February 2, 2010
Despite Lifesaving Checklist
to hospital infection rates, a first for consumers
YONKERS, NY —Far too many hospitals fail to lower the rate of deadly central-line bloodstream infections despite the availability of a simple life-saving checklist proven to prevent hospital acquired infections, says a new investigative article in the March issue of Consumer Reports. The report coincides with the addition of infection rates to Consumer Reports’ in-depth hospital ratings available online at www.ConsumerReportsHealth.org.
A First for Consumers; For Too Long “in the dark”
“For far too long, consumers have been in the dark, with no easy way to find out how well their hospitals perform when it comes to these often deadly infections,” said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center. Consumer Reports collected and compared data for ICUs in 926 hospitals, finding tremendous variations within the same cities and even within the same health-care systems. Central-line bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central-line infection.
Poorly performing hospitals include several major teaching institutions. Some examples include New York University Langone Medical Center in New York City, the University of Virginia Medical Center in Charlottesville, the Cleveland Clinic in Ohio and Weston, Florida, Strong Memorial in Rochester, New York, Hackensack University Medical Center in New Jersey, Robert Wood Johnson University Hospital in New Brunswick, New Jersey, and the Santa Monica UCLA Medical Center in California.
Meanwhile, determined reformers across the country have shown that hospitals can cut their infection rate to zero. Those hospitals range from modest rural hospitals to urban giants such as the University of Pittsburgh Medical Center Presbyterian. Other hospitals that have reported zero infections include St. Joseph Medical Center in Tacoma, Harris Methodist in Fort Worth, Santa Clara Valley Medical Center in San Jose, and seven Kaiser hospitals in California. The full list of 105 U.S. hospitals that have tallied zero central-line infections in their most recent reports can be found at www.ConsumerReportsHealth.org.
“All hospitals should be aiming for zero infections,” said Santa. “The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections,” continued Santa. Consumer Reports lays out the five simple steps contained in a low-tech, low-cost checklist developed by Peter Pronovost, M.D., Ph.D., critical care specialist and patient-safety researcher at the Johns Hopkins School of Medicine. He tested the checklist in Michigan, where a dramatic 66 percent reduction in central-line bloodstream infections was recorded in hospitals that adopted the checklist. It is estimated that the program saved more than 1,500 lives and $200 million in the first 18 months alone.
However, despite progress, and Health and Human Services Secretary Kathleen Sebelius’s recent call on hospitals to use the checklist to reduce central-line infections in ICUs by 75 percent over the next three years, an abundance of hospitals have not adopted the lifesaving checklist.
Freeing the Data
In a section of its magazine report headlined “Freeing the Data,” Consumer Reports describes a culture of secrecy at the federal government. Under the assurance of strict confidentiality, the federal Centers for Disease Control and Prevention (CDC) has been collecting and analyzing infection data from hospitals since the early 1970s. Another federal agency, the Agency for Healthcare Research and Quality, collects data from hospitals in 42 states and uses the information to track trends in quality, costs, and utilization, but it reports its findings only in the aggregate, without naming any hospitals.
“In short, many hospitals already have this information, but it will take pressure from all sides, at the state level and the federal level, to make sure consumers have full access. These reports need to be coherent, consumer-friendly, and validated for accuracy,” said Lisa McGiffert, director of Consumers Union’s Safe Patient Project (www.SafePatientProject.org ). Health reform legislation being looked at by Congress would require all U.S. hospitals to report infections for the purpose of providing that information to the public. Consumers Union, the nonprofit publisher of Consumer Reports, played a leading role in getting those provisions included.
The Consumer Reports online infection rates are from hospitals that publicly report their central-line bloodstream infection rates as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit that works with large employers and purchasers of healthcare to measure and publicly report on hospital safety and quality in 41 states in the U.S. (www.leapfroggroup.org). Citizen activists, including those working with Consumers Union, have helped enact laws in 27 states, forcing hospitals to publicly disclose their infection rates. To date, 17 of those states have published that information.
“We are making progress toward safer care, as many states now require hospitals to account for infections,” said McGiffert. Still, almost two million patients each year suffer from hospital acquired infections, including central-line bloodstream infections, and there are thousands of hospitals whose infection rates fail to see the light of day,” added McGiffert.
And consumers who can’t get their hands on information about how well their local hospitals perform should take note. “Consumers should be most wary of hospitals that are asked to report by their patients, and refuse,” said Leah Binder, CEO of the Leapfrog Group. “And on the flip side, it’s important to recognize that many hospitals demonstrate commitment to their communities by willingly reporting safety data—warts and all.”
About the Consumer Reports Infection Rates
A central-line associated bloodstream infection (CLABSI) is a type of infection that involves a central-line catheter or tube that doctors may place in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications to critically ill patients. These long, flexible catheters empty out in or near the heart so that the circulatory system can deliver what’s put in them within seconds. A bloodstream infection can occur when bacteria travel down the central line and enter the bloodstream, making the central line’s biggest virtue as a quick pathway for delivering the essentials into its biggest vice.
Since the risk of infection varies substantially across different types of ICUs, Consumer Reports is using what is known as a “standardized infection ratio,” taking into account the unique mix of ICU types in a given hospital by comparing the hospital infection data for each ICU to the national averages for each such ICU type published by the CDC. For instance, the average infection rate for cardiac ICUs nationwide is 2 per 1000 central line days (that’s the total number of days that patients are on central lines), while surgical ICUs average 2.3 infections per 1000 central line days. So an infection rate 100% above average would be 4 per 1000 days for a cardiac ICU, but 4.6 per 1000 days for a surgical ICU.
What Patients Can Do To Protect Themselves
Until all hospitals are doing as well as the top performers, patients and their families can’t assume that all necessary steps are being taken to guard against infection. Here are some steps consumers can take to protect themselves:
ü Look online to find out whether your local hospital makes its infection rate public. Subscribers to Consumer Reports’ health web site can access bloodstream infection data for 926 hospitals at www.ConsumerReportsHealth.org. The site also provides links to free state reporting sites.
ü Consumers can’t always choose their hospitals; in such cases where a hospital performs poorly, it’s best to prepare for an aggressive plan of action that includes actively communicating with caregivers about steps to prevent infections.
ü Patients, friends, and family members should insist that caregivers: wash their hands with soap or an alcohol-based solution before touching a patient; don sterile gloves before touching any catheters; and check to see that dressings are in place. They should also insist that caregivers follow the Pronovost checklist (information about the checklist is available for free online at www.ConsumerReportsHealth.org) and remove devices that enter the body, including central lines and urinary catheters, as soon as they’re no longer needed.
The Consumer Reports web site (www.ConsumerReportsHealth.org) currently rates more than 3,600 hospitals in the U. S. based on several criteria including patient satisfaction, intensity of care, and steps to prevent infection. This last measure, which is different from the CLABSI infection rate, assesses how well a hospital follows correct procedures to avoid surgical infections.
For a limited time, www.ConsumerReportsHealth.org is offering a 30-day free trial at www.ConsumerReportsHealth.org/febtrial . The cost for a year’s subscription is $19.
About the Consumer Reports Health Ratings Center
Consumers have come to trust Consumer Reports’ ratings of thousands of products and services for the expertise and independence they represent. The Consumer Reports Health Ratings Center uses similar approaches to produce ratings tables, selecting the best sources of research to rate healthcare services, drugs, devices, institutional providers, and eventually physicians and other practitioners. The Health Ratings Center (www.ConsumerReportsHealth.org) currently provides Best Buy Drugs (BBD) ratings on prescription medications for more than 20 common medical conditions; Ratings of more than 3,600 U.S. hospitals; Ratings for a wide array of healthy living products from fitness equipment to sunscreens; up-to-date safety information and effectiveness Ratings for thousands of natural medicines ; and treatment options for more than 200 conditions and diseases.