State rates Valley hospitals on patient infections

The Fresno BeeNovember 28, 2013 

Hospitals in the central San Joaquin Valley got a report card this week on how they're doing at reducing patient infections, and their grades varied, depending on which germ they're fighting.

Three Valley hospitals had lower-than-expected rates for a nasty bug that causes diarrhea, and two had higher rates for central-line bloodstream infections, according to a report released by the California Department of Public Health.

Hospital-acquired infections are of major public concern and a costly problem for hospitals. Infections are among the top 10 leading causes of death nationwide. In California, about 200,000 occur yearly, according to the state. The infections are estimated to cost California hospitals $600 million to $1.6 billion annually.

California requires hospitals to report infection for Clostridium difficile, which causes diarrhea, and for two drug-resistant infections -- methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci. Hospitals also must report central-line -- where a tube is passed into a vein -- bloodstream infections. This is the first full year of hospitals reporting surgical site infections from 29 types of surgical procedures.

Valley hospitals fell within accepted ranges for the two drug-resistant infections. The report found Community Regional Medical Center and Saint Agnes Medical Center had lower rates for Clostridium difficile, which has been increasing and causing more deaths in recent years. Kaweah Delta Medical Center in Visalia also had a lower rate, and Tulare Regional Medical Center would have shown a lower rate but for a state reporting error, hospital officials said.

The Valley hospitals were among only 46 statewide with lower-than-expected Clostridium difficile rates. Fifty-four hospitals had higher-than-expected rates. A total of 324 hospitals were evaluated for that infection in the report.

But two Fresno hospitals -- Community Regional and Saint Agnes -- had higher rates than the state average for central-line bloodstream infections. The Fresno hospitals were among 49 statewide with higher rates. A total of 374 hospitals were evaluated for that infection.

The state compared Community Regional in 16 areas of patient care where central lines are inserted. The hospital had higher rates in four -- medical/surgical, oncology, adult rehabilitation and adult step-down. Saint Agnes was rated in six areas and had higher rates in two -- critical-care and general-ward medical patients.

Saint Agnes has taken steps to address central-line infections, said Christi Paradise, infection control coordinator.

The effort started in the critical-care unit and now is being broadened to general wards, she said. For example, the hospital has put caps on central lines where medication is inserted through a needle. The caps keep the line clean and prevent germs from entering, she said. Patients also are bathed daily with an anti-microbial soap.

Saint Agnes also has expanded a staff hand-washing incentive program to the intensive care unit. The program had been a pilot project in one ward. It's too soon to know if the hand-washing program in the ICU has made a difference in hospital-acquired infections, but it has had an effect, Paradise said: "What we've seen is a big difference in compliance with washing hands."

Community Regional is working on a hospital-wide plan to reduce central-line infections, said Beverly Kuykendall, manager of infection control.

New procedures were started in the cardiac intensive care unit after the hospital reported a rate higher than the state average in 2011, she said. The need for central lines for patient care is now more closely assessed and staff follows a daily set of procedures to reduce infections. As a result, central-line infections in the cardiac ICU decreased from six in 2011 to two in 2012, Kuykendall said.

Of the infections monitored by the state, hospitals have found controlling Clostridium difficile to be a particular challenge.

"It's spreading more and it's making people sicker," said Paradise.

Many of the patients with Clostridium difficile have been on antibiotics for other illnesses and hospitals are working to curb overuse of the drugs. Saint Agnes has been "working as a team with physicians to see what we can do to control the use of antibiotics," Paradise said. Hospital rooms also are cleaned with bleach to kill the bacteria, she said.

Kaweah Delta has been closely monitoring antibiotic use and has put an increased emphasis on hand-washing because the bacteria can live on hands and equipment.

The effort has paid off, said Lucia Austin-Gil, director of performance improvement and patient safety. "We are showing improvement and it's just good to see the data reflecting that."

Community Regional has increased staff education in an attempt to lower the number of infections, said spokeswoman Mary Lisa Russell. "I suspect that is having a positive effect and will continue to drive our infection rates even lower."

Tulare Regional Medical Center also has infection-control procedures that have apparently helped reduce Clostridium difficile; officials there said they are disappointed that the state report didn't reflect the work. The state used incorrect patient numbers when it calculated the hospital rate, said Shawn Elkin, the hospital's infection preventionist.

Despite the state goof, this year's report on 2012 infections had a better reception than one released last year. Valley hospital infection prevention officials widely panned the 2011 report -- and state officials admitted it was flawed.

Hospital officials said only 66.8% of hospitals participated fully in reporting preventable infections to the state for the 2011 report. The state did not have a uniform system for collecting information from hospitals, and did not adjust rates to compensate for higher infection risks at hospitals with more acutely ill patients.

This year, more hospitals reported data -- including all in the Valley. The state is using one system for collecting information and rates are risk-adjusted.

The state report helps increase public awareness and "can help hospitals track their progress in preventing these infections," said Corey Engel, a spokesman at the California Department of Public Health.

Saint Agnes has a goal, Paradise said: "We're always working to strive for zero infections."

Kaweah likewise is working to lower infection rates in every category, said Austin Gil. "It's a commitment we have to our community to get to zero."

The reporter can be reached at (559) 441-6310, or @beehealthwriter on Twitter.

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