Copyright The Washington Post Company Feb 25, 2003

Every year, according to federal health officials, nearly 2 million Americans leave hospitals with infections they acquired there, and 90,000 die as a result.

So how many reports of life-threatening hospital-acquired infections have been received since 1996, when the nation's primary hospital accrediting body began compiling a voluntary database?

The answer, according to officials at the Joint Commission for the Accreditation of Healthcare Organizations (JCAHO): 10. Not 10,000, not 10 per day, but 10 total reports during the past six years.

In an effort to boost the number of reports by hospitals -- and to reduce the number of lethal infections among patients -- the commission has convened an expert panel to recommend ways to strengthen infection control procedures. Some of these recommendations may lead to tougher standards that inspectors will consider during visits by the JCAHO, which is funded by the 17,000 hospitals, nursing homes and other institutions it accredits.

The 20-member panel represents the third such effort undertaken by JCAHO in the past decade, according to vice president of standards Robert Wise, who is spearheading the effort.

For years the federal Centers for Disease Control and Prevention (CDC) has tried, largely without success, to persuade doctors, nurses and other health care workers to wash their hands before examining patients. Proper hand washing, CDC officials have maintained, could cut the number of hospital-acquired infections by at least 50 percent.

One reason for the underreporting of infections, Wise said, is the difficulty of determining whether a death from infection represents a preventable error or is a natural consequence of an illness. For example, did an AIDS patient who contracted a fatal infection in an intensive care unit die because of the infection or because he or she had an impaired immune system?

"Hospitals will disagree" about whether such an event is a reportable error, Wise said, unlike amputating the wrong leg or transplanting organs from a patient with the wrong blood type -- errors all would agree are reportable and preventable.

Such debate, he said, is one reason that hospital-acquired infections were not included in a landmark 1999 Institute of Medicine report that concluded that as many as 98,000 hospitalized patients die each year as a result of preventable medical errors.

But to Charles Inlander, director of the People's Medical Society, a Philadelphia-based consumer group, these arguments obscure a more fundamental problem: the lack of mandatory reporting of hospital-acquired infections.

"Right now there's no incentive to report," Inlander said. "There's no law. Why the heck would you report it if the hospital down the street isn't?" he added. "Even the CDC just gets voluntary data."

Wise said that hospitals might decide to participate in order to help educate other institutions and to prevent the repetition of mistakes.

The CDC's hospital infection estimates are based on information voluntarily reported by 315 hospitals whose officials collect data on infections and drug-resistant bacteria. The identities of the hospitals that report infections to either the CDC or JCAHO are not made public.

-- Sandra G. Boodman