When Hospitals Make You Sick

Becky Jungbauer

Date: 23 September 2008 Time: 07:57 AM ET

COMMENTARY

This story caught my eye because of the 'ew' factor, so naturally I wanted to share my newfound fear of catheters (which already took up a healthy amount of time during my daily phobia-pondering) with you all. Misery loves company, so I assume that stands true for other negatively connotated emotions like disgust, fear of microbes, etc.

After the Government Accountability Office suggested at an April hearing that more work and leadership is needed to protect patients against central line-associated bloodstream infections, the Committee on Oversight and Government Reform, chaired by Rep. Henry Waxman, D-Calif., surveyed state hospital associations to assess the incidence of CLABSIs. (CLABSIs result when large catheters inserted into veins in hospitalized patients become infected.)

How big of a problem is this? Well, CDC says that hospital-associated infections are one of the top ten causes of death in this country. Ouch. CDC estimated that in 2002, there were "approximately 1.7 million hospital-associated infections that resulted in approximately 99,000 deaths, caused substantial morbidity and suffering, and cost our nation billions of dollars."

What's even worse, in my mind, is that these infections are preventable. We're not talking rocket science, people - washing your hands seems to be pretty effective, and is something health care practitioners should be doing anyway.

14 out of 51 = major 'ick' factor

The report summarizing the survey results, released Sept. 22, found that "despite strong evidence of effectiveness, only 14 state hospital associations reported adopting or planning to adopt the program to reduce CLABSIs used by the Michigan Hospital Association and Johns Hopkins University."

Those of you residing in or planning a vacation to the following states can breathe a little easier: California, Michigan, Missouri, New Jersey, New York, North Carolina, Ohio, Oklahoma, Rhode Island, South Carolina, Tennessee, Vermont, Virginia, and West Virginia. (Those not on the list, don't despair quite yet - I'll get to you in a few minutes.)

And yes, the committee did try to survey D.C., where I currently reside and by coincidence just had the (mis)fortune to visit one of the capital's fine hospitals, but D.C. did not respond.

Anyway, the report says that "if all state hospital associations were to implement the MHA/JHU program and achieve the same results, as many as 15,680 additional lives and as much as $1.3 billion could be saved each year." That's a lot of lives, and a lot of money. That money would give us anywhere from a few days to a week more in Iraq, depending on which monthly spending figure you believe. But I digress.

The report continues, "CLABSIs are almost entirely preventable if hospitals follow certain procedures. The current CDC guidelines for preventing catheter-related infections include 111 practice recommendations, of which 39 are 'strongly recommended.'" Five simple and inexpensive practices that reduce catheter infections, listed in the report, include: handwashing (again - shouldn't this be happening anyway?); full draping of the patient (yes, privacy, please); cleaning the skin with proven cleansers (so just a quick rinse in the atrium fountain ain't gonna do it?); avoiding catheters in the groin if possible (yes, please); and removing catheters as soon as possible (why in the **** would you keep them in longer than necessary???).

There is evidence, of course, that the MHA/JHU program works: in 2003, Michigan adopted the JHU program state-wide, including participating in conferences and receiving data support. Within 18 months, according to Waxman's report, "the rate of CLABSIs in Michigan intensive care units dropped by 66 percent. The typical hospital (the median performers) virtually eliminated these infections and outperformed more than 90 percent of hospitals nationwide. The MHA estimates that during this 18-month project, they saved more than 1,729 lives and over $246 million, before taking into account the costs of administering the program."

How did some of the other states stack up? The average rate - how many patients are experiencing CLABSIs - and/or the median rate - success of the typical hopsital in the state - are listed below, for central line infections per 1,000 central line days:

• Iowa: average rate of 2.1
• Maine: average rate of 2.3
• Michigan: average rate of 1.4, median rate of 0.0
• Missouri: average rate of 2.3, median rate of 1.4
• Nebraska: average rate of 1.5, median rate of 0.0
• New Hampshire: average rate of 2.4, median rate of 0.0
• Rhode Island: average rate of 1.8
• South Carolina: average rate of 2.6, median rate of 1.5
• Tennessee: average rate of 1.7, median rate of 0.0
• Vermont: average rate of 2.4 for hospitals with a medical ICU, average rate of 2.0 for hospitals with a surgical ICU, average rate of 0.0 for hospitals with combined medical/surgical ICUs, median rate for all hospitals of 0.0
• Virginia: average rate of 2.1, median rate of 1.4

The report notes that it is possible for a state with a median of zero to still have a relatively high average rate if a few hospitals have a significant number of infections. Such a situation, they say, would suggest the need to focus resources on a few problem locations only.

Surge in biohazard suit sales seen in 34 states

All right, non-CLABSI participating states - the good news is that every state hospital association reported that it was "engaged in some activities to reduce hospital-associated infections, such as efforts to reduce ventilator-associated pneumonias and surgical site skin infections." Good to know. I was surprised that my home state of Minnesota, which consistently ranks at the top of the pile in health care, wasn't on the list.

I read MN's response, and was happy to see that indeed the hearty Midwesterners are engaged in a number of activities to reduce and prevent infections, just not the MHA/JHU program specifically.

If this program works so well, why doesn't everyone adopt it? The report says that the Agency for Healthcare Research and Quality provided the MHA/JHU program with a cool million bucks over a period of two years. As such, many hospitals apparently expressed interest in operating a similar program but cited lack of funding (federal or private) as a barrier.

So, should you require a catheter in the future, take a copy of the five simple practices listed above and don't let anyone touch you until they've committed the list to memory.

FAQs on CLABSIs, from the Michigan Health & Hospital Association: click here.
Presentation from the 2007 AHRQ annual conference on preventing CLABSI: click here.
CDC's site on: CLABSIs, click here; healthcare-associated infections, click here.

Becky Jungbauer blogs for ScientificBlogging.com.