PENNSYLVANIA, which is hardly the first in most things, this week took a bold step.

The commonwealth has become the first in the nation to report the number of people stricken by infections they picked up at a hospital.

It wasn't easy. Hospitals and their associations fought hard to keep from reporting the numbers and even now some are resisting giving a true accounting of how many patients picked up an infection because of sloppy practices - including doctors and nurses not washing their hands after examining each patient.

But the numbers the state was able to gather are startling.

In 2004, hospitals reported 11,668 hospital-acquired infections. That translates to a rate of 7.5 infections per 1,000 patients.

According to the Pennsylvania Health Care Cost Containment Council, the state agency charged with gathering the information, patients who picked up an infection at a hospital were much more likely to die than patients who didn't.

"The difference in mortality rates equated to an additional 1,510 deaths for those patients with hospital-acquired infections - 446 with bloodstream infections, 423 with urinary tract infections, 393 with pneumonia and 8 with surgical site infections," the council reports.

Besides more deaths, hospital-acquired infections accounted for 205,000 additional days in the hospital for patients and $2 billion in additional medical costs.

Little wonder that hospitals in Pennsylvania were so reluctant to comply with the requirement to report these numbers.

In fact, the reality could be even worse. While some hospitals cooperated fully, others gave incomplete or inaccurate reports. Amazingly, 16 hospitals, including several unnamed large hospitals, reported no hospital-acquired infections at all.

As long as hospitals keep these numbers secret, it will be nearly impossible to hold them accountable. Most of these hospital-acquired infections came from intravenous tubes, catheters and ventilators. But a sizable number came from health-care workers themselves. Washing their hands would have prevented many infections, experts say. What the hospitals can't wash their hands of is the responsibility.