Executive Summary

According to the Centers for Disease Control and Prevention (CDC), hospital-associated infections are one of the top ten causes of death in this country. CDC researchers estimated that in 2002 there were approximately 1.7 million hospital-associated infections that resulted in approximately 99,000 deaths, caused substantial morbidity and suffering, and cost our nation billions of dollars. Most of the costs of these infections are borne by private insurers, Medicare and Medicaid, and patients and their families.

There are simple proven steps that can be taken to reduce one of the primary causes of hospital-associated infections, "central-line-associated bloodstream infections" (CLABSIs). These infections can result when large catheters inserted into veins in hospitalized patients become infected. Recent studies by Johns Hopkins University and the Michigan Hospital Association show that CLABSIs are almost entirely preventable if state hospital associations implement programs to promote preventative measures.

At the request of Chairman Henry Waxman, the Committee majority staff surveyed state hospital associations to assess the incidence of CLABSIs and efforts by state hospital associations to reduce the rate of CLABSIs. This report summarizes the results of the survey. It finds that despite strong evidence of effectiveness, only 14 state hospital associations reported adopting or planning to adopt the program to reduce CLABSIs used by the Michigan Hospital Association and Johns Hopkins University (the MHA/JHU program). These states are California, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, and West Virginia.

The report also finds:

• Only eight state hospital associations gather comprehensive data on CLABSI rates. Surveillance is a key first step to any public health intervention and a major component of the proven intervention in Michigan. Without knowledge of the statewide rates, it is difficult for a hospital association to know the extent of a CLABSI problem or to identify institutions that need to take additional preventative measures. The eight state hospital associations which were able to provide the median and average rates for CLABSIs in the CDC standardized format are Michigan, Missouri, Nebraska, New Hampshire, South Carolina, Tennessee, Vermont, and Virginia. Iowa, Maine, and Rhode Island provided average rates but not the median. Another 12 state hospital associations report that they have begun collection of these data.

• Every state hospital association is engaged in other activities to address hospital-associated infections. Every state hospital association reported that it was engaged in some activities to reduce hospital-associated infections, such as efforts to reduce ventilator-associated pneumonias and surgical site skin infections.

• If all state hospital associations were to implement the MHA/JHU program and achieve the same results, more than 15,000 lives and over $1 billion dollars could be saved annually. Thirty-four state hospital associations did not report steps to implement the proven MHA/JHU program for reducing CLABSIs. If the remaining state hospital associations were to adopt the MHA/JHU program, as many as 15,680 additional lives and as much as $1.3 billion could be saved each year.