Four Detroit area hospitals announce worse than average infection rates

Feb 2 2010

Hospitals in the Detroit area 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 25 Detroit area hospitals, 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.

Three of the 25 reporting Detroit area hospitals, Oakwood Annapolis Hospital, Henry Ford Macomb Hospitals-Warren Campus, and Huron Valley-Sinai Hospital reported zero central line infections. Other hospitals with the lower than average infection rates include the following hospitals: Henry Ford Hospital reported a rate that is 87 percent better than the national average, meaning there were 87 percent fewer infections reported than the U.S. average for its mix of ICUs; Genesys Regional Medical Center reported 82 percent fewer infections than average; Botsford Hospital reported 81 percent fewer infections than average; and Crittenton Hospital Medical Center reported 80 percent fewer infections than average.   The infection rates are for 2008.

On the other end of the spectrum, four Detroit area hospitals reported worse than average infection rates: Detroit Receiving Hospital reported an infection rate that was 68 percent worse than the national average for its mix of ICUs; Sinai-Grace Hospital reported a rate that was 22 percent worse than average; Henry Ford Macomb Hospitals reported a rate that was 18 percent worse than average; and Oakwood Southshore Medical Center reported a rate that was 8 percent worse 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.  

Although state legislators have attempted to pass hospital infection reporting, there is currently no law in Michigan that requires hospitals to publicly report their infection rates.

"Voluntarily reporting of infection rates leaves too many consumers in the dark when it comes to this critical patient safety information," director of Consumers Union's Safe Patient Project (www.SafePatientProject.org ).  "State lawmakers should mandate hospital infection reporting so all Michigan residents can find out whether their local hospital is doing a good job keeping patients safe from these sometimes deadly infections."  

Consequently, the Consumer Reports ratings for Detroit and other hospitals located in Michigan 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   several hospitals in the Detroit 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.