No Chicago hospital reports zero central line infections

Feb 2 2010

Hospitals in the Chicago 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 15 Chicago 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.

None of the 15 Chicago hospitals reported zero central line infections. Hospitals with lower than average infection rates include: Rush University Medical Center reported a rate that is 61 percent better than the national average, meaning there were 61 percent fewer infections than the U.S. average for its mix of ICUs; Advocate Illinois Masonic Medical Center reported 55 percent fewer infections than average; Resurrection Medical Center reported 40 percent fewer infections than average; Our Lady of the Resurrection Medical Center reported 28 percent fewer infections than average, Northwestern Memorial Hospital reported 19 percent fewer infections than average, and Swedish Covenant Hospital reported 12 percent fewer infections than average.

On the other end of the spectrum, several Chicago area hospitals reported high infection rates, more than twice the national average: Louis A Weiss Memorial Hospital reported an infection rate that was 421 percent worse than the national average for its mix of ICUs; St. Anthony Hospital reported a rate that was 303 percent worse than average; Mercy Hospital and Medical Center reported a rate that was 199 percent worse than average; Norwegian-American Hospital reported a rate that was 171 percent worse than average; and Mt. Sinai Hospital reported a rate that was 122 percent worse than average.  The infection rates are for 2008.

"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."

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.

While Illinois was the first state to pass a hospital infection reporting law in 2003, it didn't start making infection rate information public until last year.  The only information available at the time of publication was insufficient for comparison purposes. Thus, the Consumer Reports ratings for hospitals in Illinois are based on Leapfrog data.

"It took Illinois an inexcusable six years after passing an infection reporting law to make this critical patient safety information available to the public," said Lisa McGiffert, director of Consumers Union's Safe Patient Project (www.SafePatientProject.org).  "Now that infection rates are finally being collected and reported by the state, we hope that it will motivate hospitals to improve care and protect patients from these sometimes deadly infections."

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.