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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.
“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, MD, MPH, 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 healthcare 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, Fla., Strong Memorial in Rochester, N.Y., Hackensack University Medical Center in New Jersey, Robert Wood Johnson University Hospital in New Brunswick, N.J., 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, MD, PhD, 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.
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 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 (http://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.”