According to Consumer Reports Health, the Medical Center reported twice the amoutn of average IV-related infections. Photo by Hanbing Zhang.
Consumer Reports Health named the University’s Medical Center among a group of hospitals with high rates of deadly bloodstream infections in its upcoming March issue.
In Virginia, all hospitals are required to report their data on infection to the state. According to Consumer Reports, the Medical Center reported 77 central bloodline infections during a 15-month period that ended in September 2009 — two times the national average. The publication released information showing the great variation between hospitals in their ability to prevent infection caused when patients receive central intravenous lines in intensive care units and the number of patients exposed to bacteria.
The infections resulted from large intravenous catheters that allow for patients in intensive care to receive nutrition, medication and fluids directly into the bloodstream, said Nancy Metcalf, senior program manager at Consumer Reports Health. Typically, she added, these particular catheters are one or two feet long and inserted into major veins.
“The danger,” she said, “is that if bacteria gets into that vein, it runs through your body in seconds and will cause horrible bloodstream infections in your entire circulatory system.”
Metcalf expressed that the best way to prevent these deadly infections is good hygiene practice at the hospitals.
“The basic idea is that you need to treat these central lines like time bombs or booby traps,” she said. “When you put them in, you need to basically have the same conditions as you would in an operating room. Infection prevention does not require fancy materials; it requires lots of soap, face masks and a hospital wide commitment from the top down.”
With these readily available methods of prevention, there is no reason as to why hospitals should report such high numbers of infection, she said. Five hospitals reported not having any central live infections during the same time period, she noted, adding that a large Norfolk hospital sized similarly to the University’s Medical Center reported 10 infections during the time period.
Kyle Benfield, associate director of Hospital Epidemiology at the University’s Medical Center, said he believes that the statistics in Consumer Reports are outdated and insists that since the findings, the hospital has taken greater strides to better prevent exposing patients to central bloodline infections. He added that since implementing the new approaches, the University’s bloodline infection rates are now below the national average.
These new approaches include the use of antiseptic coated catheters and Biopatch, a patch coated with antiseptic and placed over the site where the catheter enters the body, he said. The Medical Center also has put all workers who deal with those IVs through an educational program that demonstrates how to avoid infection, Benfield added.
“If we can sustain these new rates, we will believe we have done a good job,” he said.
Additionally, more aggressive surveillance may be another successful approach, said Peter Jump, the director of public relations at the Medical Center.
“We are better at finding the infections,” he said.
Metcalf backed the report’s findings and stressed the needlessness of such infections when the right hygiene measures are in place.
“You don’t have to have a medical degree to tell if the hospital is doing the right thing — wearing masks, cleaning the person’s skin, washing their hands,” Metcalf said. “It is not high-tech; it is basic sanitation. If you have a family member in the hospital, they need to have someone with them around the clock to make sure their needs are being met. Hospitals do great stuff and save lives but they can be very dangerous places.”
Respectfully, a fair question to ask is whether this article published in “Consumer Reports” has displayed a genuine, or, possibly, more of a convenient, if not also incomplete, commitment to the principles of aseptic technique and practices that reduce hospital-acquired infections.
By way of one example, Consumer Reports’ article does not discuss an important limitation of its study: that data about hospital infections can be biased, having not accounted for infections in hospitals associated with catheters (or any other medical device or practice) that, due to the fear of legal exposure, hospitals may under-report. The reporting by a hospital of an infection or adverse event can represent a potential conflict of interest that, through its disclosure, may cause patients to seek treatment at another competing facility. Indeed, a discussion of the potential for the under-reporting of infections, or their masking by prescribed antibiotics, is part and parcel to this article published by Consumer Union, though this article did not address this consideration.
By way of another example, Consumers Reports has not researched and addressed a most significant breach to affect adversely health care vis-à-vis hospital infections: that health care facilities across North America, including within the Veterans Health Administration, have not been completely adhering to aseptic technique the past 20 years, having universally adopted, for example, a “sterilizer” that according to the FDA has been adulterated and misbranded for more than 20 years (and now must be removed from the market within 18 months). My views about this device were discussed on the front page of the “Wall Street Journal” (12-24-04). This device’s adulteration and safety concerns notwithstanding, the America Hospital Association (AHA), while having favored its continued use while claiming to advance patient safety, has not insisted upon patient notification.
The implications to the current “standard of care” and “aseptic technique” of hospitals using today an “illegal” device to “sterilize” surgical instrument, and such organizations as AHA, among others, condoning its continued use are manifest. Consumers Union is asked to provide its commentary and to discuss the current federal regulation of medical devices (is it sufficient to ensure patient safety?), AHA’s stance, and the extent to which it believes the use for more than 2 decades of a faulty “sterilizer” for surgical instruments has affected patient safety.
As an engineer, I seek to identify, through a root-cause analysis, all of the causes of, or contributing factors to, a failure, whether in a system, a building, a medical device, a bridge or a health-care process.
A study of today’s standard of care would indicate that expectations for it have become exceedingly low, due arguably in part to acquiescence by such organizations as the AHA; it therefore should be no wonder that there would be infections in intensive care units (ICUs) involving catheters and other devices and practices, with as many as 100,000 associated deaths each year in U.S. hospitals.
Catheter infections, my argument would contend, are merely an extension of a misguided standard of care, one that has watched weeds grow for many years and therefore should not be surprised to see these weeds now flourishing in today’s hospitals, operating rooms, and ICUs.
For Consumer Reports to talk about catheter-associated infections, which is important work, but without also addressing important factors that contribute to these infections, such as today’s flawed, yet endorsed, standard of care, which advances faulty techniques that violate aseptic technique and pose an increased risk of infection, is to be remiss and to fail to identify all contributing factors to hospital infections, portending future errors, breaches, and injuries. Weeds will continue growing – no flowers are in sight.
I respectfully ask that Consumers Union be complete in its research and address all factors, not just those that are convenient, that might contribute to infections and patient deaths associated with catheters and other surgical instruments. (A Google search would reveal the more than 150 articles I have written on the topics of hospital infection and aseptic technique. And my commitment to the field of infection control and the improvement of aseptic technique is self-evident.)
Lawrence F Muscarella PhD
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