Half of the more than 2 million healthcare-acquired infections (HAIs) that kill nearly 100,000 annually are preventable, government statistics show, yet no single federal agency tracks HAIs. Only Illinois and Pennsylvania require reporting of HAIs (see "Do You Have to Report?").

In 2003, Illinois passed a law requiring that healthcare facilities make their record on HAIs public, making it the first state to do so. Healthcare facilities now report three categories of infections: surgical site infections, ventilator-associated pneumonia and central-line-related bloodstream infections. According to the Illinois Department of Public Health Web site, "all ambulatory surgical treatment centers licensed to operate" must "adopt a uniform system for submitting information for both inpatient and outpatient conditions and procedures." The information should include up-to-date comparisons relating to volume of cases, average charges, risk-adjusted mortality rates and nosocomial infection rates.

In Pennsylvania, the agency charged with collecting infection data voted to scale back a plan approved in November because the state's 200-member hospital group argued the original plan would be a financial hardship. Instead of tracking 14 types of infections, the state Health Care Cost Containment Council will monitor four.

Erratic reporting
Legislation in Florida and Missouri await implementation. The Florida bill would let patients obtain simplified information about hospital infection rates, among other things. The Missouri bill will prompt collection of new information and a report to the public from hospitals.

According to Consumers Union (www.stophospitalinfections.org), the California Senate Health Committee has approved a bill requiring infection-rate reporting and disclosure; it is now in the appropriations committee.

Many states track a few infectious diseases that medical experts say are commonly acquired in healthcare facilities, but their facilities aren't identified or required to report what caused the infections. It's difficult to treat the problem without this data. Other states and the federal government have resisted addressing the issue because HAIs are not uniformly identified by type and cause and are sometimes difficult to interpret. Two surgeons might look at the same wound and differ on whether it's infected. Hospitals that oppose making infection rates public contend that some hospitals treat older and sicker patients who are more likely to develop infections. These arguments, all valid, lead to the conundrum of how to deal with the problem.

Tracking infections in your facility
Without uniform reporting guidelines, it's up to you to closely monitor your own facility and document causal relationships leading to HAIs - then, of course, do something about it with the support of all layers of management. Your goal should be reducing the risk of acquisition and transmission of HAIs. Here's an outline for achieving that goal:

• Legitimize. Make infection control a major component of safety and performance-improvement programs; stress the seriousness.
• Classify. The Quality Interagency Coordinating Committee report, "Doing What Counts for Patient Safety," recommends you identify the occurrence of an infection; consider based on the case documentation whether an error was made after treatment; classify the error (based on the resultant infection) as either minor or serious; and identify the situations in which minor and serious errors occurred.
• Analyze. After you conduct this surveillance, collect and interpret the data.
• Educate. Disseminate the information you've uncovered to managers and staffers.
• Respond. With the help of management and staff, design a plan for preventing HAIs based on the data you've collected and relationships you've observed, and implement it.
• Assess. Identify HAI risks on an ongoing basis.