Wyoming Medical Center offers some insight into how it compares with hospitals nationwide
ALLISON RUPP Star-Tribune staff writer | Posted: Tuesday, April 10, 2007 12:00 am
Hospitals are fighting a war they can't win when they take on hospital-acquired infections, said Dr. Mark Dowell, infectious disease physician in Casper.
But, he said, Wyoming health care providers must hit "the battlefield" every day to try to prevent as many infections as possible.
"It's tough," said Dowell, head of infection control at the Wyoming Medical Center. "Every time we create a new antibiotic, the bugs find a way around it. If we are not aggressive every day, the day will come when we have organisms we can't treat."
Dowell is proud of how the medical center has responded to the increasing number of antibiotic-resistant organisms and stepped up its prevention efforts as people have become more aware of the dangers of hospital infections.
Any hospital that says it does not have infections is lying, Dowell said.
Still, it is difficult for patients to find exact infection rates and learn just how well WMC and other hospitals in the state are doing. Hospitals in Wyoming are not required by the state or federal government to make their rates public.
There is a nationwide push to require hospitals to report their infection rates to the public to allow patients to make a more informed decision about their health care.
About two million people in the United States contract a hospital infection each year and 90,000 of them die, estimates the Centers for Disease Control and Prevention show.
According to Consumers Union, the publisher of Consumer Reports, 14 states have passed laws mandating the reporting of hospital infections and others are looking at similar laws.
Wyoming has not looked into such a law, said Dan Perdue, president of the Wyoming Hospital Association. He said he could not think of a time when infection rates were ever discussed in the legislative arena.
Pennsylvania took a step forward in November 2006 when it reported that more than 19,000 hospital infection cases occurred in the state in 2005. This brought the issue of hospital infections to the forefront of providers' and patients' minds.
Wyoming health officials said infections are not an urgent problem here.
Tracy Murphy, state epidemiologist, said there have been only three or four infection outbreaks - where multiple people get an infection - at Wyoming hospitals in the past four years.
"The hospitals here by and large do a good job," Murphy said. "There are measures in place to keep (rates) low."
Jean McLean, manager of the Office of Healthcare Licensing and Surveys in the Wyoming Department of Health, said hospitals in the state are required to have an infection control program, hire someone to be in charge of the program and track infection rates, though they are not required to report those rates to anyone.
"Hospital infections are not the biggest problem in Wyoming," McLean said. "They are serious, but we don't track them. They come up with their own system.
"Generally, hospitals want to do it right," McLean said.
Many types of infections
Hospital infections include surgical-site infections, hospital-acquired pneumonia, blood stream infections and catheter infections.
An example of a hospital infection is methicillin-resistant Staphylococcus aureus (MRSA), a skin infection that is resistant to several types of antibiotics.
MRSA is "a really big deal," said Alice Lynch, infection control nurse at WMC.
Emily Jennings, a registered nurse at WMC, said MRSA is fairly common in the progressive care unit, a step down from intensive care.
"Right now, I have two patients with MRSA," Jennings said Thursday morning. "There are some days when we don't have any."
She did not disclose if these patients contracted MRSA from the hospital or came to the hospital with the staph infection.
Dowell said 54 to 70 percent of all staph infections in hospital labs nationwide are MRSA infections. At WMC, only about 29 percent of staph infections that come through the lab are MRSA.
However, he did not differentiate between which infections originated from the hospital and which were community-acquired.
Without releasing exact statistics, Dowell said there is not one type of surgery at the medical center that causes infections at a higher rate than national averages. The hospital tracks infections by type of surgery and by surgeon.
He said he is concerned with the hospital's rate of hospital-acquired pneumonia, though.
"This number is a little higher than I want," Dowell said. "People across the country are struggling with this. We are always looking at ways to improve."
No way to compare
Lynch would not disclose exact rates of infection at the medical center. She and her colleagues were worried about releasing this information to the public, because there is no state or national standard to compare these rates to.
She did say one percent or less of patients who undergo surgery at the medical center acquire a surgical-site infection and central line infections and catheter infections also have low rates.
When asked if hospital infection rates should be available to the public, Lynch said, "Yes and no."
"Unless you really understand that rate and how it is calculated, it can be really misleading," Lynch said.
Dr. Dale Bratzler, the medical director of Oklahoma's quality improvement organization, visited three Wyoming hospitals, including WMC, earlier this year to offer suggestions in prevention.
"I am a little skeptical of infection rates," Bratzler said. "No two hospitals capture the data in the same way."
He said there were some hospitals in Pennsylvania that reported they had no hospital infections during the 2005 year. He said this was impossible.
He said a hospital that does detailed reporting might have a higher infection rate, even though the hospital is doing everything right.
A hospital that takes care of a lot of patients with gunshot wounds will have a higher infection rate because of the nature of the injury, he said.
Lynch said the publishing of hospital infection rates would be beneficial, because it could open the door for physicians and patients to talk about the risk of infections.
"If your numbers are out there in the public, you are going to want them to be good," Lynch said. "You're going to want what is best for the patient."
Data led to improvement
The only data available to the public regarding infections in Wyoming is the percentage of patients who receive antibiotics one hour before incision. Giving antibiotics within this window significantly reduces the risk of a surgical-site infection, Lynch said.
These statistics can be found at www.hospitalcompare.hhs.gov.
Bratzler said he was surprised to see how infrequently several of the hospitals in Wyoming were administering antibiotics before surgery based on the data from April 2005 to March 2006.
Only 63 percent of patients at WMC and 37 percent of patients at the Cheyenne Regional Medical Center received antibiotics according to this data. The national average for the same time period was 75 percent.
Both Lynch and Joan Ivaska, director of epidemiology at the Cheyenne hospital, said the data were outdated and the hospitals have worked hard over the past year on this.
"It showed us there was a problem and where it was," Lynch said. "We had documentation issues."
Lynch said many more patients were receiving antibiotics than the numbers showed. Doctors and nurses were not documenting properly.
From October 2006 to December 2006, more than 80 percent of patients at both the Cheyenne and Casper hospitals received antibiotics before surgery, according to data Ivaska and Lynch are submitting to the federal government.
The two hospitals report and publish these rates because they are part of a U.S. Department of Health and Human Services project about improving care through information
Participation in this project is voluntary, said Jan Bloom, office director for Mountain-Pacific Quality Health Foundation, Wyoming's quality improvement organization.
All Wyoming hospitals, including the smaller critical access hospitals, report data on the hospital compare Web site, Bloom said.
"They are the only state that can say that," Bloom said. "The critical access didn't have any incentive to report, but they felt like it was the right thing to do. It's a statement to their commitment to quality."
Bloom said the number of measures that are publicly reported will continue to increase.
For example, Lynch said WMC is in the process of trying to get data out to the public on the usage of clippers to remove hair before surgery. Using a razor is associated with higher infection rates.
Dowell said the Casper hospital is hiring more staff for data collection. He is hoping to find where the infection control system is breaking down and where the hospital can improve.
Dowell said in the future more statistics about hospital safety will be available on national consumer Web sites.
"We are collecting the data now and getting a realistic picture of the numbers," he said.
Contact health reporter Allison Rupp at (307) 266-0534 or allison.rupp@casperstartribune.net.
For more on this story, click here to find out what hospitals are doing to prevent infections, and click here to find out what you can do before surgery to avoid infections. Also, click here to learn how the rise of antibiotics has hindered infection control.