Pandemic delays reporting on Hawaii’s hospital infections

The state Department of Health has fallen several years behind in producing annual reports detailing infections patients acquire during hospital stays, leaving the public with less information about how well health care facilities are doing in controlling the spread of pathogens that can prove deadly.

State lawmakers passed a law in 2011 requiring the reports amid heightened concerns nationally about the toll infections were having on patients. That year, an estimated 650,000 hospital patients nationwide acquired infections at a health care facility and 75,000 died, according to the U.S. Centers for Disease Control and Prevention. Federal health officials warned the infections had become a leading cause of death in the United States and were costing the health care system billions of dollars in associated costs.

DOH issued its first report in 2013, detailing infections for the previous year, but the last report completed is for 2018. That report detailed the state’s success in reducing bloodstream infections associated with catheters, Methicillin-resistant Staphylococcus aureus (MRSA) infections and infections associated with certain surgeries.

A slight increase was reported in infections acquired during hysterectomies, a procedure to remove the uterus. Overall, health care facilities reported 307 hospital-associated infections.

The report also listed influenza vaccination rates among health care personnel at hospitals across the state, showing that just seven facilities out of 23 in Hawaii had reached a federal target of 90% vaccinated.

Douglas Hatch, an epidemiologist with DOH working on health care-associated infections, said the COVID-19 pandemic is to blame for the falloff in reports.

“It’s quite simple,” he said. “There is a pandemic. So the entire focus in our small group has been COVID-19 prevention and response.”

He said the 2019 report could be ready in the next month or two but didn’t have an estimate of when the 2020 report would be completed. DOH initially said it was in the process of being finalized.

“People are working on it,” Hatch said. “But it’s a meticulous review of very detailed data in comparison to national rates, and there is a pandemic so it is not the highest priority. There can’t be like 12 highest priorities.”

The public reporting requirements, backed by patient advocates, are aimed at giving people better information about how safe their local hospitals are when it comes to infection control, while also exerting pressure on health care facilities to do a better job at preventing the spread of pathogens.

Patients, particularly those who are very sick and have weakened immune systems, are at increased risk of contracting a host of different bacteria, fungi and viruses when they are admitted to a hospital or long-term care facility. The risk rises significantly when they undergo surgery or tubes are inserted to deliver fluids and medications.

On any given day, one in 31 hospital patients nationwide has acquired an infection, the CDC has estimated. Health officials say the primary means of controlling infections is to ensure doctors and nurses wash their hands and that staff carefully clean rooms and medical equipment and wear protective gloves and gowns when treating infected patients.

The CDC has warned of a recent increase nationally in the rates of health care-associated infections, which it said is likely due to strains placed on staff and supplies during the pandemic. Of particular concern is a deadly fungus, candida auris, which the CDC last week reported had spread at an alarming rate. The fungus is particularly dangerous because it is resistant to multiple antifungal drugs and has a high death rate.

There were nearly 2,400 such cases reported nationally in 2022, representing a fivefold increase since 2019, according to CDC data. Another 13,163 cases have been detected in recent years through surveillance screening in which swabs are taken from patients to determine if they may be carrying the organism on their body even though they don’t exhibit signs of infection.

In Hawaii, there has been only one case of candida auris, though DOH said the state has tested only three specimens for the fungus.

While DOH hasn’t been producing its annual reports, the Centers for Medicare and Medicaid Services does calculate how individual facilities compare to national benchmarks for health care-associated infections on its Hospital Compare website.

Hatch said the data suggests Hawaii’s hospitals have been doing a good job at infection control.

“In general, the rates of (health care-associated infections) are characteristically lower in this state compared to national averages,” he said. “We should give credit to those hospitals because obviously their infection prevention and control practices, compared to national (rates), are substantially lower. It’s not easy to find a hospital that has a significantly higher rate than the national averages. All the categories, in almost all the years, in almost all the hospitals is lower than the national average.”

However, unlike some states, Hawaii’s Health Department does not validate or audit the data hospitals submit to the CDC’s National Healthcare Safety Network, which is the basis of the calculations. This should be taken into account when considering a state’s performance, according to CMS.

“States that perform more vigorous data validation activities are more likely to find hospital records of infections, and therefore these states may have higher standard infection ratios compared to states that do not perform validation,” the agency cautions.

The Healthcare Association of Hawaii, a trade group for hospitals and long-term care facilities, said in a statement that it has been proactively working with its members and DOH to prevent health care-associated infections. It recently launched a webinar series to better educate and train health care providers on infection control.