28% of Calif. Hospitals Had Worse-Than-Expected Infection Rates

California is one of 13 states and Washington D.C. where more than 25% of hospitals had higher-than-expected infection rates for at least one of six infections, according to a Kaiser Health News analysis of available CDC data, Kaiser Health News reports.

Background

About one in 25 hospital patients in the U.S. have a health care-associated infection on any given day, and 75,000 U.S. residents die from hospital-related infections annually, according to KHN. The federal government since 2012 has been publishing hospital-related infection rate analyses on Medicare's Hospital Compare website. In addition, Medicare in the fall will begin factoring hospital-related infection rates into reimbursement payments (Rau, Kaiser Health News, 10/21).

Analysis Details

For the analysis, KHN analyzed CDC data from reports submitted by more than 3,000 hospitals on:

• Catheter-associated urinary tract infections;
• Central line-associated blood stream infections;
• Infections from the antibiotic-resistant germ Clostridium difficile, or C. diff;
• Infections from the antibiotic-resistant Methicillin-resistant Staphylococcus aureus, or MRSA.
• Surgical site infections from abdominal hysterectomies; and
• Surgical site infections from colon surgery.

The hospitals were rated as having infection rates that were better, as expected or worse based on the hospital type and patient mix. The MRSA and C. diff infections were contracted between Jan. 1, 2013, and Sept. 30, 2013, while the other infections were contracted between Oct. 1, 2012, and Sept. 30, 2013 (KHN analysis, 10/21).

Analysis Findings

KHN found that 695 U.S. hospitals had reported rates that were higher than expected for one or more of the six infections. Further, researchers found that 25% or more of hospitals had worse-than-expected infection rates in 13 states and Washington, D.C. California was one of the 13 states, with 28% of hospitals reporting at least one worse-than-expected infection rate.

In addition, KHN found that seven hospitals were determined by CDC to have worse-than-expected infection rates in four of the six categories, including the highly regarded:

• New York-Presbyterian Hospital;
• Pennsylvania-based Geisinger Medical Center; and
• University of Michigan Health System.

Meanwhile, the analysis found that some major teaching hospitals generally had lower-than-expected infection rates, including:

• Denver Health Medical Center;
• Duke University Hospital; and
• Mayo Clinic's hospitals.

Reaction

Some of the hospitals contested CDC's data. Some hospitals said their infection rates appeared higher because they worked harder to identify and report the infections or as the result of the hospitals admitting more patients who were prone to contracting infections.

Patient safety expert Kevin Kavanagh said the hospital-related infection rates were the result of many hospitals not strictly following infection disease treatment protocols and a lack of specificity in the government's protocols. He added, "Right now there are too many recommendations on how to handle infectious diseases" and there is "too much leeway" on adhering to the recommendations.

Don Goldmann -- chief medical and science officer at the Institute for Healthcare Improvement and co-author of a 2011 New England Journal of Medicine study on hospital-related infections -- said, "The percentage of time that health care providers do all of the things they are supposed to do when caring for a patient with a contagious disease can be pretty low."

Goldman added that many hospitals are more likely to follow protocols when addressing rarer ailments such as Ebola, but that "[w]hen [an infection risk has] been around for a long time, it kind of becomes part of the background" (Kaiser Health News, 10/21).