When patients check into a hospital, they expect doctors there to fix what ails them, but one in 20 patients seeking care at hospitals contract a health care–based infection. Those infections escalate care costs to the tune of billions of dollars. And many of them–one in five–are part of the scary alphabet soup of superbugs that are resistant to antibiotics. The problem is not a new one, top health officials say, but as more patients receive minor surgeries and care at clinics and doctor’s offices instead of pricier hospital settings, that shift could fuel the growth of infections outside of hospitals.

Hospitals are already making some headway against pernicious infections that thrive on medical surfaces, including tubes and instruments. Preventable infections that crop up as patients receive surgery have dropped by one fifth in the past four years, the Centers for Disease Control and Prevention told a Senate panel today. Over that time, “central line–associated bloodstream infections were reduced by 44 percent and surgical site infections by 20 percent,” testified Beth Bell, director of the National Center for Emerging and Zoonotic Infectious Diseases, previewing new CDC findings comparing hospital infections, slated for release next year. Other recent data suggest that there were 30,000 fewer methicillin-resistant Staphylococcus aureus (MRSA) infections in 2011 than there were in 2005, as well as 9,000 fewer deaths. (Although rates of MRSA infection among children remain largely unchanged and disproportionately affect young infants and black children.) Similar data tracking health care–associated infections in settings outside hospitals is harder to come by, but that must start to change, Bell noted.

More complicated surgeries are now taking place in ambulatory centers, where medical personnel do not have the same level of information, Bell added, and there is a need to strengthen the principles of infection control and communication to help ward off preventable infections outside of hospitals.

The reduced infections in hospital settings can be attributed to better technical assistance and training and to programs that refuse to pay the tab for preventable health care–associated infections, federal officials testified. Medicare, state Medicaid programs and many private-sector health plans and purchases are moving toward payment systems that reward better outcomes instead of volume of services. For example, Medicare pays hospitals standard rates for original admissions but will not pay them for the additional costs associated with the care and treatment of health care–associated infections, explained Patrick Conway, chief medical officer of the Center for Medicare & Medicaid Services (CMS).

Those incentive policies, however, refer only to hospitals receiving certain kinds of payment from CMS. Long-term-care hospitals, cancer centers, children’s inpatient facilities, rural health clinics and Veterans Administration hospitals, among others, continue to be exempt from such programs (see below for the full list of exemptions). Closing the loop so that every hospital will be subject to programs that offer incentives for reducing such infections will be critical, said Senator Tom Harkin of Iowa, chairman of the Senate Health, Education, Labor and Pensions committee. “We need regulation in every state to address this,” he said.

Simple actions such as diligently following medical checklists that help to create more sanitary conditions and alert medical personnel to signs of infection could make a significant dent in the spread of infection, Bell said. “Hand washing is probably the most important thing anyone can do to reduce transmission.”

“This can be solved, but it is going to take some concerted effort,” Harkin said. “I think this is one of the most important hearings that this committee has had or will have this entire year.”

The CDC has laid out a goal of wiping out all health care–associated infections one day, but Senator Lamar Alexander of Tennessee pressed for answers about how practical that might be. “Whether we can get down to zero health care–associated infections I don’t know,” Bell admitted. “But we certainly have a long way to go. There is much, much improvement we can make as we drive toward that as a goal.”