Analysis finds California is failing to hold hospitals with high infection rates accountable for improving care
SACRAMENTO, CA – A new analysis by Consumers Union, the policy and mobilization division of Consumer Reports, found that California is failing to hold hospitals accountable for improving care when they report high patient infection rates.
Consumers Union noted that the California Department of Public Health (CDPH) fails to share with inspectors the infection data it collects from hospitals until long after it is reported, which prevents inspectors from taking timely action to protect patients. To make matters worse, many California hospitals with some of the worst infection rates have gone uninspected by the state over the past five years.
Consumers Union’s analysis is part of an administrative petition filed with CDPH, which calls on it to share the infection data it collects with state inspectors as soon as it is reported, to prioritize inspections of the worst performing hospitals if they haven’t been reviewed in the past three years, and to use its enforcement authority to require hospitals to improve infection control.
“Thousands of Californians die every year and many more suffer needlessly from preventable hospital infections,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project.
“CDPH is putting patients’ lives at risk by blocking inspectors from finding out which hospitals report high infection rates. We need effective state oversight to ensure that hospitals with the worst infection track records are held accountable for taking action to protect patients.”
California law requires hospitals to report the rates of certain patient infections to CDPH, which discloses this information to the public through its Healthcare Associated Infections (HAI) Program. CDPH recently disclosed that 19,847 patient infections were acquired in California hospitals in 2015, a fraction of all infections since not all infection types are reported. CDPH has previously estimated that 72,000-87,000 hospital patients get infected every year and that 7,500-9,000 of them die during their hospitalization.
However, the Department’s HAI Program does not have enforcement authority over hospitals and claims it is unable to require hospitals reporting high infection rates to improve infection control. CDPH’s Licensing and Certification (L&C) Program has enforcement authority but the Department deliberately does not provide inspectors with infection data reported by hospitals.
The L&C Program does not review the data prior to inspections or when investigating complaints. CDPH maintains a “firewall” between the two programs based on the belief that sharing the information with inspectors would interfere with the HAI Program’s efforts to get hospitals to voluntarily improve infection control.
California law requires that acute care hospitals are inspected every three years, but the state is woefully behind meeting this requirement. According to CDPH, 131 California acute care hospitals have not been inspected in the past five years.
Consumers Union examined three years of CDPH infection data (2013, 2014, and 2015) and found that nearly 60 percent of the state’s acute care hospitals had significantly higher infection rates compared to other California hospitals in at least one type of infection (such as MRSA, c. difficile, or surgical infections).
In 2015, the most recent year of data available, 159 hospitals had significantly high infection rates in at least one type of infection reported to CDPH. Many hospitals had significantly high infection rates in multiple types of infections over multiple years:
- 59 hospitals had significantly high infection rates in more than one type of infection for 2015 and 35 of those had significantly high rates in three or more types of infections.
- 95 hospitals had significantly high infection rates in at least one type of infection for 2014 and 2015.
- 65 hospitals reported significantly high infection rates in at least one type of infection for three years in a row (2013, 2014, and 2015)
The Ronald Reagan UCLA Medical Center provides a good example of how CDPH’s uncoordinated oversight puts patients at risk. Over three consecutive years, 2013-2015, CDPH’s HAI Program found that the hospital had significantly higher infection rates than other hospitals in the state. But the HAI Program claims it has no authority to require the hospital to make improvements based on this data and the hospital hadn’t been inspected over the past five years.
When CDPH finally investigated the hospital in March 2015 following media reports that 15 patients were sickened and three died from a CRE superbug outbreak, they found many infection control issues that put patients in “immediate jeopardy” of harm. Given the hospital’s history of high infection rates, CDPH should have taken more timely action.
“It makes no sense for CDPH to sit on the infection data it collects and keep its inspectors in the dark about which hospitals are doing a poor job protecting patients,” said McGiffert. “Voluntary efforts to improve infection prevention clearly aren’t working. CDPH inspectors should use the full array of tools available to hold hospitals accountable when they fail to keep patients safe.”
Consumers Union’s petition also calls on CDPH to adopt a policy requiring inspectors to investigate the infection prevention practices of hospitals reporting significantly high infection rates. The petition urges the Department to subject hospitals to higher fines and penalties if they have a history of failing to comply with infection prevention measures and jeopardizing patients.
Contact: Michael McCauley, mmccauley@consumer.org 415-902-9537 (cell)