Molly Rowe, Senior Editor, Leadership , November 16, 2007

So much has been written about the 100,000 people who die each year from hospital-acquired infections that by now we're almost numb to the statistic. Believe me, I know. This summer, it took three doctors, three months, and a lot of insistence on my part to determine that my recurring and painful "spider bites" were actually MRSA.

My providers prescribed an oral antibiotic and sent me off to have unrelated, pre-scheduled knee surgery in a large Boston hospital, telling me it wasn't necessary to re-test whether or not the antibiotic had been effective. I learned first-hand that while the public rushes to learn about the latest health scare and the media throws out lines like "it kills more people than AIDS," hospitals themselves are inclined to ignore the hype.

Not that senior leaders don't care about dying patients, because they do, but like a lot of clinical issues, CEOs have left the problem of "superbugs" and hospital-acquired infections to their infection control and patient safety departments. What most hospitals have missed until recently, is that HAIs go well beyond patient safety; they cost hospitals money-and lots of it. Reports have estimated that HAIs extend hospital stays by an average of 16 days and increase costs by close to $150,000 per patient.

A Massachusetts state report released this summer estimated that infections contracted during hospital stays cause up to $473 million in medical costs each year in that state alone. Several states have made the reporting of HAI rates mandatory, and other states are expected to adopt similar rules. As stricter regulations are enforced, analysts predict there will be more pressure on hospitals to screen all high-risk patients-even if they don't exhibit symptoms.

Earlier this month, Loyola University Medical Center announced it would screen patients for MRSA (Illinois already requires hospitals to screen all ICU patients). Some hospitals balk at this idea, saying they don't have the resources to comply. But senior leaders at health systems who have done it say hospitalwide surveillance actually saves resources (not to mention lives).

Take HCA, Inc., for example. HCA's adopted a system-wide surveillance system for MRSA. HCA clinicians screen every patient who's at risk for one of these infections (most facilities screen patients only after they show symptoms-often too late for preventing the passing of the infection to someone else). While this practice is unusual and even controversial (it costs time and money), Dr. Jon Perlin, HCA's Chief Medical Officer and Senior Vice President of Quality, says it's worth it.

This policy is about more than patient safety; Perlin calls it a "rational business decision." So important to business, in fact, that HCA's senior leaders actively participate by conducting weekly scripted walkarounds to ensure that the process is happening. If it's not, policy offenders are "ticketed" with a formal letter reinforcing the policy. Senior leadership's involvement is key to the success of HCA's program, Perlin says.

HCA aside, hospitals are a long way from solving the problem of HAIs. Eradication is going to take a lot more than hand hygiene posters and disinfectant; it's going to take involvement by senior leaders. If you haven't made HAIs top item on your priority list yet, you should--before your state forces you to.

Molly Rowe is leadership editor with HealthLeaders magazine. She can be reached at

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