There is a type of hospital infection that is often deadly and almost entirely preventable. Many institutions are still needlessly exposing patients to the dangerous bacteria revealed in an article in Consumer Reports by Hallie Levine. This review will talk about hospitals that do a good job and those that do not and how to keep your family and yourself safe.
Listen to this case example; by the time, Jeanne Rowe, a chief medical officer of Shore Medical Center near Atlantic City in New Jersey, faced an alarming situation: the intensive care units has reported eight infections among its patients in the previous 12 months. Why?
The infections had been traced back to centerlines vascular catheters, the intravenous tubes are used to supply medication, nutrients, and fluids to patients who need them most. The reason why medical professionals use a central venous catheter is to deliver a substance directly through a vein to the heart. However, when handled improperly, the centerlines can become the best host for bacteria. This is the centerlines are pumping germs straight into the bloodstream of the hospital’s most susceptible patients. Once there, the bacteria– including serious strains of MRSA.
The cluster of cases in Atlantic City, New Jersey was rated one of the worst in the country at preventing the infection. If the rate of infection was not fixed it could cause the hospital more than its reputation. President Barack Obama had recently signed Affordable Care Act, and among its provisions was one that lowered Medicare payments to hospitals that to many of these infections.
Rowe, a physician who specializes in medicine, have a proven track record for improving patient safety at several hospitals where she had worked in the Midwest. “We knew we had to do something about it,” she says.
Costly, Deadly, and Avoidable
About 650,000 patients develop infections after being admitted to United States hospitals in 2011, and 75,000 died, based on most recent data from the Center for Disease Control and Prevention. That would make hospital acquired (e.g., nosocomial) infections the nation’s eighth leading cause of death, just behind diabetes, and just ahead of the flu and pneumonia.
Central line infections account for roughly 5% of all acquired infections, striking more than 27,000 people in 2015, research shows. They are a particularly important subset, says Arjun Srinivasan, M.D., associate director of Healthcare Associated Infection Prevention programs at the CDC.
For one, they are deadly, proving fatal in a quarter of all cases, in part because people with the IVs are often already frail. They are costly, too, averaging $46,000 to treat, more than other nosocomial infections, according to a 2013 study in the Journal of American Medical Association. As far back as 2001, Peter Pronovost, M.D., senior vice president of patient safety and quality at Johns Hopkins Medicine in Baltimore, developed a safety checklist similar to one used by pilots prior to takeoff. He showed that when the ICU staff adhered to the protocol, central line infections could be sharply reduced, even eliminated.
Defeating Deadly Infection
When she arrived at Shore Medical Center, Rowe, doubled down on making Pronovost checklist a priority. Posters of men and women in Uncle Sam pose–the right arm out with a pointed finger–with the words, “I Want You to Wash Your Hands,” all around the hospital. Extra soap in a little gel dispensers were placed in and around patient rooms. Nurses begin scrubbing every patient’s skin chlorhexidine, a powerful antiseptic, before inserting centerlines, and then again when dressing needed changing.
Fewer centerlines means fewer chances of infection, so physicians reviewed everything which patients really needed the IVs. A secret team was put in charge to roam the hospital report staff who did not wash their hands before seeing patients. “People behave much better when they think someone is watching,” says Valerie DeJoseph, director of quality at the hospital.
Shown that extra effort paid off. In Consumer Reports’, most recent rating of about 2000 hospitals nationwide, Shore Medical Center earned top marks, going 21 months without reported a single centerline infections. To see how your hospital has performed, CR.org/central-line-infections.
Still Too Many Infections
Pronovost’s protocols, combined with the threat of reduced federal funding and more public accountability, seem to have just helped not just Shore Medical Center but many other hospitals. Though other nosocomial infections may have stayed steady or declined only slightly in recent years, those that are linked to a central lines were cut in half between 2008 in 2014, according to the CDC
It is one of the nation’s greatest patient safety success stories ever, says Srinivasan.
Consumer Reports analysis found improvement over the country, in large urban hospitals such as Ochsner Medical Center in Baltimore in New Orleans, as well as small suburban or rural ones like Wuesthoff Medical Center in Rockledge in Florida and Mercy Medical Center in Merced in California. Yet,the problem is not solved, says Doris Peter, PhD, director of Consumer Reports Health Ratings Center. “Hospitals are moving in the right direction, but progress is slowing and to my hospitals have not adequately address the problem over the past five years.”
That is true even among the nation’s prominent teaching hospitals, such as Dartmouth Hitchcock Medical Center in Lebanon New Hampshire and Ronald Reagan UCLA Medical Center in Los Angeles, both of which appear on our list of low scoring teaching hospitals.
“That is counterintuitive,” says Pronovost. “Those hospitals are supposed to be places that represent the best in our healthcare system.”
Administrators at these hospitals say that they are responding. “We identified a problem with our infection rate two years ago and immediately took corrective action,” says George Blike, M.D., chief quality and safety officer at Dartmouth. As a result, he says, the hospital’s most recent data which is not yet published by the government and thus not reflected in our ratings has shown that infection rates are dropping. Although hospital as traders say they are using versions of the Pronovost checklist, but the institution says that the hospital’s face special challenges. For example, while Reagan UCLA says it’s higher infection rates are due in part to, “the complexity of the medical cases and the severity of illnesses that we treat.” I can attest to this dilemma with the hospital that I was treated at, HSHS St. Vincent Hospital in Green Bay, Wisconsin takes more severe cases (e.g., the likelihood of death) than it’s opponent Bellin Hospital in Green Bay.
The CDC does try to adjust for those factors. In addition, Consumers Reports’ analysis found no clear evidence that hospitals with more Medicare patients–indication that they treat sicker or underserved populations–perform worse than hospitals with fewer Medicaid patients. In addition, there are examples around the country of hospitals that serve similar underserved populations will perform very differently against these infections. For example, Maimonides Medical Center in Brueggeman, New York, appears on our list of these hospitals with few central line infections whereas SUNY Downstate Medical Center University Hospital has higher than expected rates of infection.
SUNY Downstate is responding by trying to encourage a, “culture of safety,” among all team members says Michael Augenbraun, M.D., director, division of infectious disease at SUNY Downstate Medical Center.
The Path to Zero
Central line infections were once seen as inevitable when dealing with patients in intensive care units. “We thought we could maybe cut them by 10 percent,” says Srinivasan, at the CDC. However, in 2004, Pronovost, at John Hopkins, put his checklist to the test at more than 100 Michigan ICUs. “Within three months, rates were cut in half,” he says and, “by 18 months it was down by almost 70 percent.” “If hospitals are meticulous about following the checklist, most infections can be avoided, he says.”
That does, however, for everyone (e.g., all hospital staff, patients, and visitors) to adhere to the guidelines. Maureen Jewell, RN, director of quality management and performance improvement at St. Francis Hospital in Wilmington, Delaware, says, “it is very important to make this everyone’s problem to solve. We spent much of our time empowering nurses to speak of it hospital staff was not following the checklist carefully,” she recalls. “We had to make it clear that when it came to these infections, the physicians were not calling the shots, everyone else was.” Like Shore Medical Center in New Jersey, St. Francis Hospital improves from one of the lowest performing hospitals in 2011 to one of the highest rated ones.
Even some large hospitals in urban areas have improved. One that stands out: Mount Sinia St. Luke’s Roosevelt Hospital in New York City. Had been visited in October 2016, had a whiteboard outside of one of its ICUs proclaimed it had gone there are 969 days without a single centerline infection. To keep the streak alive, the hospital staff is constantly reassessing how it is doing. For example, a monthly staff meeting recently revealed that some nurses had not been using a new, more effective antiseptic dressing because it was not included in the prepackaged kits use to insert a central line, says Emilia Mia Sordillo, M.D., the physician in charge of infection prevention at the hospital. By the end of the week, “all the kits had been the right antiseptic dressing,” she says. Rowe adds, preventing the infection is not costly or all that complicated. It just takes training and patience and commitment to doing the little things right, “every single day, every single patient.” What needs to happen with hospitals to keep patients safe you might wonder.
Consumer Reports first focused on hospital infections in 2003, when CR urged states to pass laws requiring that hospitals publicly report those events. One hospital began doing that we surge rating them on infections, opening, “it would not hospitals towards solutions,” says Lisa McGiffert, director of Consumer Reports’ Safe Patient Project. That has helped, but more needs to be done. CR believes that the federal government should require hospitals to:
- Immediately report infection outbreaks or infection-controlled breaches to patients, healthcare providers, state, and federal agencies and the public.
- Undergo inspections that not only check for infections but also whether they have instituted comprehensive infection control programs involving everyone from the cleaning staff to the CEO.
- Provide a system for pages report when infections occur, to improve tracking of those events.
- Do you also have a story about hospital infection you would like to share? Check out: CR.org/share-your-hospital-infection-story.