Reasons to question Consumer Report’s report on hospital performance

Consumer Reports published new hospital ratings recently. One of the key measures in the report was CLABSI and SSI rates. The report obtained CLABSI and SSI rates from states with mandatory reporting and from the independent reporting agency, the Leapfrog Group.

One conclusion in the report is that large teaching hospitals perform poorly in preventing CLABSIs. According to the report, 3 teaching hospitals got the lowest rating in preventing CLABSIs and 64 teaching hospitals got the second lowest rating.

APIC has issued a letter to the infection prevention community to bring attention to the findings in this report. APIC pointed to several reasons why findings from the report may not tell the whole story. Patient demographics vary widely between teaching hospitals and small community hospitals. Many teaching hospitals serve as Level 1 trauma centers that treat patients with more serious illness than those treated at community hospitals. Patients with serious illnesses have a higher risk of becoming infected than others. Another reason that the report may not be reliable is due to the robustness of the infection prevention program in place at each institution examined. Hospitals with strong infection prevention practices may identify more cases of HAIs than hospitals without good practices. As a result the facility that actively tracks HAIs may appear to have worse rates than those which do track HAIs closely.

While APIC encourages the public to use the information to initiate conversations with healthcare providers to learn more about a hospital’s infection prevention program, the organization emphasizes that the public should not base their decisions and opinions solely on this report.

Link to Consumer Reports' Hospital Rating

Article on teaching hospitals having worse HAI rates than other hospitals

Handwashing and the Law of Diminishing Returns

IPs spend a lot of time monitoring and educating about handwashing. There are continuous debates about what the consequences should be for staff who are “caught” not washing their hands. One question that rarely is raised in Infection Control Committee meetings is whether there is an upper limit beyond which hand hygiene will no longer play a major role in HAI prevention. The answer can have profound effects on the amount of time and energy devoted to this one particular part of the IP role.

Two recent articles have questioned the relationship between increasing handwashing compliance and reduction of health care infections. Biggs, Shepherd and Kerr (2008) performed a mathematical analysis of the transmission of Staph by healthcare workers’ hands that became contaminated by patient contact. They concluded that a compliance levels (or imperfect hand hygiene) <50% were sufficient to stop outbreaks. They also concluded that the rate of increase in hand hygiene compliance was not associated with a similar decrease in infection transmission

Silvestri, Petros, Sarginson, et al (2005) conducted a literature review of 9 studies that looked at the relationship between hand hygiene compliance levels and actual infection rates. They concluded that [poor] handwashing can only account for 40% of transmission in intensive care units.

Why do these studies make sense in a time when hand washing is the first commandment of health care delivery? Both the literature and everyday observation provide some answers. First, glove use is becoming a universal practice. There are few studies that test how much hand contamination occurs with the use of gloves. Second, think of all of the environmental surfaces and healthcare equipment becomes contaminated and is used without cleaning. Stethoscopes, phones (both patient and clinician), bath basins, computer screens and on and on have been found to be contaminated. How effective are clean and gloved hands if contaminated equipment is used between patients without cleaning in between. I recently conducted a study in which we found that pens became contaminated within a single work shift. How many staff take pens into patients rooms, mark dressings and put the pen back into a pocket?

I think the time has come to take a harder look at housekeeping surfaces. I have found that most housekeepers want to do a good job but are hampered by a workload that allows only the most cursory of cleaning. It is about time that we stopped using precious resources on hand hygiene compliance and use them to provide more housekeepers with better equipment.

Beggs, C.B, Shepherd, S.J., and Kerr, K.G. (2008). Increasing the frequency of

handwashing by healthcare workers does not lead to commensurate reductions

in staphylococcal infections in a hospital ward. British Medical Journal of

Infectious Disease,8, 114. Available at: http:/www.biomedcentral.com/1471-

2334/8/114.

Silvestri, L., Petros, A.J., Sarginson, R.E., de la Cal, M.A.,Murray, A.E. and Saene, H.K.

(2005). Handwashing in the intensive care unit: a big measure with modest effects.

Journal of Hospital Infections, 59(3), 172 – 179.

Adoption of infection surveillance technology linked to better infection control practices

A recent study published in the American Journal of Infection Control looked at the relationship between the use of automated surveillance technology (AST) and the depth of implementation of evidence-based infection prevention and control practices.  The study analyzed survey responses from 241 acute care hospitals in California on questions related to the adoption of AST, the breadth and depth of implementation of HAI and process specific infection control practices. 

The study found a positive relationship between AST adoption and the adoption of infection control practices.  Although it’s unclear whether adoption of AST leads to better implementation of infection control practices or vice versa, it is clear that hospitals using AST are doing a better job implementing evidence-based infection control practices compared with hospitals that still rely on manual surveillance.    

Link to full article