The New Health Dialogue

The latest Illinois Hospital Report Card and Consumer Guide to Health Care identifies nine hospitals that fell behind in keeping their hospital acquired infection (HAI) rates at or below the national average in 2009. Judith Graham of The Chicago Tribune followed up with each hospital, to ask them about the infection rates -- what happened, and what are they doing to fix the problem?

Many of the hospitals acknowledged the problem but blamed out of date, inaccurate, or overzealous reporting for the high infection rates. (In fairness, Pennsylvania’s experience shows that when reporting programs get off the ground, the hospitals that are aware, honest about, and working to solve the problem may start out with the highest numbers.) Illinois, along with 27 other states, requires that all hospitals report their rates of hospital acquired infections. Specifically, according to the report card, Illinois hospitals must use the Centers for Disease Control’s National Healthcare Safety Network (NHSN) reporting system to disclose their rates of central line associated bloodstream infections (CLABIs). The safety network also tracks HAIs and other adverse health care associated events.

To respond to the problem, the hospitals on the list are turning to procedural reviews. Most are utilizing a checklist -- a standard set of steps for each procedure health care workers perform. In this case, a list of the steps that should be followed precisely each time someone places a central line IV in a patient. So long as health care workers are willing to comply, checklists are a simple, low cost, and effective tool for improving patient care and safety. Thorek Memorial Hospital in Chicago, which had the highest rate of HAIs in 2009 (22 ICU infections), re-evaluated and updated its checklist, and instituted a follow up program to make sure central lines are properly maintained and removed when they are no longer needed. So far in 2010, they’ve only had one infection.

Other strategies used by the hospitals include more staff training and empowering nurses to speak up when guidelines are ignored or overlooked, using special chemical antiseptic sponges or antibiotic coated needles at the central line IV insertion site, and making sure patients aren’t in the ICU longer than necessary. Institutions operated by St. James Hospital and Health Centers clarified who is accountable for how long an IV stays in the patient -- because multiple doctors are often involved in caring for one person, St. James specified that the primary care physician is responsible for monitoring the patient and making sure the IV comes out when it is no longer necessary. As in the ICU, the longer the patient has an IV in, the greater the risk of infection.

Illinois applied for and was granted funding from the American Recovery and Reinvestment Act of 2009 (aka the economic stimulus package) intended to help reduce hospital acquired infections. Over the next five years, the state plans to fight HAIs (focusing on CLABIs, C-diff, and MRSA) with a strategy that relies heavily on increased reporting of infection rates and progress goals. According to the Illinois Hospital report card website, their goals are to:

1. Expand Illinois HAI surveillance, detection and reporting. This includes expanding state-wide reporting of HAIs in hospitals through the National Health Safety Network surveillance system.  Effective surveillance is essential to HAI identification and monitoring.

2. Enhance development of automated HAI laboratory and surveillance reports. This will foster accurate monitoring of HAIs and reduce the work burden placed on health care infection prevention workers.

3. Establish a Clostridium difficile quality improvement collaborative at 20 hospitals across the state. Quality Improvement collaboratives help health care systems and workers implement infection reduction practices. (Read more about hospital collaboratives.)

4. Measure progress towards targets for infection reduction using NHSN data as well as evaluate and share lessons learned from the C difficile collaborative.

A complete, interactive list of Illinois hospitals and infections rates is available here. The Chicago Tribune article also caught the attention of Paul Levy, president and CEO of Beth Israel Deaconess Medical Center in Boston. On his blog, Running a Hospital, Levy suggests that Massachusetts hospitals should voluntarily start reporting infections, to hold each other accountable for patient safety standards and to demonstrate how serious hospitals are about fighting hospital acquired infections.