Pennsylvania Health Department reports on hospital infections

The Pennsylvania Department of Health Thursday issued its most complete report to date of hospital infections, finding that a disproportionate number of poor-performing facilities were in Philadelphia.

Those with high infection rates included some of the city's most storied hospitals, such as Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania.

Executives at both institutions said they had made progress since 2009, the year the report focused on. And experts cautioned against using the report to compare hospitals, because the methodology to track infections is evolving.

Nevertheless, the report will now be used to benchmark hospitals, giving them a baseline from which they must improve or face sanctions if they do not.

Hospital infections cause a vast amount of harm, which experts say can often be prevented. Across the country, an estimated 1.7 million patients get infections during care, and 99,000 die each year as a result, according to the Centers for Disease Control and Prevention.

Pennsylvania has been a leader in public reporting of such infections, first through the Pennsylvania Health Care Cost Containment Council and now by the Department of Health.

In announcing the report Thursday, Gov. Rendell said eliminating infections remains urgent for two reasons.

It "prevents unnecessary illnesses and deaths, and it also helps to eliminate the avoidable costs of treating these infections," he said, adding, "There is still more important work remaining to be done."

Several hospitals in the Philadelphia region fared poorly in two areas: those involving urinary catheters, the thin tubes placed in a bladder to drain urine, and those involving central lines, IVs threaded into large blood vessels to deliver nutrients and medicines.

Area hospitals that had higher-than-expected rates of both kinds of infections included Albert Einstein Medical Center, Methodist Hospital, Temple University Hospital, and Children's Hospital in the city, as well as Lower Bucks Hospital in Bucks County.

Children's "has devoted considerable resources to eliminating hospital acquired infections for our pediatric patients," said Kathy Shaw, interim patient safety officer. "Our data in 2010 show significant improvement, with a 40 percent reduction since this report."

Temple said that it is working to eliminate these infections using several strategies and would continue its "aggressive and sustained efforts."

Officials at Lower Bucks and Einstein could not be reached for comment.

One issue is that Philadelphia is home to many large academic medical centers that treat the most complex problems, said Kate Flynn, president of the Health Care Improvement Foundation, a nonprofit that works with local hospitals to boost patient safety.

Flynn said she saw progress in the report toward reducing the number of infections, particularly central line infections involving blood.

Statewide, the Department of Health estimated that overall infections fell 12.5 percent, extrapolating from the last half of 2008.

The report is the first to cover a full year of reporting to the Health Department and includes data on infections at individual institutions, ranging from 1,446 cases at HUP to 1 case at Barix Clinics of Pennsylvania, a Bucks County hospital specializing in obesity surgery.

HUP's numbers show how rates of infections can vary at the same hospital.

In 2009, the Penn flagship had 33 central-line-associated bloodstream infections, far fewer than the 80 predicted based on severity of illness of the patients it treated. At the same time, it had many more than expected catheter-related infections.

"Obviously that is an area where we need to improve," said P.J. Brennan, chief medical officer of the University of Pennsylvania Health System, which also includes Pennsylvania Hospital and Presbyterian Medical Center.

"The focus is how we are performing as an organization, and I am very pleased with where we are in trying to eliminate hospital-acquired infections," Brennan said. "I think we have made tremendous strides."

He noted that even though the university hospital had a higher-than-expected rate of urinary tract infections, it had cut those by 15 percent since 2008.

"I am confident that we will be better still next year, but we have more work to do," Brennan added.

Rachel Sorokin, chief patient safety and quality officer at Thomas Jefferson University Hospital and its Methodist Hospital campus, said, "We are working diligently on this," and added that numbers at both hospitals had improved in 2010.

Infections related to surgeries were the most common statewide, accounting for 6,277, or 23.7 percent, of the total.

Together with surgical site infections, urinary tract infections (6,145), gastrointestinal infections (4,848), and bloodstream central-line infections (3,271) accounted for nearly four out of five reported by the state's hospitals.

The report also found 2,117 cases of MRSA - Methicillin-resistant Staphylococcus aureus, representing 8.2 percent of the total. The report suggests that MRSA is being replaced as a major culprit in hospital infections by another bacterium - Clostridium difficile - that causes severe gastrointestinal infections. Such infections accounted for nearly 20 percent of the total.

The report cautioned against comparing hospitals based on their infection rate. Starting next month, the state will audit each of the hospitals to ensure accurate reporting.

The detailed look at urinary tract and bloodstream infections also adjusts for the type of hospital and the severity of illness.

While imperfect, those adjustments were the best approach to estimating the risk of infections at each hospital and judging how well an institution avoided the preventable ones, said Stephen Ostroff, director of the state's Bureau of Epidemiology.

"There is no way to do a perfect analysis of hospital-acquired infection data, to be able to adjust or control for every unique facet or feature of every hospital in the state," Ostroff said. "The methodology that we have been using to do this analysis is the gold standard for trying to do that sort of risk-adjusting."