TORONTO - Infection control experts have applauded the Ontario government's ambitious move to require hospitals to report a range of hospital acquired infections.
But the time frame for getting the system up and running will be daunting for a number of institutions, some admitted.
"There will be challenges. They've put a tight timeline on this," Dr. Dick Zoutman, head of infection control at Kingston General Hospital, said in an interview Wednesday.
"We're going to have a lot of work to do, I admit. So we've got to sit down and look at the logistics of doing this. For some hospitals it's going to be easier than for others."
Zoutman, who co-chairs Ontario's Provincial Infectious Diseases Advisory Committee, is strongly supportive of the move to require all hospitals to report rates of infections caused by Clostridium difficile, antibiotic resistant Staphylococcus aureus or MRSA and other infections.
Experts insist taking stock of infection rates is a necessary first step in combatting these largely preventable adverse events.
The Ontario government's full list, which was released Wednesday, also includes counts of cases of pneumonia in people who have been on mechanical ventilators, surgical wound infections, central line infections (infections at the site where a port or catheter enters the body) as well as rates showing how well hospital staff are doing following hand hygiene guidelines.
C. difficile is the first on the list. Hospitals will be required to report publicly on their rates starting Sept. 30. Three months later, they'll have to start reporting on their rates of MRSA, VRE (vancomycin-resistant Enterococci) as well as their in-hospital death rates.
By the end of April 2009, four more items will join the list: ventilator-associated pneumonia, surgical wound and central line infections and hand hygiene compliance.
That represents a significant chunk of new work to take on board over a very short period of time.
"It is ambitious. And I think that there are going to be some challenges going down the road in terms of what exactly we're collecting for those other things," said Dr. Michael Gardam, head of infection control at Toronto's University Health Network.
Gardam, who has been advocating for public reporting of hospital acquired infections, said small hospitals in particular may have trouble finding the resources to do this type of work.
"I think it will be doable in some fashion," he said. "(But) I think the devil is going to be in what exactly are we collecting for each one of those things."
A committee, headed by Dr. Michael Baker, physician-in-chief at the University Health Network, has been charged with figuring out the details - how to define cases of these infections, how they should be reported, how the data will be collated and made public after they are submitted. At this point, hospitals don't even know if they'll have to report monthly, quarterly or at some other interval.
Someone is also going to have to figure out a way to put the data in context. Rates will vary from facility to facility and a higher rate won't necessarily mean a particular hospital has sloppier infection control standards than a hospital with a lower rate.
"Comparing hospital to hospital to hospital is going to be fraught with difficulty because you need to control for all sorts of variables which we're not going to be measuring," Gardam explained.
"Hospital A might have a higher rate because its patients are older. It might have a higher rate because they've got all four-bedded rooms and my hospital has single rooms. They may not have an antibiotic control program (and) I might have one."
"So comparing Hospital A to Hospital B is going to be fraught with difficulties. (But) everybody's going to do it."
