Clinical laboratory professionals and pathologists are part of multi-disciplinary efforts to curb healthcare-associated infections
One interesting fact about a national list of hospitals that rank highest in infection prevention is that they are mostly smaller and non-teaching hospitals. This was one finding from a recent survey conducted by Consumer Reports.
The survey tracked MRSA (methicillin-resistant Staphylococcus aureus), Clostridium difficile (C. diff) and other common bacteria that are the source of most healthcare-associated infections (HAIs). These are also known as nosocomial infections when referring specifically to hospital-acquired infections.
Government Surveillance for MRSA in Hospitals Spark Debate
Clinical laboratories play a key role in detecting and halting the spread of HAIs, which continue to generate widespread headlines and draw increasing attention from the federal government. Surveillance practices for MRSA in particular have been the subject of much debate, with some hospitals implementing routine MRSA screening.
“Hospital-acquired infections are infections that are not supposed to happen,” stated Larry Massie, MD, Chief of Pathology and Laboratory Medicine for the New Mexico VA Health Care System and a Professor of Pathology at the University of New Mexico. He was quoted in Cap Today Online. “This is even more relevant now that the Centers for Medicare and Medicaid Services (CMS) doesn’t reimburse for certain hospital-acquired infections. That’s putting a lot of pressure on hospitals to control this problem because they are not recovering the expenses they incur.”
Consumer Reports Best and Worst Facilities for Infection Control
Information issued by the Centers for Disease Control (CDC) notes that:
• There were 722,000 HAIs in acute care hospitals in 2011, with more than half of infections occurring outside of the intensive care unit (ICU);
• About 75,000 hospital patients died with HAIs during their hospitalization; and,
• Pneumonia, gastrointestinal illness, blood stream and surgical site infections are most common HAIs.
In its survey, Consumer Reports reviewed more than 3,000 hospitals and ranked the best and worst facilities for infection control. The magazine stated that it focused on MRSA and C. diff because the two infections “can be a red flag that a hospital isn’t following best practices in preventing infections and prescribing antibiotics. That could not only allow C. diff and MRSA to spread, but also turn the hospital into a breeding ground for other resistant infections that are even more difficult to treat.”
Highest-rated in infection prevention by Consumer Reports (listed in order of patient volume):
• Northwest Texas Healthcare System (475 beds), Amarillo, Texas
• Jupiter Medical Center (283 beds), Jupiter, Florida
• White County Medical Center (438 beds), Searcy, Arizona
• Centennial Hills Hospital Medical Center (171 Beds), Las Vegas, Nevada
• Biloxi Regional Medical Center (198 Beds), Biloxi, Mississippi
• Johnston Memorial Hospital (179 Beds), Abingdon, Virginia
• Lima Memorial Health System (248 Beds), Lima, Ohio
• Western Arizona Regional Medical Center (90 Beds), Bullhead City, Arizona
• South Baldwin Regional Medical Center (112 Beds), Foley, Alabama
Organizations that were lowest-rated in infection prevention (listed alphabetically):
• Brooklyn Hospital Center (464 Beds), Brooklyn, New York
• Decatur Memorial Hospital (188 Beds), Decatur, Illinois
• Floyd Memorial Hospital and Health Services (329 Beds), New Albany, Indiana
• Fremont-Rideout Health Group (233 Beds), Marysville, California
• Little Company of Mary Hospital and Health Care Centers (288 Beds), Evergreen Park, Illinois
• Mercy St. Anne Hospital (96 Beds), Toledo, Ohio
• Riverview Medical Center (476 Beds), Red Bank, New Jersey
• Rockdale Medical Center (146 Beds), Conyers, Georgia
• St. Petersburg General Hospital (219 Beds), Saint Petersburg, Florida
• The Charlotte Hungerford Hospital (72 Beds), Torrington, Connecticut
• UF Health Jacksonville (620 Beds), Jacksonville, Florida
• Venice Regional Bayfront Health (312 Beds), Venice, Florida
Teaching Hospitals Face Special Challenges
Consumer Reports investigators found that teaching hospitals and hospitals that are larger did not do as well as smaller and non-teaching hospitals. They acknowledged that this could be because teaching hospitals may do a better job of reporting infections or may see sicker patients who require more complex procedures. Yet even when data was adjusted to account for some of those factors, teaching hospitals still tended to do worse, they said.
“Yes, teaching hospitals face special challenges. But they are also supposed to be places where we identify best practices and put them to work,” observed Lisa McGiffert, Project Director of the Consumers Union Safe Patient Project. “Obviously, that is not happening as well as it should.”
Focus on Patient Safety and Infection Prevention Recipe for Success
Reid Health Hospital in Indiana, which according to the Consumer Reports’ study ranked among the nation’s top 16 hospitals for infection prevention, credits the hospital’s long-term focus on patient safety and infection prevention for its success in minimizing HAIs. To support protocols used to help keep infections from spreading, technology is used that alerts the infection prevention team when a medical laboratory test result is positive for a multi-drug resistant organism. Also, “secret shoppers” monitor hand-washing compliance.
“All staff are our infection prevention liaisons and take patient safety very seriously,” Greg Carter, Infection Control Practitioner for Reid Health, said in a statement. “We are a multi-disciplinary team that works closely with our physicians, pharmacists, lab team, environmental services and others to make Reid Health a safe and clean environment.”
CMS Incentive Programs and Penalties
Hospitals have been incentivized to reduce the spread of infections since the passage of the Affordable Care Act (ACA) in 2010, which established the Hospital-Acquired Conditions (HAC) Reduction Program. CMS last year penalized 721 hospitals for having high rates of infections and other patient injuries.
Kaiser Health News (KHN) reported that one out of every seven hospitals in the nation had their Medicare payments lowered by 1% during the fiscal year that ran from October 2014 through September 2015, accumulating penalties totaling an estimated $373 million.
Medicare rated hospitals on:
• Their frequency of central-line bloodstream infections caused by tubes used to pump fluids or medicine into veins;
• Infections from tubes placed in bladders to remove urine; and,
• Rates of eight kinds of serious complications such as collapsed lungs, reopened wounds and broken hips.
In its 2016 inpatient prospective payment system rule, CMS expanded the HAI program. Beginning in fiscal year 2019, populations covered by the Central Line-Associated Blood Stream Infections (CLABSI) and Catheter-Associated Urinary Tract Infections (CAUTI) measures will include medical and surgical ward locations, in addition to adult and pediatric ICUs.
Health researcher Eric Schneider, MD, Senior Vice President for Policy and Research at The Commonwealth Fund in New York, told KHN that proven methods for reducing medical errors and infections, such as:
• better hand hygiene;
• checklists on procedures to follow during surgeries; and,
• computer-generated physician orders rather than paper, are not routinely followed in many hospitals and clinics.
“There’s a pretty strong sense among the experts we talked to that they are not widely implemented,” he said. “Too many clinicians fail to use those techniques consistently.”
Upcoming Dark Daily e-briefings will feature profiles of pathologists and clinical laboratory professionals who are involved in successful HAI programs that have national recognition. The goal is to share best practices, lessons learned, and the most effective strategies that medical laboratories in hospitals are using to both reduce the incidence of hospital-acquired infections, as well as improve patient outcomes through better utilization of lab tests that shorten time to diagnosis and help inform the selection of antibiotics.
—Andrea Downing Peck