Hospital cooperation key to reducing rates of infection, study finds

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When it comes to patient infections, no hospital is an island.

Doctors, hospital employees and the public often frequent different hospitals and health care facilities, while patients routinely get transferred, precipitating the spread of such dangerous infections as MRSA to a variety of places.

About 1.7 million health care-acquired infections occur annually in the United States, resulting in nearly 100,000 deaths, the U.S. Centers for Disease Control and Prevention reported in 2002 with recent confirmation of the numbers. One of every 20 hospitalized patients will contract an infection.

But based on a new study, researchers from the University of Pittsburgh, Harvard University and University of California, Irvine, are urging hospitals to cooperate in an effort to reduce hospital infections by sharing infection-rate data and adopting the practice of isolating patients carrying MRSA bacteria.

"Unless they are associated financially or legally, hospitals often have their own separate infection control programs and procedures," said Bruce Y. Lee, a Pitt associate professor of medicine and biomedical informatics. He said hospitals aren't isolated but instead share patients extensively with other hospitals in their area, facilitating the spread of MRSA infections.

The team's study was published Tuesday in the journal Health Affairs.

The team including medical professionals, computer scientists, modelers and economists used the Pittsburgh Supercomputing Center to develop simulations to help understand how infections spread from hospital to hospital then to test strategies to reduce infection rates of methicillin-resistant Staphylococcus aureus or MRSA, a bacterial infection that's resistant to most antibiotics.

The simulation demonstrated that a hospital's decision to test patients for MRSA upon admission then isolate those who test positive -- a process known as "contact isolation" -- can help to reduce the prevalence of MRSA not only at that location but in other hospitals.

"Getting hospital workers and physicians to comply with procedures is not always an easy task," said Dr. Lee, who is also director of Pitt's Public Health Computational and Operations Research group. "They may not want to put on gowns and gloves. But when you do it and in a concerted manner, it can be successful."

The team built a virtual county, reflecting population data and characteristics of those who use the hospitals in Orange County, Calif., including the flow of people in and out of the hospitals. Each simulated person included characteristics typical of that region's demographics. MRSA infection rates mirroring those of Orange County hospitals were built into the computer model.

The simulation then tested various scenarios, combinations of hospitals and rates of isolation of patients who tested positive for MRSA. The more that hospitals work together and coordinate infection control efforts, "the more they all benefit," Dr. Lee said in a release. "For example, doubling the number of hospitals that adopt contact isolation can more than double their improvement in infection control."

When the simulation included all the hospitals in Orange County that isolated infected patients simultaneously with a 75 percent compliance rate, MRSA prevalence decreased an additional 3.85 percent over what the hospitals could have achieved on their own. Long-term acute care facilities fared even better, with a 12.13 percent additional decrease. That might not sound like high success rates, but the research said a ripple effect can lead to steadily declining infection rates.

But getting hospitals to cooperate poses a challenge. Dr. Lee said publicizing the study may encourage hospital administrators at otherwise competitive facilities to see the advantages and join together to control the spread of dangerous infections.

The research team continues refining its Regional Healthcare Ecosystem Analyst computer program for use in analyzing what benefits are possible for hospitals in different cities and regions.

"Dr. Lee's research is ground-breaking in its ability to directly help patient care," said Steven D. Shapiro, UPMC's senior vice president and chief medical and scientific officer. "More importantly, this type of research gives us a glimpse into the future in the sense that as we obtain more and more patient information electronically, we have the opportunity to turn this information into intelligence, applying advanced analytical tools.

"This could fundamentally change health care, resulting in better care at lower cost, which is a national priority," he said.

health

David Templeton: dtempleton@@post-gazette.com or 412-263-1578.


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