New Yorkers at High Risk of Hospital Infections
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New York hospitals are being urged to adopt more aggressive anti-infection measures after a report showing that patients undergoing surgery in 2007 at facilities in New York State developed infections at a rate higher than the rest of the country.
In the report released yesterday, the state’s Department of Health found that in surgical intensive care units, the rate of infections associated with a kind of intravenous hookup called a “central line” was 3.7 for each 1,000 days that patients had such a hookup. The national rate in 2007 was 2.7 infections for each 1,000 days, meaning that New York patients had a 37% greater chance of infection than the national average. A central line is a tube into a major vein that allows doctors to administer medication or monitor the patient’s condition.
The infection data, which did not include hospital-specific information, was publicized in compliance with a 2005 law that required the state to track infection trends. Next year, health officials are expected to publicize infections rates by facility.
But some said yesterday’s report shows where hospitals need to improve.
“The only acceptable infection rate is zero, so hospitals that settle for being below average are dangerous places to be,” the founder of the Committee to Reduce Infection Deaths, Betsy McCaughey, said.
State health officials said they could not explain the disparity between infection rates in New York and the rest of the country. But they said in New York City, the rate of central line-associated infections was lower than the rate in upstate hospitals, and they said that upstate infection rates drove the statewide average higher.
In New York City, 2.8 out of 1,000 central lines at medical intensive care units resulted in infections, compared to 3.6 upstate. In the city, another 2.7 out of 1,000 central lines in surgical ICUs resulted in infections, compared to 4.8 in upstate facilities.
Officials credited a collaborative among 60 hospitals in the New York metropolitan area aimed at reducing hospital-acquired infections. According to the most recent data provided by the collaborative, which was established in 2005 by the United Hospital Fund and the Greater New York Hospital Association, the rate of central line infections was 2.33 infections for each 1,000 central line days as of December 2007, down from 4.98 infections for each 1,000 central line days in June 2005.
But Ms. McCaughey said the data shows room for improvement. She criticized the state for leaving infections off a list of preventable hospital errors that the state’s Medicaid program will no longer pay for starting in October. She compared the state policy unfavorably to a federal policy announced last summer by the Center for Medicare and Medicaid Services, which will not reimburse hospitals for infections and other preventable hospital errors. “Medicaid has a responsibility to use its purchasing power to pressure hospitals to eliminate infections,” Ms. McCaughey said. “New York taxpayers should not be paying to treat infections that shouldn’t happen.”
A spokeswoman for the state’s health department, Claudia Hutton, said the new Medicaid policy does not include infections in the list of errors it would not pay for because that initiative was concentrated on the types of things that “never, ever should happen,” such as operating on the wrong patient or on the wrong body part. “Infections you want never to happen, but infections, there’s a more likely risk that they can happen,” she said.
In recent months, the city’s public hospital system has adopted an aggressive approach to dealing with hospital-acquired infections. In September, the Health and Hospitals Corporation began publicizing infection and death rates at its 11 hospitals. In May, HHC reported a 55% drop in the rate of central line bloodstream infections, which fell to 3.4 from 7.6 in 2005.
HHC officials credited the adoption of “best practices” in intensive care units, as did officials speaking on behalf of the collaborative established by The United Hospital Fund and the Greater New York Hospital Association.
“We knew it was a problem, we knew it led to morbidity and mortality, and we knew there was something you could do about it,” the director of health care finance at the United Hospital Fund, Sean Cavanaugh, said of the group’s initial focus on central line infections. The collaborative now targets other infections and other preventable hospital events.
Officials at one participating hospital, the Beth Israel Medical Center, said its medical and surgical facility in Brooklyn and the cardiac intensive care unit at the Petrie Campus in Manhattan have gone 1,000 days without a central line-associated infection as of Monday. “We want to be a hospital that has zero infections, that’s the goal,” Beth Israel’s chief of infection control, Dr. Brian Koll, said.
Dr. Koll said the public reporting of infection rates would push hospitals to act on the data when they see varying levels of performance. “It’s going to have to be, ‘Drill down a little more,'” he said. “We all will admit health-care acquired infections are a problem,” he said, adding that hospitals that perform below average will seek to improve, and hospitals doing better than average will want to be the best.