State slow to implement anti-infection measures

California legislators passed some of the nation's toughest anti-infection laws in 2006 and 2008 to assure that patients are protected from dangerous bacteria in the hospitals that are supposed to heal them.

That campaign has faltered, due to thin resources and missteps at the state Department of Public Health, which is charged with protecting the health of state residents.

Critics say a key reason is that hospitals have too much control over the agency's program to combat hospital-acquired infections. Department officials counter that they are committed to making the complex laws work, but have been plagued with budget cuts and funding delays.

The laws granted the department authority to regulate hospitals' anti-infection programs and mobilize state resources to fight Clostridium difficile and other bacteria that can sicken and even kill hospital patients.

Today, the far-reaching anti-infection campaign envisioned by the laws' sponsors has yet to materialize:

• The department only recently began crafting regulations to enforce the 2006 and 2008 laws, frustrating consumer groups and hospitals alike. Completed regulations are not expected for at least another 18 to 24 months.

• The 2006 law mandated that hospitals produce anti-infection programs and reports. The department did not design a survey to determine whether they were until 2010.

• A 2008 law required the department to collect infection data from hospitals and make them public. It mandates data on individual hospitals' surgical site rates be made public by Jan. 1, 2012. Its first report released five months ago was so flawed the department's director warned that consumers should not use it to compare hospitals.

• Now department officials are considering dumping more than two years of data about surgery-related infections at hundreds of hospitals without making that information public.

Last month, state Sen. Elaine Alquist, D-Santa Clara and author of the 2008 law, met privately with top department leaders to criticize their decision to curb future surgical infection reporting. That decision was reversed.

In response, the California Hospital Association asked a Superior Court judge to block temporarily the surgical reporting, arguing that the Department of Public Health still hasn't written regulations to guide hospitals. The judge instead set a June 22 court date.

The industry group supports public reporting, but the surgical infection data are massive, and the department still hasn't held required hearings, said Jan Emerson-Shea, the group's spokeswoman.

Officials overseeing the state's fight against hospital infections said they have been hobbled by budget cuts, staff furloughs, funding delays and red tape.

"We had no resources," said Jon Rosenberg, chief of the state's hospital infection program.

Critics fault the department for not using its “bully pulpit” to speak out more forcefully about the problem.

"There's certainly no sense of urgency, that is for sure," said Lisa McGiffert, who directs the patient safety program for Consumers Union, publisher of Consumer Reports. "If this were TB, avian flu, there would have been a huge call-out."

Dr. Howard Backer, the department's interim director, said in a written statement that the agency shares the public's concerns about hospital infections.

"The Department's Healthcare Associated Infections program has made significant progress in implementing California’s broad public reporting requirements, which are the most stringent in the nation," Backer states.

Dr. Ronald W. Chapman, a former Solano County health officer, will become the new permanent director in mid-June, the Brown administration announced last week.

Department officials said they are pushing ahead to make the new laws work.

Grappling with a backlog of proposed regulations, the agency is speeding up its writing of hospital rules such as those needed to fight infections, officials said. And despite the late start, they said, inspectors have now surveyed infection programs at 91 of 383 hospitals, finding 83 deficiencies at 30 facilities.

Asked to rate the department's performance, Loriann De Martini, its chief pharmaceutical consultant and acting quality control chief, said her staff is committed to preventing hospital infections.

She added, though, that the department is not on the front lines, and that the real prevention "is in the hands of clinicians providing care in those hospitals."

The nation has seen a groundswell in patient safety initiatives in the past decade, triggered by a 1999 U.S. Institute of Medicine report, "To Err is Human," that found medical errors were killing nearly 100,000 people a year. About 12,000 Californians die of hospital infections annually.

State agencies nationwide began requiring hospitals to report infections and other problems publicly. California legislators passed one of the first such laws in 2004. Then-Gov. Arnold Schwarzenegger vetoed it.

Schwarzenegger signed a law mandating infection reports in 2008, making California the last large state to require that such data be made public. It still doesn't count infections in nursing homes or surgical centers.

Consumer advocates criticize what they contend is the influence of hospitals in setting the anti-infection agenda.

They point to the 24-member panel that advises the state's hospital inspection program. It includes 15 hospital employees, including three from Sharp Healthcare in San Diego County, and only three members representing patients and consumers.

Many of the hospital members are infection specialists. Some have significant institutional memory and helped prepare the language for the 2006 law, Rosenberg said.

The panel has voted several times to delay or limit public reporting.

The department is now considering possible changes to the panel, creating bylaws and changing its makeup, said special consultant Loriann De Martini. The panel plans to discuss the issue June 9 in Sacramento.

"We recognize that this is an area that we need to work on," De Martini said.

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