Report Identifies Teaching Hospitals That Threaten Patient Safety

Infection-control progress is slowing, data suggest

Too many hospitals needlessly expose patients to dangerous bacteria, according to a new analysis from Consumer Reports. The study examined the five-year performance of 2,000 U.S. hospitals in preventing central-line infections. A total of 31 teaching hospitals made the report’s lowest-performing “zero tolerance” list.

Approximately 650,000 people developed infections after being admitted to U.S. hospitals in 2011, and 75,000 died, based on data from the Centers for Disease Control and Prevention. Central-line infections account for approximately 5% of all hospital-acquired infections, affecting more than 27,000 people in 2015, the report notes. Central-line infections can be deadly––proving fatal in up to a quarter of cases, partly because people with IVs are often already frail. These infections are also expensive, averaging $46,000 to treat––more than other hospital-acquired infections, according to a 2013 study.

The Consumer Reports analysis found improvements in infection control all around the country, in large urban hospitals, such as Ochsner Medical Center in New Orleans and Johns Hopkins Bayview Medical Center in Baltimore, as well as smaller suburban or rural ones, such as Wuesthoff Medical Center in Rockledge, Florida, and Mercy Medical Center in Merced, California.

And yet the problem isn’t solved, according to Doris Peter, PhD, director of the Consumer Reports Health Ratings Center. “Hospitals are moving in the right direction, but progress is slowing, and too many hospitals have not adequately addressed the problem of hospital-acquired infections over the past five years.”

That’s true even among the nation’s prominent teaching hospitals, such as Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, and Ronald Reagan UCLA Medical Center in Los Angeles, both of which appear on Consumer Reports’ list of low-­scoring teaching hospitals. “That’s counterintuitive,” Peter says. “They are supposed to be places that represent the best in our health care system.”

Central-line infections were once seen as inevitable when dealing with patients in intensive-care units. “We thought we could maybe cut them by 10%,” a CDC spokesman told Consumer Reports.

But in 2004, Peter Provonost, MD, of Johns Hopkins put an infection-control checklist to the test at more than 100 intensive care units in Michigan. “Within three months, rates were cut in half,” he said, and by 18 months they were down by almost 70%. “If hospitals are meticulous about following the checklist, most infections can be avoided,” he added.

But that requires buy-in from everyone—from senior administrators and physicians to cleaning staff and nurses.

Maureen Jewell, RN, director of quality management and performance improvement at a hospital in Wilmington, Delaware, said it was important to make hospital-acquired infections everyone’s problem to solve.

“We spent much of our time empowering nurses to speak up if hospital staff weren’t following the checklist carefully,” she recalled. “We had to make it clear that when it came to these infections, the physicians weren’t calling the shots—they were.” Saint Francis Hospital improved from one of the lowest-performing hospitals in 2011 to one of the highest-rated ones.

According to the Consumer Reports analysis, the lowest-performing U.S. teaching hospitals at preventing central-line infections in intensive care units from January 1, 2011, to December 31, 2015, included the following (listed in alphabetical order):

  • Atlanta Medical Center in Georgia
  • Banner-University Medical Center in Tucson, Arizona
  • Brooklyn Hospital Center in New York
  • Community Regional Medical Center in Fresno, California
  • Cooper University Health Care in Camden, New Jersey
  • Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire
  • Emory University Hospital Midtown in Atlanta
  • Eskenazi Health in Indianapolis
  • George Washington University Hospital in the District of Columbia
  • Grady Memorial Hospital in Atlanta
  • Holy Cross Hospital in Silver Spring, Maryland
  • Howard University Hospital in the District of Columbia
  • Hurley Medical Center in Flint, Michigan
  • Indiana University Health University Hospital in Indianapolis
  • Interim LSU Public Hospital in New Orleans
  • Long Beach Memorial Medical Center in California
  • MacNeal Hospital in Berwyn, Illinois
  • Maine Medical Center in Portland, Maine
  • Maricopa Integrated Health System in Phoenix
  • Nebraska Medicine-Nebraska Medical Center in Omaha
  • Palmetto Health Richland in Columbia, South Carolina
  • Robert Wood Johnson University Hospital in New Brunswick, New Jersey
  • Ronald Reagan UCLA Medical Center in Los Angeles
  • SUNY Downstate Medical Center University Hospital in Brooklyn, New York
  • Truman Medical Center-Hospital Hill in Kansas City, Missouri
  • Tulane Medical Center in New Orleans
  • UC San Diego Health in California
  • UF Health Jacksonville in Florida
  • University Hospital in Newark, New Jersey
  • University Medical Center of El Paso in Texas
  • University of Iowa Hospitals and Clinics in Iowa City, Iowa

Source: Consumer Reports; November 21, 2016.