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Maryland Hospital Infection Rates at Bottom Of March 2011 Volume 24, Number 2 The Abell Report What we think about, and what we’d like you to think about Published as a community service by The Abell Foundation Battling deadly infections in Maryland hospitals: ABELL SALUTES: Maryland Hospital Infection Rates at Bottom Jhpiego: For Helping of National Rankings; State’s Hospitals Launch Developing Countries Develop First-Class Initiative to Bring Them Down to Zero Health Care Hopkins’ patient safety expert leads fight to change hospital culture Before Najini Khan lay down to By M. William Salganik of hospital-acquired infections. The give birth, the 25-year-old Nepalese HSCRC reported 14,206 avoidable woman cleaned the house, fed the goat aryland’s rates for hospital- hospital-acquired infections in the year and cow, bathed her five-year-old acquired infections are pub - ended June 30, 2010, costing $175 mil - daughter, and made dinner. Najini’s Mlic for the first time, and they lion to treat. 3 labor was long, strenuous, and life- are troubling. The CDC and MHCC data track threatening. After giving birth to her Of 17 states that reported data, only one type of infection, those traced daughter, the new mother began to Maryland ranked worst when the feder - to catheters inserted in or near the heart bleed heavily. Postpartum hemorrhage al Centers for Disease Control and of patients and known as central line- is the leading cause of maternal deaths, Prevention (CDC) published the first- associated bloodstream infections, or 1 the majority of which occur in the ever comparison of state infection rates CLABSI. And with 33 states not developing world. But a community in 2010. reporting—states can decide whether to health worker had prepared Najini for Responding to a legislative man - participate—it’s impossible to know precisely where Maryland stands even just such an emergency. date, the Maryland Health Care Com - on that one type of infection. More - During prenatal visits to Najini’s mission (MHCC) disclosed hospital- 2 over, Maryland is one of only five of the village in western Nepal, community by-hospital rates for the first time in 17 reporting states that audits its data, health worker Chandrakali Kurmi October 2010 as well, comparing each and those five show the highest report - explained what to do if Najini began to hospital to national benchmarks. Of 45 hospitals included in the MHCC ed rates, an indication that the unveri - hemorrhage. She outlined the steps of report, only the Johns Hopkins Hospi - fied data from other states is underre - a community-based intervention tal newborn intensive care unit was bet - porting the problem. developed by Jhpiego, a Johns Hop - ter than the national benchmarks by a The HSCRC reports on a full range kins affiliate, to help save the lives of statistically significant degree. Eight of of hospital-associated infections, but the majority of women in the develop - the 45 hospitals—including three Bal - doesn’t have comparable data from oth - ing world who give birth at home. timore hospitals: University of Mary - er states. The CDC report covers the Kurmi counseled Najini, her hus - land Medical Center, Sinai Hospital first half of 2009, while both state band, and other family members on and Johns Hopkins Bayview—had datasets include the second half of 2009 the use of misoprostol, a lifesaving pediatric and adult rates that were sig - and the first half of 2010, so they’re not drug that helps stop bleeding, and the nificantly worse than national peers. directly comparable. need to go to the local health facility if Maryland’s Health Services Cost Despite measurement limitations, the bleeding persisted. That was exact - Review Commission (HSCRC) has however, Maryland’s hospitals admit ly what happened to Najini after giv - begun quantifying the financial impact they have a problem—and say they are ing birth to a lively baby girl. As instructed, Najini took the three white Data discussed in this report can be found in tables on pages 8 through 11. continued on page 12 continued from page 1 the Pronovost team and to publish data a “standardized infection rate” (SIR) for accountability. for CLABSI of 1.30—meaning its rate determined to fix it. Some hospitals are already report - is 30 percent higher than a multi-state “I’m not explaining it away. We own ing progress; University of Maryland, sample from 2006-2008. Massachu - it,” said Barbara Epke, vice president of which posts its infection data on the setts, a comparable state, had SIR LifeBridge Health, parent of Sinai internet, has shown a sharp drop since of 0.59—half of Maryland’s rate. Over - and Northwest hospitals, and chair of the state numbers were compiled. 4 all, the rate for the 17 reporting states the Maryland Hospital Association’s CLABSI is only one type of hospi - was 0.82. Council on Clinical and Quality Issues. tal-acquired infection. Some medical In Maryland, there were 601 “We look terrible. It’s out there. What professionals also use the term “health CLABSI cases in the fiscal year that can I say?” care-acquired infections” to encompass ended June 30, 2010, with a treatment “Maryland came out at the bottom infections picked up in doctors’ offices, tab of about $16 million, according to of the heap,” said Dr. C. Patrick ambulatory surgical centers, and other the HSCRC. Of those 601 patients, Chaulk, executive director of the nonhospital settings. According to esti - 77 died in the hospital, a lower death Maryland Patient Safety Center, an mates by the CDC, health care- rate than the national estimates. The independent non-profit that the hospi - acquired infections occur 1.7 million data don’t show whether those deaths tal association helped launch several times a year in the United States, result - were the result of CLABSI or of the years ago. “There’s a real commitment ing in nearly 100,000 deaths annually. 5 condition, such as cancer or trauma, to seeing if it can be fixed.” The safety Most of the data collection so far, that put the patient in the hospital in center and Maryland Hospital Associa - however, has occurred in hospitals, and the first place. And, that CLABSI tion (MHA) are spearheading a that’s why many patient-safety efforts— infection rate actually represents statewide initiative to reduce CLABSI, and this report—concentrate on hospi - improvement, with a CLABSI rate 20.9 with the MHA setting a goal of elimi - tals rather than other health settings. percent lower for fiscal 2010 than 2009, nating CLABSI completely. In 2007, an Abell Foundation as the impending public data release Dr. Peter Pronovost, a Hopkins report 6 provided a national overview of pushed hospitals to focus on central physician and national expert on hospi - the problem of hospital-acquired infec - line infections. tal-acquired infections, brought home tions. At that time, the Foundation “Almost as many people die of the stakes to more than 300 people— planned to follow up with a report on bloodstream infections as die of breast doctors, nurses, infection control spe - Maryland once data became public. cancer,” Dr. Pronovost said in an inter - cialists—representing nearly every What follows is that report. view. “But unlike breast cancer, we have Maryland hospital at a December meet - a cure. And it’s cheap.” ing to launch the initiative. He showed CLABSI: An expensive—and dead - Central line-associated bloodstream a photo of a cute 18-month-old. ly—hospital-acquired infection infections are often the first focus of “My hospital killed this little girl,” The costs of CLABSI are substantial. efforts to reduce hospital-acquired he said. “She died of what started as a “Each year in the United States, cen - infections because CLABSI is common, central line infection.” tral venous catheters may cause an esti - expensive to treat, deadly, and relatively Prompted at least in part by public mated 80,000 catheter-related blood - easy to recognize and measure. Also, exposure of the infection rates, nearly stream infections, and as a result, up to there is a substantial body of research— all of Maryland’s hospitals are signed up 28,000 deaths among patients in inten - much of it conducted by Dr. Pronovost for the Pronovost-led CLABSI initia - sive care units (ICUs),” Dr. Pronovost and his colleagues—that shows CLAB - tive. Although they’ve all had and colleagues wrote in an often-cited SI can be reduced dramatically, quickly, CLABSI-reduction efforts in the past, New England Journal of Medicine arti - and at a low cost. they’re now agreeing to implement in cle. 7 “Given that the average cost of care “We have one goal, and that goal is full Dr. Pronovost’s infection-fighting for a patient with this infection is very simple: zero. Zero central line- protocol, which has been shown in $45,000, such infections could cost up associated blood stream infections,” several studies to significantly reduce to $2.3 billion annually.” Carmela Coyle, president and CEO of rates of CLABSI. They’re also agreeing In the CDC report covering the the Maryland Hospital Association, to confer regularly with each other and first six months of 2009, Maryland had said at the kickoff for the CLABSI The Abell Report is published quarterly by The Abell Foundation 111 S. Calvert Street, 23rd Floor, Baltimore, Maryland 21202-6174 • (410) 547-1300 • Fax (410) 539-6579 The Abell Reports on the Web: www.abell.org 2 continued from page 2 fered and died needlessly at the prema - of stay dropped about two-thirds of a ture age of 50 thanks to medical errors day in Michigan, compared to half a effort.
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