Boulder Community Hospital Disputes Consumer Reports Story on Infection Rates
February 15, 2010
Boulder Community Hospital disputes Consumer Reports story on infection rates
BCH using strategies to prevent deadly central-line infections
By Laura Snider Camera Staff Writer
Posted: 02/01/2010 06:14:27 PM MST
Colorado's report on hospital-acquired infections
Preventing hospital infections
Researchers at Johns Hopkins University developed a simple five-step checklist that health care workers in intensive care units can follow to reduce infections related to central lines -- intravenous catheters that provide patients with medicine, nutrition and fluids.
When the checklist was tested in Michigan, hospitals saw a 66 percent decrease in central-line infections, saving more than 1,500 lives and $200 million over 18 months, according to the researchers.
Here's a look at what the checklist asks caregivers to do:
Wash their hands using soap and water or alcohol gel before and after examining the patient or managing the catheter.
Disinfect the patient's skin using a 2 percent chlorhexidine-based preparation or other appropriate antiseptic before inserting the catheter and during catheter dressings and changes.
Use full-barrier precautions, which include wearing a mask, cap, sterile gown and sterile gloves when inserting the catheter.
Avoid placing the catheter in the groin, if possible, because the groin area is difficult to keep clean.
Remove unnecessary catheters since the risk of infection increases the longer the catheter is in place.
Boulder Community Hospital has 129 percent more infections than average among patients being treated with the help of intravenous central lines, according to an analysis in the March
Beth Fischer Reasoner, Boulder Community Hospital s manager of infection prevention and employee health, holds central-line insertion kit used to help staffers remember to use sterile techniques when inserting intravenous lines. ( PAUL AIKEN )issue of Consumer Reports.
But officials from Boulder Community disputed the accuracy of the data used by the magazine and called the article's conclusions misleading.
Bloodstream infections introduced through central lines -- which are inserted into a major vessel of the heart to deliver medication, nutrition and fluids to people in intensive care -- are some of the most deadly. Only 15 percent of all hospital infections are caused by central lines, but 30 percent of all hospital-infection-related deaths are caused by them, according to Consumer Reports.
"We know from very good research -- from the successes of at least 100 hospitals (that had no infections in 2008) -- that these are very preventable infections," said John Santa, M.D., director of the Consumer Reports Health Ratings Center. "These infections are the responsibility of the hospitals and doctors that put the lines in. Patients don't do anything to cause these infections."
Consumer Reports reviewed data for 28 Colorado hospitals that was provided largely by The Leapfrog Group, an organization that collects information from voluntary hospital surveys. Based on that data, the magazine found that Boulder Community had the highest infection rate: seven infections per 1,841 "central-line days" in 2008.
Hospitals in Colorado are also required to submit their central-line infection rates to the state. The latest report of those rates, which was released Jan. 15 by the Colorado Department of Public Health and Environment, shows that Boulder Community had only three central-line infections from Aug. 1, 2008, to July 31, 2009. The hospital also reported three infections during the same period the year before.
Boulder Community officials said they had no idea why Leapfrog's numbers didn't match the hospital's records, and they're following up with Consumer Reports to understand the discrepancies.
In the state report, 11 other hospitals had a central-line infection rate that was the same or worse as Boulder Community's.
"As this situation demonstrates, trying to simplify a complicated situation even if you've got the best intentions, can lead to misleading conclusions," said Rich Sheehan, spokesman for Boulder Community.
Santa acknowledged that the newly released state data puts the hospital in a better light, but Consumer Reports used the Leapfrog data because it was the most current information available when the magazine's analysis was conducted.
"Leapfrog was reporting data for the calendar year 2008," he said. "When this story went to press, that was the latest data we had."
Regardless of the numbers, Consumer Reports contends that there shouldn't be any central-line infections.
The infections are "almost completely preventable," the magazine says, if hospitals follow a relatively simple routine that involves a five-point checklist, asking caregivers to wash their hands and disinfect a patient's skin.
Continually emphasizing these relatively straightforward sanitary measures is key to keeping the deadly infections at bay, Santa said.
"I don't think that there's any hospital in the United States that doesn't have a protocol that says, 'wash your hands, use sterile techniques, only put your lines in as you need them and take them out as you don't need them,' " he said. "The problem is it's not a priority. People are doing all of these important things every time."
Beth Fischer Reasoner, who manages infection prevention at Boulder Community, said the hospital has made these types of procedures a priority.
Not only has it adopted the five-point checklist mentioned in the Consumer Reports article, but Boulder Community also has a task force dedicated to tackling these kinds of infection issues. The hospital has also created a central-line insertion kit, which is used every time a line is put in to help staffers remember to use sterile techniques.
"It's a battle, and we have a very strong program in place to prevent infections specifically with central lines," Reasoner said. "We're always striving for zero. There's a lot of controversy out there about whether zero is truly attainable. I'm not sure that we're prepared to make an argument one way or the other, but zero is our goal."
Two other Boulder County hospitals were included in the Consumer Reports study. Longmont United Hospital had 56 percent fewer infections than average in 2008 and Exempla Good Samaritan reported no central-line infections, according to the magazine.
Contact Camera Staff Writer Laura Snider at 303-473-1327 or email@example.com.
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