Central-line bloodstream infections rate vary in San Francisco hospitals

Feb 2 2010

Hospitals in San Francisco vary dramatically in terms of how well their intensive care units (ICUs) prevent central-line bloodstream infections, a cause of death, disability, and expense in our nations' hospitals that is largely preventable.  On February 2, www.ConsumerReportsHealth.org will post hospital infection rates for 29 Bay area hospitals, including six in San Francisco, along with other critical patient safety and satisfaction information for consumers.  Bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central-line infection.

In San Francisco, three out of six hospitals reported zero central line infections: St. Luke's Hospital, Saint Francis Memorial Hospital, and St. Mary's Medical Center.   California Pacific Medical Center-Pacific Campus reported an infection rate that's 43 percent better than average, meaning there were 43 percent fewer infections than the U.S. average for its mix of ICUs.   Kaiser Foundation Hospital- San Francisco reported an infection rate that's 40 percent better than average.   The infection rates are for 2008.

On the other end of the spectrum, UCSF Medical Center reported an infection rate that's 80 percent worse than the national average for its mix of ICUs.   In the larger Bay Area, where Consumer Reports Health rated 29 hospitals, Consumer Reports found extreme variation between hospitals, even hospitals run by the same health care system.  For example, Kaiser Foundation Hospitals in Hayward, Santa Rosa, Vallejo, and South San Francisco reported zero central line infections, while Kaiser Foundation Hospital in San Jose had an infection rate that was 14 percent worse than the national average and the Kaiser Foundation Hospital in San Francisco reported a rate that's 40 percent better than average.    

"Infection rates can vary widely from hospital to hospital and even within the same hospital chain or system," said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center.  "Providing patients with infection rate information enables them to identify which hospitals are making patient safety a priority and which ones are not."  According to a related investigative report in the March issue of Consumer Reports, of the 926 U.S. hospitals whose infection rates were analyzed by Consumer Reports Health, 105 hospitals tallied zero central line infections (listed online at www.ConsumerReportsHealth.org).  

"All hospitals should be aiming for zero infections," said Santa.  "The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections," continued Santa.    

The Consumer Reports online ratings are based on hospitals that publicly report their infection rates as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit, works with large employers and purchasers of health care to measure and publicly report on hospital safety and quality in 41 states in the U.S. (www.leapfroggroup.org).  Citizen activists, including those working with Consumers Union, the nonprofit publisher of Consumer Reports, have helped enact laws in 27 states, forcing hospitals to publicly disclose their infection rates.  To date, 17 of those states have made that information publicly available.  

California has passed a hospital-infection reporting law but the state has not started disclosing infection rates to the public.  Under the state's law, the Department of Health is required to issue its first report on central line-associated bloodstream infections on January 1, 2011.  "California has already failed to meet some of the initial requirements of its hospital infection law so we are concerned that it will miss the deadline for issuing its first infection rate report next year," said Lisa McGiffert, Director of Consumers Union's Safe Patient Project (www.SafePatientProject.org ).  "Until the state makes infection rates public for all California hospitals, consumers will be left with an incomplete picture of this critical patient safety information."  

Consequently, the Consumer Reports ratings for California hospitals are based on Leapfrog data.  "It is important to recognize that many hospitals demonstrate commitment to their communities by willingly reporting safety data—warts and all. Consumers should be most wary of hospitals that are asked to report by their patients (or customers), and refuse," said Leah Binder, CEO of the Leapfrog Group.  Binder noted that more than 25 hospitals in the Bay Area declined to provide their data to Leapfrog during the reporting period.  A complete list of non-reporting hospitals can be found at www.leapfroggroup.org/decline.

A Central Line Associated Bloodstream Infection (CLABSI) is a type of infection caused by the presence of a central line catheter.   A "central line" or "central catheter" is a tube that is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications.   These long, flexible catheters empty out in or near the heart so that the circulatory system can deliver what's put in them within seconds.  A bloodstream infection can occur when bacteria or other germs travel down the central line and enter the bloodstream, making the central line's biggest virtue as a quick pathway for delivering the essentials into its biggest vice.  

Since the risk of infection varies substantially across different types of ICUs, the Consumer Reports ratings are using what is known as a "standardized infection ratio," taking into account the unique mix of ICU types in a given hospital by comparing the hospital infection data for each ICU to the national average for each such ICU type published by the federal Centers for Disease Control and Prevention (CDC).   For instance, the average infection rate for cardiac ICUs nationwide is 2 per 1000 central line days (that's the total number of days that patients are on central lines), while surgical ICUs average 2.3 infections per 1000 central line days.  So an infection rate 100% above average would be 4 per 1000 days for a cardiac ICU, but 4.6 per 1000 days for a surgical ICU.

The Consumer Reports web site (www.ConsumerReportsHealth.org) currently rates more than 3,600 hospitals in the U. S. based on several criteria including patient satisfaction, intensity of care, and steps to prevent infection.  This last measure, which is different from the CLABSI infection rates, assesses how well a hospital follows correct procedures to avoid surgical infections.