The following article was published in the San Jose Mercury News on January 22, 2012
Rates of preventable infections vary at Bay Area hospitals, state data show
by Sandy Kleffman,Jan. 22, 2012
For the first time, Californians can compare infection rates at their hospitals in reports released this month by the state Department of Public Health.
The statewide data highlight the need to do more to safeguard patients from largely preventable infections often caused when sloppy practices or contamination let harmful bacteria slip into a patient's bloodstream.
Because hospitals self-report infections, some may appear to have low rates because they don't monitor as well or are less forthcoming, the report cautions.
The documents are meant to spur improvement and to help patients and families scrutinize risky practices.
State leaders expect a clearer picture to emerge as successive years reveal trends.
An estimated 12,000 Californians die annually from such illnesses, the state found in 2010
The new reports are required by a 2008 law sponsored by state Sen. Elaine Alquist, D-San Jose.
"Hospitals need to be safe, and they need to be held accountable," Alquist said in an email. "We should be able to get hospital safety ratings in the same way that we get car safety ratings."
The reports are the first in the nation to show how often hospital intensive care employees follow a safe practices checklist for inserting so-called central lines, which are catheters put in a blood vessel.
Central line infections are among the deadliest.
Tips to prevent central-line infections
- Make sure employees cleanse their hands each time they enter the room to touch a patient.
- Clean your hands when you visit a patient.
- If a central line or catheter is being installed, make sure the hospital worker wears a mask, cap, sterile gloves and gown and uses an antiseptic cleanser on the patient's skin.
- Ask if a central line is needed and how long it should remain.
- Speak up when employees do not follow safety practices.
- Speak up if the skin around a central line is sore or red, or if bandages are wet or dirty.
In the East Bay, employees at Alameda Hospital followed the entire checklist 54 percent of the time, and workers at Kaiser Permanente in Antioch did so 77 percent of the time.
Hospitals with more than 99 percent compliance included San Ramon Regional, Hayward's St. Rose, Oakland's Highland, Kaiser Walnut Creek and Antioch's Sutter Delta.
In the South Bay, hospitals with the lowest compliance rates included San Mateo Medical Center at 59 percent, O'Connor Hospital in San Jose at 75 percent, Regional Medical Center in San Jose at 75 percent and Kaiser Santa Clara at 76 percent.
All other South Bay hospitals had rates exceeding 90 percent.
"The real target is truly 100 percent," said Jon Rosenberg, chief of the state's hospital infection program. Campbell resident Milla Giguere strongly supports such reporting.
In 2006, her husband, Scott, became ill with end-stage liver disease and was in and out of hospitals while awaiting a liver transplant.
But then a test revealed he had an antibiotic resistant form of a staphylococcus bacterium, known as MRSA. The infection disqualified him from receiving a liver transplant, doctors told the couple.
He died that July at 46.
"We were so in shock to even find out that this is something in a hospital," Giguere said. Because her husband had stayed in three hospitals, Giguere said she isn't sure where he became infected. But she is convinced it occurred in a hospital. "We just don't want to see this happen to other people."
Giguere said one time, she stopped a nurse from reinserting an oxygen tube that had dropped on the floor.
But she would have been even more on guard if she had known about MRSA.
Health experts say patients and relatives can make sure hospital workers follow sterile procedures and should ask health care providers what they do to ensure safety. Many hospital leaders welcome such exchanges.
"We'd love the patients and family members to speak up if something concerns them," said Dr. Lucy Tompkins, medical director for hospital epidemiology and infection control at Stanford Hospital.
In addition to MRSA, the reports cover other types of infections frequently transmitted in hospitals, including Clostridium difficile and vancomycin-resistant Enterococcus (VRE).
Most Bay Area hospitals ranked average when compared to similar institutions statewide. But that's not good enough, advocates and some health experts argue.
"When it comes to infections, average is not where you want to be," said Lisa McGiffert, director of the Consumers Union's Safe Patient Project. "The goal is zero."
Hospitals that ranked significantly better than average in their medical or surgical critical care units included O'Connor Hospital in San Jose, Santa Clara Valley Medical Center in San Jose, and Seton Medical Center in Daly City and Moss Beach. None had central line infections last year.
Stanford had one of the strongest showings for central line infections, ranking better than average in three areas of the hospital.
It does several things beyond the safety checklist, including bathing intensive care patients every day with an antiseptic wipe, and having patients use mouthwash to reduce bacteria and fungi, Tompkins said.
"We follow our own rates of infection very carefully every day. If we spot any trends at all, then we go and investigate."
Santa Clara Valley Medical Center in San Jose encourages employees to speak up if they see someone not following safety guidelines, said Nancy Johnson, infection prevention manager.
The report identifies several hospitals with central line infection rates that were significantly worse than the state average in one area of the hospital.
Kaiser Walnut Creek and John Muir Medical Center in Walnut Creek ranked poorly with two infections each in their neonatal critical care units among infants weighing 1,001 to 1,500 grams
A John Muir neonatologist noted that the infection data is a year old.
The hospital has since made changes, including auditing employee hand-cleansing practices.
On Jan. 30, John Muir will have gone a full year without any central line infections in its neonatal critical care unit, said Dr. Nick Mickas.
Kaiser also saw success in reducing central line infections since the report. Leaders visit sites to ensure that safety practices are being followed and to learn of issues that may hinder attaining a zero infection rate, according to a statement from Barbara Crawford, vice president for quality and regulatory services.
Since 2010, the Kaiser's 21 Northern California hospitals have seen a 51 percent drop in non-ICU central line infections and an 11 percent reduction in intensive care unit infections, Crawford said.
Also in the worse-than-average category for central line infections was the pediatric general care unit at Kaiser in Oakland and Richmond, which had eight infections, and the medical/surgical critical care unit at Sutter Delta Medical Center in Antioch, which also had eight.
Sutter Delta was the only East Bay or South Bay hospital with a worse-than-average ranking for MRSA cases, reporting 10 from April 2010 to March 2011.
A high rate may be a result of aggressive monitoring and identification of infections, noted Sutter Delta spokeswoman Angela Lombardi. She also pointed out that the report shows Sutter Delta followed the safety checklist for inserting central lines 99 percent of the time.
Alquist's bill is often referred to as "Nile's law," after Nile Moss, a 15-year-old Orange County boy who died of a hospital-acquired MRSA infection in 2006. His mother lobbied heavily for Alquist's bill and would like to see some changes next year.
"Hospitals are not getting penalized for noncompliance," Carole Moss said. "Verification and validation is critical. We owe this to those who have lost their life to a preventable infection. "