By  Misti Crane

The Columbus Dispatch 
Wednesday September 4, 2013 

Infections picked up in hospitals carry an enormous toll.

They drag out hospital stays, put patients in intensive care and sometimes kill. And they come with a whopping price tag as well.

A study in this week's issue of Journal of American Medical Association Internal Medicine estimated the annual cost of five common and preventable health-care-associated infections at $9.8 billion.

To patient advocates and those involved in quality improvement, that isn't a shock. For years, hospitals have been under pressure to drive down infections, from buckling down on hand-washing rules to regulating procedures so the safest approach is used every time.

Efforts at national and local levels - including several efforts in Ohio - have aimed to improve patient care and decrease infections in the past several years and have reported success.

They're to be commended, but that's only the beginning, said Dr. Julia Hallisy, founder of the Empowered Patient Coalition and a California dentist who calls hospital infections an "epidemic."

Hospitals that have made strides in driving down infections to the point they're almost unheard of are still outliers, she said, and they need to become the norm. There also should be greater public reporting of infection rates, Hallisy said.

"Zero is possible in some of these infections. You know, is it possible at every hospital every day across the board? Maybe not, but it certainly is happening at certain institutions, and they're sustaining it," she said.

Dr. Jim O'Brien, vice president of quality and clinical services at OhioHealth Riverside Methodist Hospital, said he's seen how standardizing care and emphasizing hygiene can help.

Central-line infections - those that involve catheters inserted into large veins - at OhioHealth hospitals dropped from 28 in fiscal year 2011 to 12 the next year and to nine in the fiscal year that just ended.

That said, maintaining optimal care can present challenges, he said. Humans are by nature inconsistent and fallible.

"I think one of the tough things is that a lot of this is about great attention to small details, and the immediate consequences if you don't pay attention to those details aren't obvious," O'Brien said.

"It would be easier if every time you touched a patient without washing your hands they screamed out in pain, but they don't."

A hand-hygiene initiative is one of several efforts that hospitals here say have made a difference. "Secret shoppers" who checked up on staff members found observation of proper techniques go from 29 percent in August 2010 to 86 percent last November.

"The best thing to do is educate and come up with ways to inspire people," said Carol Elder, infection-control specialist for the Mount Carmel Health System.

Elder said Mount Carmel leaders continually look for ways to tackle bacteria and prevent infections. Recently, the system is using disposable antiseptic cloths to bathe intensive-care patients. The cloths eventually could be used more widely.

Dr. Susan Moffatt-Bruce, chief quality and patient-safety officer for Ohio State University's Wexner Medical Center, described work there to reduce infections as "relentless."

Infection rates have come down with changes in procedures and upgrades that include new catheters and antiseptic soap in intensive care.

"I think that we need to strive for perfection," Moffatt-Bruce said.

That said, there are limitations to what hospitals can control, said Ohio State infectious-disease expert Dr. Julie Mangino.

Smokers and the obese are at a higher risk for infection, for instance. And sometimes patients don't get optimal care after they leave the hospital, she said.

"We have to take responsibility for what we can influence, but there are some variables where we have no impact."