New York Hospitals Try New Ways to Prevent Infections
By: CORINNE RAMEY
Feb. 17, 2016
To reduce infections patients acquire inside its hospitals, NewYork-Presbyterian Hospital conducted surveys of housekeeping staff and embedded researchers with them as they cleaned.
Researchers discovered barriers to better cleaning often stemmed not from disregard for the patient but from respect.
“Some of our housekeepers are reluctant to get right up in a patient’s space,” said David Calfee, the hospital’s deputy medical director for infection prevention and control. “They worry they’ll get in the way or the smell would be offensive to the patient.”
The project is one way New York hospitals have sought to fight hospital-acquired infections. While infections associated with hospital stays in the state have declined, according to a report by the state’s Department of Health, they have remained higher than rates nationwide, data from the U.S. Centers for Disease Control and Prevention show.
The state estimates 2,000 people died in 2014 of the tracked infections. Of these, 877 were from infections that occurred more than three days into a hospital stay. Infections discovered after this period are assumed to have originated within the hospital.
“This greatly exceeds the number of deaths due to other well-known infections such as AIDS and influenza,” says the state report, which was released in January. The report shows decreases in infection rates from 2007 to 2014.
The CDC tracks infections using a statistic it calls the standardized-infection ratio, which takes into account the different types of care patients receive and the different procedures they undergo. Those statistics were higher in New York state than the national average.
The state said its intensive auditing could explain the higher numbers.
The CDC agrees that possibility exists. “However, we do not know whether this additional auditing can fully explain the number of infections being reported,” said CDC spokeswoman Melissa Brower.
Even if the state does have more thorough reporting, Linda Greene,president-elect of the Association for Professionals in Infection Control and Epidemiology, a trade group, said, “We have to identify opportunities for improvement, and there is still a great deal of work to be done.”
In the hospitals tracked by the state, the most common infection is one caused by the bacterium Clostridium difficile, or C. diff. The infection, most common among people taking antibiotics, results in diarrhea and intestinal problems.
There were 8,890 C. diff infections that began in the hospitals in 2014. The infection rate declined 32% from 2010 to 2014, the health department said.
There were 1,361 surgical-site infections following colon surgery, or infections in 7.1% of such procedures in 2014. Following abdominal hysterectomy surgery, there were 361 infections, or in 1.9% of these procedures, according to the health department.
Hospitals had 1,345 infections from CRE, a drug-resistant bacterium that causes infections with high mortality rates.
In 178 hospitals statewide, the health department tracked 16 types of infection. It issued hospitals 79 so-called red flags, or warnings for infection rates that significantly exceeded the state average. Hospitals that receive flags must submit plans to the state on how they will reduce their infection rates. New York City hospitals receiving red flags for two consecutive years include Mount Sinai Hospital, for colon surgical-site infections and C. diff, and Memorial Sloan Kettering Cancer Center for C. diff.
A Mount Sinai Hospital spokeswoman called the C. diff and colon-surgery results disappointing and said the hospital had already established a multidisciplinary task force to reduce all infections.
Mini Kamboj, director of Memorial Sloan Kettering’s infection-control program, said its numbers are high because some cancer patients, such as those who receive transplants, are at a much increased risk of infection. The state’s statistical adjustment doesn’t sufficiently take this into account, she said.
Area hospitals noted to have rates significantly lower than the state average for two consecutive years include the Hospital for Special Surgery, for hip surgical-site infections; Maimonides Medical Center, for C. diff and central line-associated bloodstream infections in the ICU; and Mount Sinai St. Luke’s for C. diff.
The state views the report itself as an infection-prevention measure.
Hospitals initially had “healthy skepticism” that the reporting program would unfairly compare hospitals or tarnish reputations, said Paul Graman, professor of infectious diseases at University of Rochester Medical Center and a member of a technical-advisory board that works with the health department. “But on most of these measures, we have measurable improvement,” he said, attributing it to the state-surveillance program and the work of the hospitals themselves.
Some advocates say hospitals still aren’t taking simple steps to prevent infections. Nurses and doctors don’t wash their hands enough and some hospitals don’t clean with bleach, said Betsy McCaughey, a former lieutenant governor and chairman and founder of advocacy group Committee to Reduce Infection Deaths.
“Hospitals in New York state do perform worse than national average,” she said. “That is true year after year, even at prominent hospitals identified as the best in the country.”
Area hospitals say reducing infections is a priority, and they continually search for better approaches.
NYU Langone Medical Center looked at hip-surgery infection rates and found 2% of first-time hip-surgery patients contributed 30% of infections, said Michael Phillips, hospital epidemiologist and director of infection prevention and control. These patients were older and more medically complex.
The hospital now repeatedly applies a certain antiseptic for this population, Dr. Phillips said.
At NewYork-Presbyterian, the researchers are now working with cleaning staff to come up with specific scripts to use when getting close to patients.
“We haven’t run across people who don’t care,” Dr. Calfee said.