Highly regarded Cedars Sinai Medical Center got a poor score recently for its efforts to prevent two types of infections among its patients last year, according to an annual report card released by the Centers for Disease Control and Prevention.
Cedars is far from alone; a number of local hospitals earned low scores in at least two infection categories, including Ronald Reagan UCLA Medical Center in Westwood, St. Vincent Medical Center and White Memorial Hospital in Los Angeles.
Hospitals that received poor grades say preventing infections is a complex challenge; they point out that many factors contribute to their infection rates, including the population they serve and what type of care they provide, especially if they provide a lot of specialty care.
The CDC's latest report card, which lists its scores by hospital, covered the period between late 2012 and late 2013. It rates hospitals on their management of six different types of infections.
According to the CDC, one out of every 25 people hospitalized in the U.S. gets an infection, and of those, 75,000 die. In California the rates are a bit lower, said Julianne Morath, president of the Hospital Quality Institute in Sacramento.
The CDC uses a formula to predict how many infections hospitals will have, and "and consistently California has less than predicted infections,” she said, "with one exception: the catheter acquired uterine tract infection."
Cedars Sinai in Los Angeles – prominent not only in California but nationwide – got a couple of bad grades for its rates of the catheter related infection known as CAUTI, and an intestinal infection called C. Diff. The hospital ranked better than the national average in two categories, and the same as the national average in the other two.
There are several factors that play a role in the rates of infection, said Dr. Rekha Murthy, Cedars' director of epidemiology.
"The data that is reported publicly doesn’t necessarily always reflect the complexity of the patient population that is served," she said. At Cedars, "a high proportion are elderly, over a third are over the age of 65 and even a third of those are over 85, which is significantly higher than other comparable medical centers," Murthy added. "These elderly patients are at higher risk than other populations for these two types of infection, not only because of chronic diseases but because of depressed immune system."
Murthy also pointed to Cedars' complex care, from organ transplants to neurosurgeries, as factors in the rates of infection.
Regarding catheter infections, Murthy said doctors and nurses are hyper vigilant about whether a patient needs a catheter, and for how long. Another factor that boosted the rates last year, Murthy said, were new CDC reporting guidelines.
The CDC altered the requirements for reporting CAUTI’s in January 2013, said Katherine Allen-Bridsen, team leader in the CDC’s division of health care quality promotions surveillance branch. Under the new rules, anytime a patient has a fever and a urine culture that tests positive for bacteria - which does not necessarily indicate an infection - a hospital must report the results to the CDC.
Fevers can be brought on by illness or other types of infection, said Murthy, so Cedars has changed when and how often its staff orders urine cultures. She said the hospital's rates of catheter infection have dropped by half or more over the past year.
C. Diff is an infection that shows up in the intestinal tract, and its resistance to antibiotics makes it difficult to treat. So Cedars staffers are being prudent about antimicrobial use, Murthy said.
Another part of the fight against infections is ensuring they don’t spread in the hospital from patient to patient. For this, Cedars has instituted some simple but important housekeeping efforts, she said.
The job of cleaning computer keyboards became someone’s direct responsibility, noted Murthy, adding that cleaning staff now spray the edges of privacy curtains and replace them regularly with detachable curtains that have an antimicrobial coating.