Hospitals in Houston area vary in terms of how well their ICUs prevent bloodstream infections

Feb 2 2010

Hospitals in the Houston area vary 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 12 Houston 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.

According to Consumer Reports Health, none of the Houston area hospitals reported zero central line infections, leaving room for improvement across the board.  Only one Houston area hospital came close to zero infections in the reporting period: Park Plaza Hospital reported a rate that is 86 percent better than the national average, meaning that there were 86 percent fewer infections reported than the U.S. average for its mix of ICUs. Other hospitals with lower than average infection rates include: Methodist Hospital (67 percent better than average); Nacogdoches Medical Center (57 percent better than average), and Cypress Fairbanks Medical Center Hospital (12 percent better than average).  The infection rates are for 2008.

On the other end of the spectrum, the hospitals that reported the highest infection rates were Clear Lake Regional Medical Center with an infection rate that was 81 percent worse than the national average for its mix of ICUs. Spring Branch Medical Center reported a rate 48 percent worse than average, Conroe Regional Medical Center reported a rate 40 percent worse than average, West Houston Medical Center reported a rate 33 percent worse than average, and Mainland Medical Center reported a rate 21 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 Rating 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."      

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.  

There is an existing law in Texas requiring hospitals to report specific types of infections rates, including central line infections rates in ICUs. However, the law's implementation was delayed until funding was authorized for it in 2009.    

"Now that Texas has the funding it needs, the state should move forward with implementing its infection reporting law," said Lisa McGiffert, Director of Consumers Union's Safe Patient Project (www.SafePatientProject.org ).   "All Texans have the right to know whether their local hospital is doing a good job keeping patients safe from these sometimes deadly infections."

Consequently, the Consumer Reports ratings for Texas 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 who are asked to report by their patients, and refuse," said Leah Binder, CEO of the Leapfrog Group.    

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.