One Valley hospital gets a star for reducing infections; another needs state help

Hospitals in the central San Joaquin Valley are among the best and the worst at reducing health care associated infections, according to California public health officials.

Mercy Medical Center in Merced is among 16 hospitals in California to have achieved 2020 goals for reducing all types of infections, according to the California Department of Public Health’s 2018 report.

But Community Regional Medical Center in Fresno is among 12 hospitals that have been targeted for having multiple years of high central line associated bloodstream infections, which result when a tube is passed into a vein.

Of the 12 hospitals with high bloodstream infection rates, 10 improved and now meet national baseline standards, but Community is one two hospitals, along with Los Angeles Olympia Medical Center, to continue to have a higher incidence of infections than national infection baselines in 2017.

By law, hospitals must report cases of five different health case associated infections: Clostridium difficile, a common cause of diarrhea in hospital settings, and two drug-resistant infections — methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci. Hospitals also must report infections that occur at surgery sites and central line bloodstream associated infections.

Public health officials said California hospitals in 2017 made the most progress in reducing infections since reporting began in 2009. In 2017, acute-care hospitals reported 2,602 fewer infections than in 2016. And statewide, reportable infections are now lower or “better” than 2015 national baselines. The most progress in fighting infections was seen in reducing C. difficile infections, which have decreased since 26 percent since 2015, the state said.

Although progress has been made in reducing hospital acquired infections in California and nationwide, they remain a problem. On any day, about one in 25 hospital patients has at least one health care associated infection, according to the federal Centers for Disease Control and Prevention.

For the first time this year, California reported the progress that each hospital is making in reaching 2020 goals. The state said 40 hospitals, or 12 percent of 335 hospitals in the state, are on track to reach 2020 goals for all health care acquired infections.

But areas of concern remain: Of 39 hospitals targeted for help by the state to reduce C. Difficile infections, seven were worse; five hospitals were worse for three infections; 10 hospitals were worse for two infections. And of 12 targeted for help to reduce central line bloodstream associated infections, Community and Olympia Medical Center had worse results in 2017.

Community had 69 central line infections in 2017, according to the report.

“Like many hospitals we are on a never ending journey to improve quality,” said Dr. Thomas Utecht, senior vice president and chief medical and quality officer.

Utecht said a doctor-led team reviews every potential hospital acquired infection for opportunities to improve, including patients being seen by a vascular specialist and infection preventionist nurses. “A review of our more recent data demonstrates improved performance, with a rate of 0.38 in September 2018 (national baseline is 1.0).” Utecht said.

Community also is getting help from The California Department of Public Health. A liaison infection preventionist with the Healthcare-Associated Infections Program is providing consultation, and has made 21 recommendations for improvements that the hospital has implemented, said Mark Smith, a spokesman for the department.

Based on observations and a review of preliminary data, Community has made progress in reducing central line bloodstream infections, Smith said.

Other hospitals in the central San Joaquin Valley also are working to improve. Kaweah Delta Medical Center in Visalia had worse than national baseline rates for MRSA infections in 2017. But this year, Kaweah Delta was below the national average and has had zero cases in September, said Sandy Volchko, director of quality and patient safety. “We had to circle back. We had to revisit our best practices,” she said.

Other hospitals had something to cheer from the report. Valley Children’s Hospital in Madera scored better than baseline levels for central line bloodstream associated infections. A full list of hospitals and their infection scores are available on the California Department of Public Health web site.

At Mercy Medical Center, educating staff and patients about infection prevention paid off in the hospital reaching 2020 infection reduction goals. Banners on each floor remind staff and visitors of isolation rules, such as putting on gowns and gloves and hand washing. And infection control signs are in all patient rooms, said Vanessa Collins, infection preventionist.

Doctors and nurses follow a set of instructions for inserting tubes in veins, said Dr. Jorg Schuller, Mercy vice president of medical affairs. Infection prevention is a priority, Schuller said.

At the public release of the infection report Thursday, Schuller and Collins said “we all celebrated during our quality meeting this morning.”

This story was originally published October 26, 2018 at 12:23 PM.