State begins publishing hospital infection rates

The Washington State Department of Health has begun posting hospital infection rates online making it possible for anyone to compare infection rates between Washington hospitals.

The reports, which were mandated by the a law passed by the state legislature in 2007, are produced by the Department’s Health Care Associated Infections Program in collaboration with the Washington State Hospital Association.

Cassie Sauer, a spokesperson for the hospital association, said the reports will help patients chose where they want to get care but will also help hospitals learn how they are doing compared to other facilities.

The scrutiny will also “hold our feet to the fire” when it comes to improving infection control, Sauer said.

The first report covers two kinds of infections in patients in intensive care units (ICUs): bloodstream infections from central lines and pneumonias that develop while patients are on ventilators.

Central lines are large catheters used to deliver fluids and drugs intravenously. Because of their size these lines are typically inserted through the skin into large veins within the chest.

They often stay in place longer than intravenous lines that are typically inserted into a patient’s arm, increasing the risk of contamination.

If central lines become contaminated, they can quickly seed the bloodstream with bacteria and cause often life-threatening infections.

Hospitals can reduce the risk of such infections by requiring staff to use strict sterile technique during insertion of the line, to scrupulously observe line-care practices that can prevent contamination, and to remove the line as soon as it is no longer needed.

Central line-associated bloodstream infections

The new report found that in Seattle’s major hospitals central-line associated blood stream infection rates varied by the type of ICU.

For example, in general, rates were lower in medical ICUs than in burn and trauma ICUs where cases tend to be more complex and difficult to treat.

Overall, rates among the major Seattle hospitals ranged from zero per 1,000 line days to as high as 3.11. In almost all cases, the differences between hospital rates were not statistically significant and below national averages.

One exception was a rate of 3.11 bloodstream infections per 1,000 line days, which was found at one ICU at the Swedish Medical Center’s Cherry Hill facility.

“When we saw those numbers at Swedish, we took them very seriously and put a lot of work towards reducing those rates,” said Dr. Derel Finch, assistant director of Critical Care at Swedish.

An investigation found that the infections were occurring because of deficiencies in line care, Dr. Finch said.

Finch said the Swedish staff conducted a thorough analysis of their procedures and implemented a range of new processes to improve central line care.

“We’ve seen a significant reduction in our infection rates, and they are now on par with most of the hospitals in the Washington state area,” he said.

Ventilator-associated infections

The second group of infections covered in the report were pneumonias that develop while patients are on ventilators, called ventilator-associated pneumonias.

To be supported by a ventilataor patients must have a tube inserted into their trachea, or windpipe, which impairs their ability to cough and clear their airways, increasing their risk of developing pneumonia.

The risk of these ventilator-associated pneumonias can reduced by adopting such measures as keeping the patient sitting up at a 30-degree angle, providing regular oral care, and, again, removing the ventilator as soon as it is no longer needed.

For the ventilator-associated pneumonias, the ICUs were grouped into five categories to reflect their patient populations.

Harborview Medical Center, for example, because it is the region’s only level one trauma center and therefore cares for some of the most difficult-to-treat cases, was placed in a category all by itself.

It had an ventilator-associated pneumonia rate of 11.30 per 1,000 ventilator days, higher than other centers.

Rates among the other major Seattle hospitals ranged from 0.00 to 1.16 per 1,000 ventilator days, differences that were not considered statistically different.

One Tacoma hospital, however, Mary Bridge Children’s Hospital reported a rate of 8.72, considerable higher than other hospitals in its category.

The hospital recognized the problem in mid-summer 2009, the report says, and has “implemented a set of comprehensive corrective measures.”

Dr. Tim Dellit, medical director of Infection Control at Harborview, says that while such reports are helpful in encouraging hospitals to reduce their infection rates, it’s difficult to compare hospitals on the basis of such rating reports.

“Hospitals are very different in terms of the patients they serve and the procedures they perform,” he said.

“It is more important to me as an infection-control person is to see what are our own internal trends,” Dellit said. “I want to know how we are doing internally, and whether what we are doing is improving the care of our patients.”

Compared to national averages, Washington hospitals are “actually doing quite well,” he said. “But it will be interesting to see if we can drive them down even further.”

In addition to providing hospital infection rates, the Health Care Associated Infections Program’s Website provides information about central lines and ventilators as well as tips on how to protect themselves from infections while in the hospital.

Rates for surgical site infections will be published later this year.

PHOTO CREDIT:Methicillin-resistant Staphylococcus aureus - Janice Haney Carr / CDC

To learn more:

• To view the report and to learn what you as a patient can do to reduce hospital infection rates visit Health Care Associated Infections Program Website.
• Read the 2008 Seattle Times investigative series Culture of Resistance about hospital infections caused by MRSA, methicillin-resistant Staphylococcus aureus.

• Visit the Centers for Disease Control and Prevention’s (CDC) National Healthcare Safety Network for additional information about health care-associated infections.

Tags: Hospital-Associated Infections, Hospitals, Quality of Care

Category: Harborview, Infections, Swedish Hospital