CHCH Center, Sac Bee investigate hospital-acquired infections
Filed under: Health data, Hospitals, Hot Health Headline
In a series titled “Death by Complication,” the California HealthCare Foundation Center for Health Reporting and The Sacramento Bee teamed up to investigate hospital-acquired infections in the state as well as efforts to combat them.
In the centerpiece, the CHCF’s Deborah Schoch used records and privacy waivers granted by a cooperative family to explore how an apparent hospital-acquired C. difficile infection seems to have killed an otherwise healthy 75-year-old man who was originally hospitalized for a broken femur. The cause of death was listed as “complications.” His story was far from unique, Schoch writes.
One in 20 hospital patients get infections. In California, roughly 200,000 people get hospital infections annually, and 12,000 of them die, according to state Department of Public Health statistics. That makes such infections one of the state’s leading causes of death, ahead of automobile accidents and Alzheimer’s disease.
Yet these deaths have remained mostly in the shadows. They often are classified as “deaths from complications,” an oblique term used in obituaries and often unquestioned by relatives and friends.
Even the best doctors can be baffled whether an infection was acquired before or after a patient was admitted, and if it was the principal cause of death or no factor at all.
Many health care providers historically have viewed hospital infections - going by obscure names or acronyms such as C.diff, CLABSI, VRE and the more familiar MRSA - as a sometimes inevitable consequence of being hospitalized.
In related pieces, reporters find that while hospitals are waking up to the toll taken by hospital-acquired infections, neither they nor the state have really managed to take authoritative measures to address the problem.
See the full series, complete with infographics, on CHCF’s site.
Hospitals to start reporting infection data Jan. 1
Hospitals are set to begin reporting information about hospital-acquired bloodstream infections to the federal government on Jan. 1, with the data becoming available to the public later in the year through the Hospital Compare website, according to an article by Tony Pugh of McClatchy Newspapers. Pugh also reports that hospitals will start reporting on surgical site infections in 2012.
The article includes a graphic that shows what states currently require public reporting of hospital-acquired infections.
While reporting to Hospital Compare will be voluntary, hospitals that fail to comply will “lose 2 percent of their Medicare funding beginning in fiscal year 2013.”
There are nearly 250,000 catheter-related bloodstream infections a year in U.S. hospitals, contributing to roughly 31,000 patient deaths annually. There are more than 290,000 surgical site infections a year, contributing to more than 8,200 deaths.
(Hat tip to FairWarning.org)
Reminder: AHCJ has compiled easy-to-use Excel spreadsheets of much of the data currently available from Hospital Compare. The up-to-date files, available to AHCJ members, are designed to allow you to compare more than three hospitals at a time – unlike the Hospital Compare look-up tool – using spreadsheet or database software to filter, sort and use other analysis tools with precision. You can look at hospital mortality and readmission data, as well as patient satisfaction.
AHCJ will be looking at making the new infection data available to members similar to what it offers for the mortality, readmission and patient satisfaction data.
AHCJ also has tip sheets to help you understand and analyze the data:
- Finding patterns and trends in health data: Pivot tables in spreadsheets
- Intro to investigating health data using spreadsheets
Wash. health data now includes infection rates
Filed under: Health data, Hospitals, Public records, Tools
Washington state has solidified its position as a leader in health data transparency with the publication this year of hospital surgery infection rates. The data is broken down hospital-by-hospital and includes numbers for the rates of certain infections following cardiac surgery, orthopedic surgery and hysterectomy, as well as for compliance with infection prevention numbers. For more numbers, including some which have been published for several years now, visit the state hospital association’s transparency center.
The unexpected highlight of this year’s data? A press release, pointed out by blogger and hospital executive Paul Levy, in which the Washington State Hospital Association official proudly announces that “Washington’s hospitals are enthusiastic participants in providing this new information about surgical infection rates.” Credit for this transparency lies with state lawmakers, but the hospitals deserve some props for publicly embracing the effort as well.
Missouri data disclosure details infection fight
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public health, Public records, Studies, Tools
Missouri law requires hospitals to disclose infection rates for intensive care and certain surgeries. It doesn’t keep that data around for long, but St. Louis Post-Dispatch reporter Jim Doyle still managed to review data from 2005 to 2009.
Robots sanitize an ICU room by spraying hydrogen peroxide vapor into the air at St. John’s Mercy Medical Center.
He found that while numerous local hospitals lagged behind national infection rates, most were improving. A story that could have been a dire assessment of health care-associated infections instead became (mostly) a profile of local hospitals’ drive to cut down on the transmission of such infections. He doesn’t draw a clean line between the state’s monitoring and increased anti-infection efforts, but it’s tempting to read between the lines.
Doyle’s second installment continues the theme, discussing the aggressive, nonstop effort that is required to contain drug-resistant bacteria. Measures range from checklists to room-enveloping antibacterial vapors.
Missouri’s disclosure laws are an important step toward infection fighting, Doyle found, but their narrow definition allows hospitals some wiggle room and may miss serious systemic issues. Speaking of systemic issues, I highly recommend Doyle’s sidebar on why Missouri infection data is so hard to keep around.
Outpatient inspections show serious lapses
Filed under: Health data, Health journalism, Hospitals, Hot Health Headline, Public records, Studies
AP medical reporter and AHCJ board member Carla K. Johnson used FOIA requests to uncover a wealth of infection-control violations at outpatient clinics in Illinois. The majority of Illinois ambulatory centers have yet to be inspected under the tough new rules, but 76 percent of those which have been inspected also have been cited. The inspections are part of a national push to increase the oversight of ambulatory care centers.
Previously, inspectors from the Illinois Department of Public Health visited the centers about every seven years. But the state last year began more vigorous and frequent inspections of outpatient surgery centers, following directives from national health officials. The state now plans to inspect a third of Illinois centers each year, said Karen Senger, a supervisor in the Health Department’s Division of Health Care Facilities and Programs.
The crackdown resulted from a hepatitis C outbreak in Las Vegas believed to be caused by unsafe injection practices at two now-closed clinics.
Johnson’s state request turned up a laundry list of specific violations, all of which she summarized in one nifty sentence: “The five-second rule appears to be alive and well in Illinois same-day surgery centers, where medical staff were observed picking up items that had fallen to the floor and behaving as if they weren’t contaminated by germs,” Johnson wrote. In an e-mail to Covering Health, Johnson said her story should be easy to localize and explained just how she obtained the inspection reports and why they are now available.
I FOIA’d state inspection reports (CMS-2567s) for ambulatory surgery centers in Illinois that were cited for deficiencies in infection control during the past 12 months. States have been directed by HHS to use a new audit tool to look for infection control problems, following an outbreak linked to two centers in Las Vegas.
Infection-reduction measures vs. the real world
The Wall Street Journal’s Katherine Hobson writes about the recent JAMA study which she says demonstrates that publicly reported infection control measures, including checklists, “don’t actually correlate with post-op infection rates.”
The study was designed to evaluate the six infection control measures tracked by the Surgical Care Improvement Project. Those measures include everything from antibiotics to hair removal and blood glucose levels.
None of those measures correlated with infection rates individually, Hobson writes, but when taken in aggregate things start to look a little better.
Study lead author Jonah Stulberg, a recent graduate of Case Western Reserve University School of Medicine (where the research was conducted) tells the Health Blog that the score is called an “all-or-none” composite, which is like a pass/fail: The hospital gets credit for a particular patient only if all the appropriate measures are taken.
With the statistics out of the way, Hobson addresses the biggest question: Why aren’t these prevention measures making a difference in the real world? The answer, as it always seems to be in these situations, is that life is complicated and human beings aren’t robots.
… there’s a big difference between a practice being proven to be effective in a clinical trial and then developing a measure that tries to estimate how often it’s done and then report it publicly.” Real life is messier, and factors such as surgical skill and hand-washing practices are tougher to measure.
Dale Bratzler, CEO of the Oklahoma Foundation for Medical Quality, tells the Health Blog the results don’t surprise him. Individual process of care measures for things such as heart attack and pneumonia also haven’t been shown to correlate with outcomes, he says.
Outpatient care can lead to more infections
Filed under: Health data, Health journalism, Health policy, Hospitals, Hot Health Headline
With a nod to the established dominance of outpatient surgery, NPR health blogger Scott Hensley explores a recent JAMA study which demonstrates that outpatient, same-day surgery carries with risks of infection that Hensley said were “a lot higher than they should be.”
Random inspections of nearly 70 surgery centers in three states found that two-thirds had at least one significant lapse in controlling infections. One common problem was the use of single-dose medication vials for more than one patient — found in 28 percent of the inspections.
Quite a few stakeholders have thoughts on the study, starting with a companion editorial by surgery professor Philip S. Barie (bio). The relevant trade group has also produced a response, as has HHS Secretary Kathleen Sebelius. Both say about what you might expect. The industry group says that an industrywide infection clampdown and new CMS standards for such activities have helped control the problem in the time since the study’s data was collected, and Sebelius trumpets current and future HHS efforts to avoid as many health-care-associated infections as possible.
Taken from an industry group report, this graph shows at a glance exactly why outpatient surgery is such a significant issue.
CDC report includes state data on infections
Filed under: Government, Hospitals, Member news, Studies
The CDC has released a report detailing health-care-associated infections, specifically central line-associated bloodstream infections.
This is the first such report to include any state-specific information, according to the CDC, though it only includes states that require reporting of CLABSIs to the National Healthcare Safety Network. The CDC expects this to serve as a baseline report to help guide prevention plans and activities.
Peter Pronovost, M.D., who spoke about patient safety and health care associated infections at Health Journalism 2010, was among the participants in a telebriefing about the report. A transcript of that briefing should be available later today.
Pronovost strategy influences Ore. infection data
Filed under: Health data, Hospitals, Public health
Prompted by Peter Pronovost’s keynote speech at Health Journalism 2010, The Oregonian’s Joe Rojas-Burke has been digging through the data on hospital infection rates to be released in accordance with an Oregon law that went into effect last year. The final statewide reporting date comes later this month, but The Oregonian has early results for 11 local hospitals.
Peter Pronovost, M.D., delivers the keynote speech at Health Journalism 2010. (Photo: Pia Christensen/AHCJ)
As part of the story, Rojas-Burke profiled hospitals with particularly low infection rates, especially one which had joined the Stop BSI network championed by Pronovost last month at AHCJ’s conference in Chicago. AHCJ members can see a copy of Pronovost’s presentation here.
The story builds on several things Pronovost shared at the conference, including the program’s background and state-by-state participation statistics.
Related
Other stories and blog posts related to Pronovost’s presentation:
- The Checklist and Future Culture of Medicine, Medical Lessons
- Hospitals slow to adopt renowned program, The Lund Report
- Hospital infection rates, a deadly problem, KSMU-FM
AHCJ members can read more stories from the conference
Transmitter tracks health-care workers’ washing
Despite constant reminders and a high-level of industrywide awareness, studies indicate that less than half of American health care workers wash their hands as frequently as they ought to. This contributes to the health-care-associated infections that kill tens of thousands annually. Now, NPR’s Gigi Douban reports, one Alabama hospital has resorted to high-tech monitoring devices to keep tabs on the handwashing practices of its employees.
Workers wear a special wireless transmitter, from which, Douban writes, “the hospital can tell when she entered a patient’s room, whether she washed her hands and whether she washed again on the way out. The information is sent to hospital officials, including the CEO.”
“If they’re habitually not complying, we can send them an e-mail or send them a text message, something that goes to them personally,” says Harvey Nix, CEO of Proventix, the company that developed the monitoring system at Baptist Princeton.
According to Douban, the CDC is currently investigating the effects of the technology upon the behavior of health workers.
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