Fewer central line blood steam infections at OHSU largely brought down average, consumer rep quetions outcome
June 9, 2011 – Oregon hospitals reported overall lower rates of healthcare acquired infections last year as a result of a statewide effort and a public reporting system now in its third year.
The recently released annual report of the healthcare acquired infections program
within the Office of Oregon Health Policy and Research showed Oregon hospitals had reduced rates of two out of three types of infections the program monitors.
Central line blood stream infections caused by a catheter and surgical site infections following knee surgery went down from 2009, while surgical infections related to coronary artery bypass grafts were slightly higher. All three were below the national average.
Bringing down the rate of preventable healthcare infections can largely be attributed to two efforts. One involves eliminating blood stream infections through a national program founded at Johns Hopkins University, and the other involves using a surgical checklist from the Oregon Patient Safety Commission
So far, 11 hospitals are now involved in the national program to stop blood stream infections or Stop BSI
, said Diane Waldo, director of quality and clinical services for the Oregon Association of Hospitals and Health Systems. And all but two of the state’s 56 acute care hospitals are using the surgical checklist.
“We’re going in the right direction, which is really terrific,” Waldo said.
The Stop BSI program, created by Dr. Peter Pronovost, lays out standardized methods for hygiene and preparation before inserting a catheter into a blood vessel, among other things.
“The beauty of this project is it has credibility,” Waldo said. “It says we are all going to practice in a standardized manner.”
The goal is to completely eliminate central line blood stream infections. But even with complete coherence, some infections will invariably get through, said Dr. John Townes, director of infection control at Oregon Health & Science University.
OHSU was largely credited for reducing the overall rate of blood stream infections by bringing the number of occurrences at its own facility down to 11 in 2010 from 27 in 2009.
Townes said the hospital started taking a new approach by investigating every infection and adopting the steps outlined by national experts. He credited the Stop BSI program and increased vigilance to reduce the rate of infection.
“Whenever you focus on a problem, the problem tends to go away,” Townes said. “By focusing on it we can make improvements.”
In 2010, central line blood stream infections occurred less than once per 1,000 patients as opposed to 1.37 per 1,000 patients in 2009. For knee surgery infections, hospitals brought the rate down to 0.79 per 1,000 compared to 0.91 in 2009.
Hospitals reported slightly higher rates, however, for surgical site infections related to coronary artery bypass grafts going from 2.1 occurrences per 1,000 patients to 2.27 per 1,000 in 2010.
Dee Dee Vallier, the sole consumer advocate on the advisory board, questioned the accuracy of the reports. The program currently does not validate the results through medical charts or discharge data. It does, however, test a sample of blood stream cultures.
In states that have validation, Vallier said, the number of infections are much higher.
“Really we don’t know what is actually truthful and accurate,” Vallier said. “I have asked about validation since day one. People who have done this fro years say if you don’t validate you’re not going to get an accurate report. Hospitals that are doing a good job of reporting may look bad and those doing a bad job will look good.”
Vallier said she would also like to see the program move faster in expanding the types of infections that are publicly reported.
Some of the improvement last year could be the result of better distinguishing an infection, Townes said.
“There are problems with the case definition of a central line blood stream infection where you get a false positive rate,” Townes said. “But that’s not the whole issue.”
The annual report also compares hospitals of similar size, in which there were only a few outliers. Townes cautioned against comparing facilities because hospitals might interpret infection definitions differently, or some hospitals might be better at detecting infections than others.
This year, the Centers for Medicare and Medicaid Services said it would stop paying for “never events” such as certain types of infections. Payment may be one incentive to prevent infections, but certainly not the only reason, Waldo said.
“It’s more of the climate and the expectation that hospitals will come together and learn from each other,” Waldo said. “A bigger awareness is around quality in general.”
Townes warned that publicly reporting infections could act as a disincentive to care for the sickest patients.
“It’s reasonable to have these things reported,” Townes said. “It becomes problematic when one puts too much emphasis on comparing crude, unadjusted rates from one hospital to another.”
To Learn More
To view the complete report on Oregon healthcare acquired infections click here.
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