Report finds nearly 26,000 infections in PA hospitals

Hospitals in the Philadelphia region fared poorly in so-called hospital-acquired infections in 2009, according to a new report issued by the Pennsylvania Department of Health. Overall, 250 hospitals across the commonwealth reported that 25,914 patients contracted infection during the course of their care.

The report due out Tuesday afternoon detailed the number of infections at each of the hospitals and included a detailed examination of two common types of infections – catheter-associated urinary tract infections and central-line-associated bloodstream infections.
 
Of the 194 hospitals that reported urinary tract infections, 32 had rates that were significantly higher than expected based on the type patients treated. Nearly half (15) of those were in Philadelphia or its Pennsylvania suburbs. In contrast, 12 of the 44 hospitals with better than expected rates of catheter-associated urinary tract infections were based in the region.

And 13 of the 19 hospitals that had higher than expected rates of central-line associated bloodstream infections were from the Philadelphia region. Philadelphia hospitals accounted for four of the 22 hospitals that achieved better than expected results.

Medical experts say that many of these so-called hospital-acquired infections can be prevented, saving lives, unnecessary illness and millions or even billions of dollars of care. The full report and a consumer oriented version of it are available on the Pennsylvania Department of Health's website.

The report by the Department of Health is the first to cover a full year of reporting by 250 state hospitals and includes data on infections at individual institutions, ranging from 1,446 cases at the Hospital of the University of Pennsylvania to 1 case at Barix Clinics of Pennsylvania – the Bucks County hospital specializing in obesity surgery.

The 2009 data will serve as a benchmark for the hospitals which must achieve annual reduction targets or face possible sanctions, ranging from fines to bans on new admissions.

Infections related to surgeries were the most common, accounting for 6,277, or 23.7 percent, of the reports hospitals made to the Centers for Disease Control and Prevention which collects the data. The numbers are then distributed to three separate Pennsylvania agencies. Together with surgical site infections, urinary tract infections (6,145), gastrointestinal infections (4,848), and bloodstream infections (3,271) accounted for nearly four out of five reported by the state's hospitals.

The report cautioned against comparing hospitals based on the infection rate in part because hospitals that are good at finding them could be doing a good or better job at avoiding the preventable ones as hospitals that report few. Starting next month, the state will audit each of the hospitals to ensure that they are accurately reporting infections. In addition, hospitals are required to notify patients, or family members, by letter when the patient contracts such an infection during the course of care.

The report also examines how well a hospital performed with two types of infections – catheter associated urinary tract infections and central line associated bloodstream infections. In those two areas, the report attempts to adjust for the type of hospital and the severity of illness of patients its serves.

While imperfect, the adjustments were the best approach to estimating the risk of infections and how well a hospital did to avoid preventable ones, said Stephen Ostroff, director of the bureau of epidemiology in the department.

"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 fro trying to do that sort of risk adjusting."

The infection reporting is required under Act 52 which became law in the summer of 2007. Before that time, the Pennsylvania Health Care Cost Containment Council issued several reports on the problem. In 2006 the council reported that there were 30,237 cases of infections in Pennsylvania Hospitals. The next year the council found 27,949 infections.

But hospitals chafed at the council's methodology and helped support Act 52, which was passed by the General Assembly and signed into law by Gov. Rendell in August 2007. Under the act, infection rates are measured based on the number of patients at risk. For example the number of days patients have urinary catheters in place is used as a denominator to provide a more uniform measure of urinary tract infections across different hospitals.

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