As part of its new hospital ratings, Consumer Reports has reported that some well-established teaching hospitals have higher rates of central-line-catheter-related bloodstream infections (CRBSIs) than the national average. Three Council of Teaching Hospitals members received the magazine's lowest rating, and 64 received its second-lowest rating for infection prevention.
The Association of Professionals in Infection Control and Epidemiology has challenged the findings as only a partial picture of a complex problem.
"We understand that the data are aggregated, but there are issues with the aggregation," says Carolyn Chrisman, BBA, vice president for quality integration and improvement at Carilion Clinic, whose Roanoke, Va.-based Carilion Medical Center was one of Consumer Reports' second-lowest-rated teaching hospitals, with a rate that it reported was 24% worse than national rates for its mix of ICUs in calendar year 2010. "One of the biggest issues is that the type of patients seen in Level One trauma centers such as ours is very different. We work hard to follow the guidelines, but some of these patients are just more compromised."
Checklists for preventing CRBSIs are widely used in U.S. hospitals and have been shown to reduce infection rates. "But that's only part of the story. What about care and maintenance of the central line after it is inserted, which we're trying to focus on here?" Chrisman says.
At Carilion, a quality team was chartered in 2007 to address BSIs, and that group is planning to reconvene. Having the right supplies readily available when needed for central-line insertions is another challenge, and Carilion has developed carts and kits to help make sure that they are, Chrisman adds. "We also have data from 2011 that show significant improvement" over the 2010 data reported by Consumer Reports, she says.
Bradley Flansbaum, DO, MPH, FACP, director of the hospitalist program at Lenox Hill Hospital in New York City, another teaching hospital on Consumer Reports' lower-performing list for BSIs, with a rate that was 75% worse than national rates for the hospital's mix of ICUs, notes the benchmark has been set high for hospitals. “Some institutions have shown zero bloodstream infections, so the question of what's acceptable has been established. We know what we need to do," he says.
But achieving zero infections is more than just following the checklists, he adds. Ultimately it requires a change of hospital culture, even around issues as mundane as poor hand hygiene, against which all hospitals struggle, he says.
For more information on preventing BSIs, visit the Institute for Healthcare Improvement's Five Million Lives Campaign.