Pierce County’s two largest hospitals received low rankings from a national consumer organization for their failure to stop transmission of certain serious infections inside their facilities.
Consumer Reports, in data released Wednesday, gives Tacoma General Hospital and St. Joseph Medical Center the second-lowest and lowest ranking for their record in avoiding the spread of two pretty nasty bugs. The first is MRSA, a type of staph bacteria that is resistant to many antibiotics, and Clostridium difficile, also known as C-diff, a germ that can cause deadly diarrhea and killed 29,000 people in 2011.
Top medical officials from both hospitals said Tuesday that they are working diligently to reduce the number of those infections, and cautioned that rates of infection of MRSA and C-diff aren’t the only way to evaluate hospital quality.
“This measure is still a little rough,” said Karen Koch, administrator for quality and patient safety for MultiCare Health Systems, parent company of Tacoma General. If a person wants to look at infection rates to judge the caliber of the hospital, she said, evaluating central-line infections, catheter urinary tract infections and surgical site infections are a better tool. Both hospitals generally ranked higher in those three categories.
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“These are cases where we’re actively doing something to the patient,” she said. “They remain a pure, more accurate reflection of quality.”
Eliminating MRSA and C-diff is a tall order, said Dr. Mark Adams, chief medical officer for CHI Franciscan Health, the parent company of St. Joseph Medical Center.
“These two are fairly tenacious,” he said. In addition to typical hygiene and disinfection measures, both Franciscan and MultiCare have started using ultraviolet light machines as well. They’re sealed in a patient room and ensure that UV light, which kills C-diff, touches every surface.
MultiCare’s machine “looks like a little R2-D2,” Koch said, referring to the small sidekick robot from “Star Wars.”
To earn a top rating in each category, a hospital had to report zero infections to the federal Centers for Disease Control, which is the source of the data that Consumer Reports analyzed. Nationally, 322 hospitals achieved that for MRSA, and 357 for C-diff. Those hospitals are in such places as Searcy, Arkansas, and Amarillo, Texas. Several high-profile hospitals had low rankings, including Johns Hopkins in Maryland and the Cleveland Clinic in Ohio.
Consumer Reports uses colored circles to list their rankings on a five-point scale. In Olympia, Providence St. Peter Hospital received the middle ranking for avoiding C-diff and the second-to-last for MRSA. Capital Medical Center fared better, receiving the second-to-best ranking for C-diff and no ranking on MRSA because the hospital is relatively small.
Of the five largest hospitals in the state, as measured by those with 300 or more patient beds, none scored particularly well. Swedish Medical Center was in the middle on both infections; Harborview was in the middle on MRSA and second-to-last on C-diff; and the University of Washington Medical Center was second-to-last on both.
The MRSA and C-diff rankings are part of Consumer Reports’ three-part series focusing on America’s antibiotic crisis, which has implications far beyond a hospital’s walls. The increasing prevalence of the two infections is the result of antibiotic misuse and overuse.
Everyone has a responsibility in that, Adams said.
“It’s both prescribing physicians and demanding patients,” he said. For example, most childhood ear infections will clear up on their own. “But when we start talking about patient satisfaction, it takes a lot longer and more effort to say ‘no’ than to give the antibiotic.”
In the case of C-diff, the wide availability of newer over-the-counter heartburn drugs like Prilosec and Prevacid also may contribute to the problem. The drugs, called proton-pump inhibitors, suppress stomach acid that causes heartburn. But that acid also kills C-diff, so the drugs remove a natural defense. Then, antibiotic use removes helpful bacteria, leaving people vulnerable to C-diff spores that may have been lingering in their gut.
Consumer Reports analyzed data from the CDC on MRSA and C-diff from October 2013 to September 2014. Having access to data on C-diff was new; the CDC only began requiring hospitals to report it in January 2013.
MultiCare and Franciscan officials said the data don’t take into account the original source of infection, because the reporting requirements are only for positive blood tests on the fourth day or later of admission. Those patients often already were infected before they arrived at the hospital, local officials say.
For example, Tacoma General reported four cases of MRSA, but those patients were infected before they were admitted, said Susan Gustafson, a registered nurse and director of infection prevention for TG’s parent company, MultiCare Health Systems.
“The majority of these cases are coming in to us from the community,” Gustafson said. “We are dealing with them appropriately to prevent transmission.”
Adams of Franciscan said one patient accounted for three infection reports. The woman was a drug user, and she injected drugs using her intravenous line while she was in the hospital, causing three separate infections.
However, the CDC says it takes measures to account for that and that the data indicate infections that happen after a patient is admitted to the hospital. Doris Peter, director of the Consumer Reports Health Ratings Center, said the CDC reported that the C-diff data in particular “was a proxy for in-patient prescribing.” In other words, the rate of C-diff infection is directly correlated to the use of antibiotics in the hospital.
“That’s a very strong statement,” Peter said. “I asked them (to clarify) three times.”
The hospital’s reputation isn’t the only thing at stake. Last fall, the federal government began reducing Medicare payments to hospitals that ranked among the lowest for preventing hospital-acquired infections. Neither TG nor St. Joe’s is in that category, federal data show.
Peter said one hospital CEO told her a story that shows naming a problem is the first step toward solving it.
“Their catheter (infections) went down 60 percent just by measuring” them, she said. “They didn’t do anything. The rate went down just because they were paying attention.”
NUMBER OF INFECTIONS BY HOSPITAL
The chart below indicates the number of infections reported by each hospital to the federal Centers for Disease Control between October 2013 and September 2014.
UW Medical Center
Providence St. Peter
Source: Consumer Reports