published Wednesday, June 23rd, 2010

Hospitals aim to eliminate preventable infections


by Emily Bregel
Audio clip

Chris Clarke

Hospital industry associations in Tennessee and Georgia have set a lofty goal of wiping out all preventable infections in their intensive care units, and some local hospitals already are seeing results from their increased focus on the issue, officials said.

The Tennessee Hospital Association is encouraging hospitals to reach zero preventable infections in hospital ICUs within three years, concentrating on central-line bloodstream infections, MRSA -- a drug-resistant staph infection -- and surgical site infections.

"If it was easy, we wouldn't have to be tackling it," said Chris Clarke, senior vice president for clinical services at the Tennessee Hospital Association. "People do struggle with that. Is that (goal) too big or audacious? But if you don't strive for it, then you might settle for less."

The Georgia Hospital Association also is aiming for zero infections but hasn't set a specific timeframe, said Denise Flook, coordinator for infection prevention and workforce initiative at the association.

  • photo
    Staff Photo by Danielle Moore/Chattanooga Times Free Press Sarah Gregg, a registered nurse at Hutcheson Medical Center in Fort-Oglethorpe, puts on latex gloves and a medical mask before a patient visit Thursday afternoon. The hospital has stepped up to try and cut down on preventable infections among employees and patients at the hospital.

Both hospital associations are part of a national effort to eliminate catheter-related bloodstream infections, an initiative led by Dr. Peter Pronovost, a patient safety expert at Johns Hopkins Hospital in Baltimore, Md.

He received international attention for his development of a checklist protocol that drastically reduced infection rates at hospitals that implemented it. Those practices, which include donning cap, gloves and gown before inserting a central-line IV, are in place at local hospitals, officials said.

The initiative also enlists front-line caregivers, not only infection control officials, in the effort, Ms. Flook said.

"This program teaches it's their role, it's their responsibility and they'll be held accountable for every bloodstream infection that happens on their unit," she said.

For many local hospitals, small but crucial changes have shown quick results.

Erlanger hospital has recorded no central-line infections in ICU for the past four months, said Coretha Weaver, infection control coordinator. A major factor has been a return to using a team of experts who put in IVs using best procedures and holding them accountable for infections, she said.

Hamilton Medical Center in Dalton, Ga., has added a similar dedicated IV team.

Memorial Hospital has not had any central-line infections in the ICU for three months, and the Parkridge East campus has had zero such infections for more than a year, officials said.

A report published by the Tennessee Department of Health last year documented the central-line infection rates among hospitals in the state. Memorial Hospital, Parkridge Medical Center and Erlanger hospital's results all fell within the normal range when compared to national averages.

But some Tennessee hospitals' results were significantly higher than the national average, Ms. Clarke said.

"We're not where we need to be yet," she said.

NATIONAL CAMPAIGN

Nationally, health care providers and payers increasingly are shining the spotlight on hospital-acquired infections. Such infections cost hospitals an estimated $28.4 billion to $33.8 billion every year, according to a March 2009 report from the U.S. Centers for Disease Control and Prevention.

"It's a huge financial burden that not only our hospitals but also patients have to deal with every day," said Jerri Underwood, Parkridge chief nursing executive.

In Tennessee, a single central-line infection costs a hospital on average $21,098, according to the state hospital association.

In 2008 there were 495 central-line infections in adult and pediatric ICUs in Tennessee, according to a report published by the state health department. Georgia hospitals do not have to publicly report this information.

The infection-prevention focus gained traction with the Institute of Medicine's 1999 report stating that as many as 98,000 people a year die from medical errors, said Dr. Mark Anderson, who oversees Memorial's infection prevention program and is infection prevention adviser at Hutcheson Medical Center in Fort Oglethorpe.

Many of those deaths were caused by preventable infections, he said.

"Most of us that do this think all this increased attention (on prevention) for the most part is great," Dr. Anderson said. "It's an area that's often been overlooked by the health care system. It's a constant danger in the health care setting."

Two years ago, the U.S. Centers for Medicare and Medicaid Services began denying hospitals payment for treatment of conditions that it deems preventable, including bloodstream infections related to improper catheter use.

The Centers for Medicare and Medicaid Services wants to make hospitals report their central-line infection rates and some surgical-site infection rates, data which would be released publicly the next year in 2012, Ms. Flook said.

LOCAL EFFORTS

Other methods are being used to prevent different infections. Using a new type of equipment and a new sterilizing agent, Hamilton Medical Center has recorded only one case of ventilator-associated pneumonia in the last 18 months, said Dr. Mark Elam, medical director for infection prevention.

Parkridge is taking part in a national study to compare methods of preventing MRSA. In the study, one group of patients who are MRSA-positive when they enter the ICU will be isolated and treated with "decolonizing agents," such as special nasal swabs and skin wipes.

Other MRSA-positive patients will be isolated but not decolonized, which is the current standard. In another group, all patients -- both those with or without MRSA -- will be decolonized, Ms. Underwood said.

"We used to think (an ICU) patient is so sick, they're going to get an infection anyway," Ms. Weaver said. "But a lot of facilities have shown that, even in the sickest patients, some infections are preventable, and we should really get organized and go after preventing the ones that we can."

ON THE WEB

Tennessee Center for Patient Safety: tnpatientsafety.com

WHAT IS A CENTRAL LINE?

A central line, or a central venous catheter, is a thin tube placed in a large vein to provide long-term access to the bloodstream in order to administer fluids or draw blood. Central lines can be left in place for weeks or more, and they potentially can cause bloodstream infections.

Source: WebMD

CENTRAL-LINE ASSOCIATED BLOODSTREAM INFECTIONS

In 2008 Tennessee hospitals reported actual infections vs. expected number of infections (based on the hospital ICU's particular patient population):

* Erlanger hospital: 22 vs. 20

* Parkridge Medical Center: 8 vs. 8.4

* Memorial Hospital: 11 vs. 19

Source: "Tennessee's Report on Healthcare Associated Infections: January -- December, 2008"

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Continue reading by following these links to related stories:

Article: Life with unspoken fear

Article: Bacterial infection growing stronger

Article: MRSA infections on rise outside hospitals

about Emily Bregel...

Health care reporter Emily Bregel has worked at the Chattanooga Times Free Press since July 2006. She previously covered banking and wrote for the Life section. Emily, a native of Baltimore, Md., earned a bachelor’s degree in American Studies from Columbia University. She received a first-place award for feature writing from the East Tennessee Society of Professional Journalists’ Golden Press Card Contest for a 2009 article about a boy with a congenital heart defect. She ...

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