Three Washington, D.C.-area teaching hospitals have ranked in the lowest-scoring group nationally on preventing infections when their patients are hooked up to central lines, intravenous tubes that supply fluids, medications, and nutrients to those in dire need. Two institutions in the region rated highly.
Consumer Reports deserves credit for its continuing reporting on hospital acquired infections (HAIs), a scourge that in 2011 afflicted 650,000 already ailing Americans and which contributed to 75,000 deaths. The advocacy group says 27,000 patients were felled with central line infections in 2015, with a quarter of these especially sick and frail individuals dying of them. Treating patients for central line infections cost on average $46,000—more than for any other HAI.
The area teaching hospitals that the magazine ranked poorly, based on an analysis of federal data from 2011 to 2015, were: George Washington University Hospital, Holy Cross Hospital in Silver Spring, and Howard University Hospital. The two high-ranking institutions were: MedStar Franklin Square Medical Center in Baltimore and Sentara Norfolk (Va.) General Hospital.
I’ve written how federal officials recently gave one-star ratings, their lowest, to five area hospitals, including George Washington University Hospital and MedStar Georgetown University Hospital, both of which teach medical residents.
As for central line infections, the shameful aspect of them is how preventable they are: The magazine says that hospitals that require caregivers to adhere to a check-list, developed by a doctor and now an executive at Baltimore’s Johns Hopkins Medicine, slash and even eliminate this cause of patient misery.
Teaching hospitals should excel at preventing central line and other HAIs, experts say, because these often are flagship institutions with extensive resources and an ostensible commitment to medicine’s best practices. They’re not only supposed to execute these but also to imbue them in caregivers in training. Such hospitals say they’re often unfairly singled out on quality measures, as they take on some of the sickest, most frail patients with complex conditions and bad circumstance.
But quality watchdogs—both Consumer Reports experts and federal overseers—take all this into account, and this weak performance defense doesn’t stand up to scrutiny, they say. The magazine’s best and worst lists include hospitals near to each other that serve similar, notably sick and poor populations. Some institutions of high repute are ranked low, while other less-known hospitals score high.
Although many HAIs have stayed stuck at the same levels, central line infections were halved between 2008 and 2014, partly due to carrot-and-stick quality elements in the Affordable Care Act aka Obamacare.
A sustained, comprehensive institutional commitment is required to cut or eliminate central line infections and other HAIs, experts say. While leadership needs to start at the top, nurses need to drive a lot of this, especially if empowered to call out doctors and colleagues for sloppy practices that don’t adhere to highest hygiene and safety standards.
Hand-washing campaigns, of course, are critical, and some hospitals have successfully tapped roving, “undercover” monitoring teams to boost enforcement. A colleague notes that at one academic medical center, the medical chief of staff assists in HAI campaigning by naming at monthly doctors’ meetings scofflaws and, to start with, for minor offenses, rearranging their parking privileges.
I see in my work the continued toll that hospitals can inflict on patients with HAIs and other mistakes. I’ve written on how some experts at Johns Hopkins now see medical error as the No. 3 killer of Americans, claiming 250,000 lives annually. Yes, doctors and hospitals have tough, sometimes thankless roles. But they can stamp out preventable infections, and they must take all appropriate steps to do so.