Contagious diseases are as old as time and routinely appear in health care settings. New ones emerge from time to time. Yet the U.S. health care system, the most expensive in the world, was tragically unprepared for the emergence of Covid-19.
Health care facilities should excel at preventing the transmission of infection, but far too many fail at it. Health care-acquired infections are estimated to kill 99,000 people a year in hospitals alone.
The problem goes far beyond shortages of personal protective equipment. The steps necessary to prevent health care-acquired infections are the same ones needed to prevent workers and patients from spreading Covid-19 in health facilities: wash hands, disinfect, and obey hygiene rules.
Some facilities are much better than others at preventing infections, and were safer long before the pandemic caused a run on N95 masks. But we have spotty information on which ones are good and which ones aren’t. There is no uniform collection of infection rates across the country in the full range of facilities where Americans receive care, like hospitals, nursing homes, assisted living facilities, ambulatory surgery centers, military and VA facilities, hospices, and dialysis centers.
Without mandating nationally consistent data across all facilities, it is not possible to track the hot spots with precision, nor is it possible for families to make truly informed decisions about which nursing home or hospital is safest for their loved ones.
The Centers for Disease Control and Prevention (CDC) has the capacity and protocols in place to collect and calculate standardized infection rates for the full range of health care facilities at the national level. In most cases, however, it is not mandatory for facilities to report their data and too many opt to withhold it.
Without this information, Covid-19 has federal agencies flying blind. The Centers for Medicare & Medicaid Services (CMS), the agency that runs Medicare, scrambled to get Covid-19 infections in nursing homes reported in May, requiring the nation’s 15,400 nursing homes to report cases and deaths. But by then, tens of thousands of nursing home residents and workers had died. They are by far the most vulnerable of all Americans, comprising at least 40% of Covid-19 deaths so far.
We all must take responsibility for preparedness, and that starts now, not when the next pandemic hits our shores. Congress is negotiating a relief fund to shore up the economy, with a portion devoted to hospitals and health care providers hit hard by the pandemic. That is a good and responsible step for the caregivers who risk their lives every day to get us through this national emergency.
But we must also assure full accountability and transparency for that taxpayer investment. Mandatory national collection and reporting of infection rates is an appropriate way to show Americans that we will be better prepared next time. It will also give experts the tools they need to quickly home in on hot spots and take action.
The CDC is the right agency to collect these data. It already has a robust and tested system in place, so no new infrastructure would be needed. It already partners with all state health departments on collecting and monitoring public health data. In turn, the states rely on the CDC to eliminate many of the significant bureaucratic burdens of monitoring these kinds of data.
Health care workers are putting their own health at risk to care for victims of the pandemic and others needing care, and have been risking their lives to treat infections long before Covid-19 came along. We honor them when we make a commitment to infection prevention a national priority by insisting that infections acquired in health care facilities will be monitored and reported with the highest levels of transparency.
Congress and the White House need to act to make this happen. That’s why The Leapfrog Group, which I lead, has joined with AARP and more than 100 patient advocacy organizations to strongly urge leadership from Washington to require reporting by all of the facilities in which Americans receive health care. We believe it is imperative that elected officials expand the CDC’s systematic national monitoring and public reporting of infection rates as part of the next Covid-19 response package currently being discussed.
America’s health care system should be the world leader in fighting infection, whether it is those acquired in health facilities, a problem that has persisted for years, or a terrible new pandemic. We’ve seen this system come up short when tested by both.
The discipline of monitoring, tracking, and publicly reporting infection rates is a vital public health responsibility, and one that can quickly scale to meet the demands of new infectious diseases, such as a novel coronavirus. Facilities able to prove their effectiveness at preventing health care acquired infections are much better positioned to handle an emergency surge of new infections.
Congress needs to mandate infection reporting across all health care facilities to give public health authorities at the CDC the data they need to do their job and give the public the information they need to protect themselves and their loved ones.
Leah Binder is the president and CEO of The Leapfrog Group, a nonprofit watchdog organization.