Wisconsin hospitals reduce central-line infections
By Guy Boulton of the Journal Sentinel
May 21, 2013
Painstaking work by Wisconsin hospitals in recent years has sharply lowered the occurrence of one of the most deadly types of infections: those from central lines used to deliver fluids, medication and blood to patients.
Infections in intensive care units from central lines — tubes placed in a large vein in a patient's neck, chest or arm — were 56% lower last year than a national baseline established in 2008, according to a report by the Wisconsin Division of Public Health.
That progress — which included a 21% reduction from 2011 — has stemmed from a series of initiatives since 2009 by the Wisconsin Hospital Association, as well as from projects by individual hospitals.
"In 2011, we really started seeing some dramatic decreases," said Kelly Court, chief quality officer for the Wisconsin Hospital Association.
"We are not just preventing infections," Court said. "We are saving lives." That's because for every 10 patients with a central line infection, one or two will die.
The work has been spurred in part by Medicare's publicly disclosing the infection rates at individual hospitals.
"There is a reputation cost for hospitals," said Clifford McDonald, a physician and medical epidemiologist with the federal Centers for Disease Control and Prevention.
Now that same scrutiny is being directed to two other types of healthcare-associated infections:
■ Methicillin-resistant Staphylococcus aureus, a type of staph bacteria commonly known as MRSA, resistant to certain antibiotics.
■ Clostridium difficile, known as c. diff, linked to an estimated 14,000 deaths a year in the United States.
Hospitals began reporting their rates for the two infections to the CDC this year. The information won't be public until next year.
Acute-care hospitals must report their infection rates to the CDC or receive lower payments from Medicare. Hospitals with fewer than 25 beds are exempt.
In addition to infection rates from central lines, rates for urinary tract infections associated with catheters and surgical site infections for colon surgery and abdominal hysterectomy by hospital are publicly available on Medicare's Hospital Compare website.
Wisconsin hospitals also have reduced the occurrence of infections from urinary tract infections, compared with the national baseline. These infections are more common but less deadly than central line infections.
Their performance on the two measures for surgical site infections is mixed, according to the report by the Wisconsin Division of Public Health. The infection rates for colon surgery are lower than the national baseline but higher for abdominal hysterectomy.
Many hospitals also have begun voluntarily giving the state information on their infection rates for hip and knee replacement surgery.
That information is not publicly available by hospital. But the Wisconsin hospitals reporting their infection rates — roughly a third of the hospitals that do the surgeries — overall had a lower rate for knee surgery and a higher rate for hip replacement surgery than the national benchmark, according to the state report.
The goal is to see how they compare to other hospitals, said Gwen Borlaug, coordinator of the health care-associated infection prevention program for the Division of Public Health.
The chances of getting an infection while hospitalized can be less than 1 in 2,000 at many hospitals. But the infections can be deadly, particularly for those from central lines.
For that reason, hospitals made reducing those infections a priority.
That requires adhering to precise procedures with unfailing consistency.
The Wisconsin Hospital Association program is largely based on the Comprehensive Unit-Based Safety Program, a checklist of sorts developed by Peter Pronovost, a physician and professor at Johns Hopkins Medicine, who showed that infections could be reduced to almost zero by meticulously following standardized procedures.
"There are a few key things you have to do every time," Court said.
That takes work.
Emphasizing hand-washing — one of the basics in preventing infections — sounds simple. But it means that a nurse must wash hundreds of times a day.
To bring a pitcher of water to a patient, a nurse must wash his or her hands before picking up the pitcher — and then again when leaving the patient's room, Court said.
Court cited Aurora Health Care as a health system that has made impressive progress in reducing infections.
In the fourth quarter of last year, Aurora did not have a central-line infection in any of the 14 intensive care units at its hospitals, said Kathy Leonhardt, a physician and vice president of patient experience and patient safety.
The health system has participated in a number of programs to reduce infections and standardize its procedures. But Leonhardt, too, said that the real challenge is creating the right culture within a hospital.
The underlying complexity of the statistics on infection rates prevents state comparisons. But McDonald of the CDC said that Wisconsin's rate of central-line infections and its progress against the national benchmark make it one of the better-performing states.
Wisconsin and other states are making slower headway in reducing infections from urinary catheters.
"We are making progress," McDonald said. "In some areas, we are making less progress than we would like."
Now the focus will include reducing infections from MRSA and c. diff. Both could be challenging. Infections from c. diff, which causes diarrhea, continue to increase.
"We have a lot that works," McDonald said. "We have a lot that could work that hasn't been implemented yet."
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