Preventing hospital infections: It's a matter of process

How many of us know someone who has contracted a hospital infection? If the statistics are anything to go by, they affect too many of us. But preventing infections doesn't require luck or magic. It involves following tried-and-true steps that have been proven over time. Some of these steps are simple, like hand washing, but others are a little more complicated. But how well a hospital follows the steps to prevent infections can tell you a lot about how seriously the hospital takes patient safety. Lisa McGiffert, campaign manager for our advocacy-based site StopHospitalInfections.org, has been fighting for years to eradicate hospital infections.  We caught up with her to help give some insights into some important new infection-prevention data we've just added to our Hospital Ratings.

Lisa, why is information like this so important?

It's really important that consumers have information like this because more than 290,000 surgical infections occur in US hospitals each year—2 out of every 100 surgeries. And if you're unlucky enough to get a surgical infection, you're five times more likely to be admitted after discharge and twice as likely to die.

These numbers are stark, but another reason we really care about surgical infections is because they can be prevented. All surgery patients are at risk for infection because an incision creates a pathway for germs to enter the body. So in addition to maintaining a sterile environment, following these steps will help to make sure patients are not contaminated with bacteria.

Can you give us some background on the data?

The data used in our Hospital Ratings are from the Surgical Care Improvement Project (SCIP), a national initiative to prevent surgical infections by following a series of proven steps. If surgeons and attending physicians follow these steps routinely, the number of infections can be reduced because the measures create a protective barrier against infection. The three steps are: 1. Giving the patient an antibiotic at the correct time before surgery; 2. Giving the right drug for the patient's type of surgery, based on the established guidelines and; 3. Discontinuing antibiotics within 24 hours after surgery (in most cases).

Note that this last step is not immediate infection prevention but it's critical to reducing the overuse of antibiotics and antibiotic resistance, which is infection prevention over time.

What do these Ratings say about a hospital?

The important thing about these three steps is that they're done every time, which is why they're sometimes called "process measures". We know that prevention is all about process—if doctors get the steps right, they wash their hands every time and always have sterilized equipment, they will prevent surgical infections.

While these Ratings are not a proxy for overall infection rates, they do tell us that, if a hospital has a high level of compliance, it has an organized infection control department overseeing that the steps are being done routinely. And it could be a proxy for other prevention practices. A hospital that spends time making sure these SCIP practices are put into place is probably going to have a system in place to prevent other infections like bloodstream infections or ventilator-associated pneumonia, both of which happen a lot. A high Rating might also tell you that the hospital is taking evidence-based medicine seriously, which is in the patient's best interest.

How can consumers use these Ratings?

They indicate how well a hospital supports an environment of safety for patients. Really, the people rated are the surgeons but the hospital has to invest in creating the systems to make following infection prevention easy, make it work and support it. The Ratings also help people understand what should be happening before and during their surgery. It allows patients to have discussions with their doctors. If you're having a scheduled surgery and meet with your surgeon, you could ask if he or she is going to follow these three steps, and if not, ask why. It's a good reminder for your surgeon and tells him or her that you're aware of the steps they should be taking. These steps should be used on all patients,with some exceptions, like allergies, so don't be afraid to ask your surgeon.

To find out how well your hospital follows these steps to prevent infection, look up your hospital now using our hospital Ratings tool. And to see what our patient safety advocates, like Lisa McGiffert are doing to help make hospitals safer, visit StopHospitalInfections.org.