent higher than the national average, the report noted. Although for most of the other reported infections, national data is too old or incomplete to make meaningful comparisons.
New York's data shows some procedures with infection rates that have not fallen and gives a first baseline for others: hip replacement infection rates have largely remained constant since 2007, and 2012 was the first year in which abdominal hysterectomy infection rates were reported.
And the data shows some of the ambiguity in how modern hospitals actually detect and track the microbial underworld.
In some cases, such as infections from the potentially deadly, increasingly antibiotic resistant Clostridium difficile bacteria, detected increases may be related to more advanced testing.
Since 2010, among 89 hospitals that adopted more sensitive lab technology, C. difficile infections rose by 14 percent. Meanwhile, among the other 88 hospitals using the previous generation of C. difficile testing technology, infection rates fell by 15 percent, according to the report.
In total, New York's 175 hospitals reporting data under the 2005 law (excluding Veterans Affairs, critical access, psychiatric, long term and acute care hospitals) saw 12,523 infections acquired by patients in their facilities, 9,945 of them being C. difficile -- one of most problematic bacterial infections to plague providers and their patients in recent years, with associated hospitalization stays tripling over the past decade and some 14,000 Americans dying from the infections annually, according to the Centers for Disease Control.
In 2012, hospital-onset C. difficile affected New York hospital patients at a rate of 8.3 infections per 10,000 patient-days. While there is not reliable C. difficile infection data nationally, New York's 2012 rate is slightly higher than the pooled rate of 7.4 per 10,000 patient-days and median rate of 5.4 per 10,000 patient-days that the CDC found in a sample of 711 acute care hospitals in 28 states in 2010.
Although emerging therapies using beneficial microbiota transplants or recolonization show promise for treating C. difficile, the recent increases in its prevalence in hospitals -- at "historic highs," according to the CDC -- has made it something of a national priority. HHS had set a target of reducing C. difficile infections nationally by 30 percent by 2013, and at the moment, it's not clear if that will happen. Targeted reductions of 30 percent for C. difficile hospitalizations by 2013 are not set to be met.
Those challenges aside, New York, one of 31 states plus Washington, D.C. requiring hospitals to report facility-acquired infections to the CDC's national database, has seen measurable benefits in both financial and human health since 2007.
The 53 percent reduction in adult, pediatric and neonatal central bloodline infections since 2007 have saved somewhere between $18 million and $72 million in avoided treatment and hospital stays, the New York Department of Health estimates.
Declining surgical site infections, decreasing by an average of 16 percent across several procedures since 2007, has saved between $12 million and $35 million in shorter hospital stays and avoided complications, the state notes.