Hospitals in Los Angeles 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 41 Los Angeles 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.
Of the Los Angeles area hospitals rated by Consumer Reports Health, four reported zero central line infections: Presbyterian Intercommunity Hospital, Kaiser Foundation Hospital Harbor City, Foothill Presbyterian Hospital, and Monterey Park Hospital. Other hospitals with lower than average infection rates include: Huntington Memorial Hospital, which reported a rate that is 86 percent better than the national average, meaning that that there were 86 percent fewer infections reported than the U.S. average for its mix of ICUs; Cedars-Sinai Medical Center reported 81 percent fewer infections than average; and St. Vincent Medical Center reported 75 percent fewer infections than average. The infection rates are for 2008.
On the other end of the spectrum, several Los Angeles area hospitals reported high infection rates, all more than double the national average. Alhambra Hospital Medical Center reported an infection rate that was 440 percent worse than the national average for its mix of ICUs; Kaiser Foundation Hospital Woodland Hills reported a rate that was 304 percent worse than the national average; and City of Hope National Medical Center reported a rate that was 280 percent worse than the national average. Other hospitals that reported higher than average infection rates include: Downey Regional Medical Center reported a rate that was 182 percent worse than the national average; Hollywood Presbyterian Medical Center reported a rate that was 180 percent worse than the national average; St. Francis Medical Center reported a rate that was 177 percent worse than the national average; Citrus Valley Medical Center – Queen of the Valley Campus reported a rate that was 153 percent worse than the national average; Santa Monica – UCLA Medical Center reported a rate that was 143 percent worse than the national average; and West Hills Hospital and Medical Center reported a rate that was 126 percent worse than the national average.
In Los Angeles, variation among hospitals is true across the board and even within the same system of Kaiser Permanente-owned hospitals and medical centers, which range from a reported rate of zero infections to 304 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.
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 70 hospitals in the Los Angeles metro 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.
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