Reforms adopted in response to CU’s petition calling for tougher action to protect patients
SACRAMENTO, CA – The California Department of Public Health (CDPH) announced new policies today and confirmed other practices that aim to better protect patients from getting infections while being treated in the hospital. The policies were described by CDPH in a letter to Consumers Union, the policy and mobilization division of Consumer Reports, which filed a petition with the Department in January urging it to do more to hold hospitals reporting significantly higher infection rates accountable for improving care.
“Most infections are preventable but too many California hospitals are failing to do all they can to protect patients,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project. “For too long, the state has relied on voluntary efforts by hospitals to lower infection rates and that clearly hasn’t been working. We welcome today’s announcement as an important first step by the Department of Public Health to do more to hold hospitals accountable for improving care when they report high infection rates. Now it’s time for the state to use its enforcement power to require poor performing hospitals to take action and keep patients safe.”
In its administrative petition last month, Consumers Union noted that the CDPH fails to share with inspectors the infection data it collects from hospitals until long after it is reported, which prevents inspectors from taking timely action to protect patients. To make matters worse, many California hospitals with some of the worst infection rates have gone uninspected by the state over the past five years.
Consumers Union’s petition called on CDPH to share infection data with state inspectors in real time as it becomes available, to prioritize inspections of the worst performing hospitals if they haven’t been reviewed in the past three years, and to use its enforcement authority to require hospitals to improve infection control. The petition also called on CDPH to adopt a policy requiring inspectors to investigate the infection prevention practices of hospitals reporting significantly high infection rates and to subject hospitals to higher fines if they have a history of jeopardizing patients by failing to prevent infections.
CDPH’s response to Consumers Union’s petition indicated that the agency will begin or has started to implement a number of the petition’s recommendations, including:
- Sharing Infection Data & Prioritizing Inspections: CDPH indicated that it has begun sharing infection data with the enforcement staff in the Department’s Licensing & Certification Program to improve regulatory oversight. Infection data was shared with inspectors for the first time in October 2016 and included a list of hospitals with significantly higher infection rates over consecutive years to consider as priorities for inspection. Consumers Union and its activists have been calling on the CDPH to adopt this policy over the past year.
- Conducting Inspections Every Three Years: CDPH noted that it will conduct inspections of hospitals every three years as required by state law. The Department indicated that this started in 2016 and will continue in the future.
- Higher Fines For Immediate Jeopardy to Patients: CDPH acknowledged that immediate jeopardy fines are being used in certain cases and that it has the discretion to “consider all factors” when considering how much to fine a hospital. The petition recommended that the Department factor in repeated patterns of high infection rates when determining fine amounts. CDPH did not indicate whether this factor had ever been considered.
- Sharing Expertise & Training With Department: CDPH indicated that its Hospital Acquired Infection Program and Licensing & Certification Program share expertise and training to assist regulators when investigating infection complaints. However, the regulators only have two infection preventionists assigned to assist with infection issues during complaint inspections and investigations.
CDPH did not respond to the petition’s recommendation that hospitals should be fined for failing to report medical device-related infections but indicated that they were developing regulations to provide hospitals with guidance on adverse event reporting. The petition specifically cited hospitals where duodenoscope-related infections had occurred. It is unknown whether those hospitals reported these adverse events, as required by state law.
The Department also did not respond to the petition’s recommendation that it should initiate complaint investigations against hospitals identified in the annual infection report as having significantly higher infection rates. Instead, CDPH wrote, “[T]he HAI surveillance data are not designed or intended to be used for regulatory action. L&C does not initiate complaint investigations based solely on HAIs surveillance data used to evaluate temporal trends.
“Hospitals with significantly higher infection rates are outliers among their peers,” said McGiffert. “This should be ample evidence to warrant a complaint investigation by the Department’s inspectors to determine why so many patients are getting infections and what steps hospitals should take to prevent them.”
California law requires hospitals to report the rates of certain patient infections to CDPH, which discloses this information to the public through its Healthcare Associated Infections (HAI) Program. CDPH recently disclosed that 19,847 patient infections were acquired in California hospitals in 2015, a fraction of all infections since not all infection types are reported. CDPH has previously estimated that 72,000-87,000 hospital patients get infected every year and that 7,500-9,000 of them die during their hospitalization.