Photo: Scanning electron micrograph of MRSA bacteria, couresty Centers for Disease Control and Prevention.
Every year tens of thousands of Coloradans who go to the hospital to get healed actually get sicker. They get infections as a result of their medical care. An unknown number of those people die.
Hospitals don’t have to make their infection rates public, except for a handful of procedures.
The state health department publishes an annual report with that information, in part to help consumers pick the safest hospitals. This year’s report has just been released.
Colorado Public Radio Health Reporter Eric Whitney got some expert help deciphering that report.
In the first of two stories on hospital infections, he found that consumers would be hard pressed to get a clear picture of hospital safety from the state’s infection report alone.
WHITNEY: Kerry O'Connell is painfully familiar with hospital-acquired infections. O’Connell had surgery to repair his dislocated elbow back in 2004. The surgery was pretty simple. The infection he got at the hospital was not.
O'CONNELL: Had no idea that you could actually contract infections from surgery that would make your arm swell up like a watermellon and could almost kill ya.
WHITNEY: The staph infection O'Connell got from surgery meant he had to go back under the knife four more times and spend weeks as an invalid.
O'CONNELL: I ended up spending about 2 months on antibiotics, they put a catheter in your chest and pump you full of Vancomyicin twice a day, you sit under an IV pole. Took about $60,000 worth of medical care to kill off some bugs and remain on this earth.
WHITNEY: So when the state decided four years ago to start requiring hospitals to report some of their infection rates, O’Connell volunteered to be a citizen representative on an advisory panel for the process.So I asked him to help a hypothetical patient who needs ankle surgery to pick a hospital with the lowest risk of infection.
O'CONNELL: Well, the very first thing patients need to do is talk to your doctor and find out where your doctor has privleges at, where he's allowed to do surgery.
WHITNEY: That's typically two or three hospitals. But if you go to the infections report and look for those hospitals' infection rates for ankle surgery, you're not going to find it. The report only lists rates for six different kinds of surgeries.
O'CONNELL: If you can't find ankle surgery then you start looking at knee surgery or something somewhat similar.
WHITNEY: The idea is that hospitals only need to report infection data on a handful of procedures to show how they do at infection control overall. National experts say that kind of snapshot is valid. They say that requiring hospitals to report on every kind of surgery would be too expensive. So if you need an orthopedic operation, like on an ankle, you can look at how hospitals do on the two orthopedic surgeries the state tracks: knee and hip replacement.
For each, there are several columns of numbers. Let’s start with the one comparing hospitals to national averages:
O'CONNELL: Most everybody on these pages will be “same” as the national average. But it's a very broad statistical analysis, and you ask, the majority of people come out as average, so it doesn't have a huge lot of meaning. The infection count column is really the most important one.
WHITNEY: That infection count column tells you how many infections each hospital had for a given operation. But just because one hospital has twice as many infections for hip surgery as another doesn't mean it's twice as bad. You also have to look at how many hip surgeries total each hospital did. If one hospital has a higher number of infections, but it did a lot more of that kind of surgery overall, then it’s infection rate could still be pretty low.
But infection control experts says even comparing rates instead of raw numbers doesn’t give a real apples-to-apples comparison. Dr. Connie Price is head of infection control at Denver Health.
PRICE: so if you're a professional athlete, maybe 30 years old and you have to get your hip replaced, and you're healthy and you don't have any other chronic medical conditions that correlate with risk of infection, that patient probably shouldn't be compared to somebody who's getting their hip replacement because they're 80 years old. Perhaps they're smoking, perhaps they have very uncontrolled diabetes. All of those things have been shown to increase the risk of infection.
WHITNEY: Colorado's hospital infection report tries to take those factors into account, and offer an apples-to-apples comparison among the state's hospitals. It does it by running the risk factors through a mathematical formula. Dr. Price is an advisor to the state health department on those formulas.
PRICE: and our methods are far from perfect, so the consumer needs to keep that in mind, and needs to consider other factors that are more well established in choosing their hospital care.
WHITNEY: It's also worth noting that the infection numbers in the state's report come from the hospitals themselves. And none of those numbers are audited for accuracy.
So, do the numbers really mean anything? We ran that by Kerry O’Connell, who reviews all the numbers from his patient-advocate position on the state advisory panel. He says that interpreting the numbers, let alone their accuracy, would be pretty hard for the average person.
O'CONNELL: no, you have to have some pretty significant math skills. It’s probably easy for engineers and scientists and people who are used to numbers. For everyday people- are probably going to be pretty overwhelmed by it.
WHITNEY: But O’Connell says in the four years he’s been getting to know hospital infection control people, he thinks they’re honest in the numbers they report. And he thinks the report is valuable, even if it’s not the kind of thing prospective patients can easily use to tell which hospital is safe for infections.
Dr. Lisa Miller echoes that. She's the state’s acting chief medical officer. She says that even if the numbers aren’t perfect, they do have real impact on hospitals.
MILLER: It does get facilities’ attention, and certainly I think that’s the way that this can work to drive down infection rates, is if those facilities know that these data are being publicly published, and if you’re one of those facilities that have a higher rate, I can bet that you are looking a little more carefully at your procedures and seeing what you can do to make sure you’re following all the recommended prevention steps.
WHITNEY: Many in the medical community - doctors, hospital administrators and patient advocates like Kerry O’Connell agree the report puts the right kind of pressure on hospitals to improve.That should help in the long run, but it doesn’t help patients now who want a simple, precise way to find out whether their hospital is good at keeping infections under control.
That kind of report just doesn’t exist. Patient advocates say consumers should consider the state report, on-line report cards put out by the Colorado Hospital Association and other sources when weighing the risks of surgery at a particular facility. Then, they say, have a good, informed discussion with your doctor about infection risks and what the two of you can do to avoid them.
Part two of our series, explaining why hospital infections are so hard to prevent, is available here.
To read Colorado's Health Facility Acquired Infections report click here.
The Colorado Hospital Association offers "Hospital Report Cards" here
The federal government's "Hospital Compare" website is here