Pennsylvania hospitals are doing better in preventing infections stemming from healthcare-related mistakes, but those infections still remain a public health challenge, according to a new report from the Pennsylvania Health Care Cost Containment Council.
The PHC4 released its report, “The Impact of Healthcare-associated Infections in Pennsylvania 2010,” and noted that there has been a decline in HAIs, or “infections that patients acquired during a hospital stay.”
The report shows that about 1.13 percent of the 1.88 million patients admitted to hospitals in the state in 2010 contracted at least one HAI, which is down from 1.2 percent of patients in 2009. The mortality rate for patients with an HAI also went down – it fell from 9.4 percent in 2009 to 9.1 percent this year.
“I think hospitals have made a considerable effort in preventing what is a very serious issue in healthcare,” said Dr. Dana Kellis, chief medical officer at PinnacleHealth. “There are a number of areas where we’ve had no infections in a year or a year-and-a-half, and there are other areas where infections have declined. We’re continuing to strive to eradicate all infections.”
PinnacleHealth CEO Michael Young clarified some particular categories where the health system was able to achieve zero infections.
“Our Cardio-Thoracic Intensive Care Unit (CTICU) has not seen one of these infections in more than two years, and our Intensive Care Unit (ICU) at the Community General Hospital was CLABSI (central line-associated bloodstream infection) free for 16 months,” said Michael A. Young, president & CEO of PinnacleHealth.
“In the last two years, we have had no ventilator-associated infections in our adult critical care units,” he added. “While the data clearly supports PinnacleHealth has fewer infections than other hospitals in the state, it is our patient-focused care that drives the exceptional service our community expects and deserves.”
The decrease in the number of infections was also a good sign for Carlisle Regional Medical Center CEO John Kristel.
“I think it’s great news,” he said. “As a state, we should be proud of the commitment that all of the hospitals have shown in reducing infection rates. We’re happy to be a part of it, and we’ll stay after it and keep reducing the numbers.”
PHC4 started reporting on HAIs in 2005, and in 2007, hospitals in the state began reporting HAI data using the Centers for Disease Control and Prevention’s National Healthcare Safety Network – a web-based system for reporting data. The data is then made available to PHC4, the Pennsylvania Department of Health and the Pennsylvania Safety Authority.
Room for improvement
Though the numbers are improving, PHC4 also notes in its summary that HAIs remain one of the country’s most important public health challenges. According to PHC4, the CDC estimates that 1.7 million patients contract an HAI every year nationwide, and nearly 99,000 of them die.
While the mortality rate for Pennsylvania patients with an HAI in 2010 was 9.1 percent, the mortality rate among patients without an HAI was only 1.7 percent.
Because of those numbers, HAIs are one of the issues that hospitals feel are important to tackle.
“(It’s important) because it’s really the best thing to do in terms of quality of patient care,” Kristel said.
In addition to the mortality rates, the annual direct medical costs of HAIs in U.S. hospitals are estimated at $28.4 billion to $33.8 billion.
Some of those costs go up when a patient with an HAI has to come back to the hospital for treatment when they were not expected to return. The report indicated that in 2010, among the patients who acquired an HAI, 31.3 percent were readmitted within 30 days for an infection or complication, whereas only 6.3 percent of patients who did not contract an HAI were readmitted within 30 days for an infection or complication.
“HAIs increase the cost but also it worsens the outcome in patients,” Kellis said. “They are more likely to suffer serious complications.”
PHC4 noted that there isn’t a direct correlation between an HAI and the reason for the infection or complication, though there is clearly a higher percentage of patients with HAI who return to the hospital in a short amount of time.
“Patients with a healthcare-associated infection continue to be readmitted at higher rates than those whose cases were not associated with an infection,” said PHC4 executive director Joe Martin. “Those readmissions remain an important opportunity for quality improvement and cost control. And with public-sector health programs like Medicaid and Medicare facing serious cost challenges, it behooves us to redouble our efforts to prevent these infections from occurring.”
Along with readmission rates, patients who did get an HAI also stayed in the hospital longer. In 2010, the average length of stay for a patient with an HAI was 21.9 days, while the average length of stay for a patient without an HAI was 5 days.
HAIs can happen in a variety of ways at the hospital, but there are certain types of conditions and procedures that had the highest rate of infections in hospitals.
Among the conditions with the highest percentage of patients contracting an HAI were leukemia and lymphoma; respiratory failure in adults; abdominal hernia; heart valve disorders; and blood clots of the artery in the abdomen or limb.
Procedures where the highest percentage of patients contracted a surgical site infection (SSI) in 2010 were peripheral vascular bypass surgery; colon and rectal surgery; small bowel surgery; surgery to repair hernia and liver; and pancreas and bile duct surgery.
Surgical site infections were the most common type of HAI at 26.8 percent of all HAI cases, and urinary tract infections accounted for 22 percent of all HAI cases.
As the list of areas indicates, surgeries done in the abdomen area tend to have the highest rates of SSIs.
“Look at surgeries in the abdomen, something like bowel surgery,” said Kimberly Rivera, infection control manager for PinnacleHealth. “There’s always the potential there for infection. With appendicitis, there’s already an infection agent in the abdomen, which will increase the likelihood of infection.”
Joan Silver, the vice president of quality for PinnacleHealth, added that urinary tract infections specifically have a high infection rate because of how the treatment works.
“With urinary tract infections, you’re taking a catheter that’s outside and putting it inside the body,” she said. “Any time you introduce anything into the body from the outside, you’ll get a chance of infection. We can reduce the number of days that the catheter is in the patient and make sure it’s clean and needed. We should pay attention to doing what is really needed and appropriate for the patients.”
Though the abdomen can prove a troublesome area in fighting off healthcare-associated infections, it’s also not a lost cause to aim to eliminate them.
“There are very well worked out standards for using antibiotics and cleaning the abdomen to minimize the risk of infection,” Kellis said. “Despite the hazards, our goal in all of this is to have zero infections. We do have a heavy emphasis on hand-washing, and we make sure our operating rooms are operating as safely as possible. We restrict the number of people coming in and out.”
Carlisle Regional Medical Center also uses the evidence-based procedures from the CDC that PinnacleHealth follows, and Kristel noted that in addition to making sure staff wash their hands before entering a room and after leaving it, there also are procedures for proper hair removal and for antibiotic use to cut down on surgical infection rates.
“An evidence-based rule is that physicians select the best antibiotic for the patient,” he said. “In addition to picking the right medicine, there’s also the proper timing of when a patient gets the medicine.”
Taking antibiotics in a certain time period can work in preventing an infection. According to CRMC, patients should receive prophylactic antibiotics within an hour before surgical incision and they should be discontinued within 24 hours after the surgery ends.
So, even as hospital staff work on preventing infections, it’s just as important to have the patient involved as well.
“It really is a team effort,” Kristel said. “The patient and families know what they need to do when they’re discharged. Often, a lot of our patients go home after surgery the same day. Patients can follow up with their physicians, who can keep an eye out for signs of infection.”