Report: Oregon hospitals make progress on curbing infections

Oregon hospitals met national prevention targets for central line-associated bloodstream infections in adult and pediatric intensive care units and wards, but fell short in neonatal intensive care units, according to a new state report issued Wednesday on health care-associated infections.

“Health Care-Associated Infections: 2016 Oregon Annual Report” was published by the Healthcare-Associated Infections (HAI) Program at the Oregon Health Authority’s Public Health Division. It examines data on health care-associated infections that Oregon hospitals were required to report to OHA in 2016. It contains HAI data for 61 individual hospitals and 60 freestanding dialysis facilities in Oregon, and has aggregate summaries and facility-specific data for Oregon hospitals’ performance on 10 categories of HAIs, with national benchmarks for comparison.

The 2016 report found that hospitals around the state also performed well in preventing catheter-associated urinary tract infections in adult and pediatric wards and ICUs compared with peers around the country. Performance compared to national estimates for hospital-onset bacterial infections, including Clostridium difficile and Methicillin-resistant Staphylococcus aureus (MRSA), remained stable.

Hospitals demonstrated ongoing improvements in preventing surgical site infections following heart, laminectomy, and hysterectomy surgeries. But they didn’t meet 2013 U.S. Department of Health and Human Services (HHS) targets for reducing surgical site infections following hip- and knee-replacement surgeries.

Becca Pierce, Ph.D., Oregon HAI Program manager, says Oregon continued to exceed the 50 percent HHS reduction target for central line-associated bloodstream infections, also known as CLABSIs, in adult and pediatric settings, observing 59 percent fewer infections than were predicted from national data. Oregon remains a high-performing outlier in the fight against catheter-associated urinary tract infections, seeing 36 percent fewer infections than predicted based on national baselines and showing progressive declines since 2014.

“We’re still seeing a problem with CLABSIs in neonatal ICUs, where extremely vulnerable patients are cared for,” Pierce said. “There’s also more work to be done to prevent C. difficile and surgical site infections at joint prosthesis sites.”

She noted that inappropriate or excessive antibiotic use is a major driver of C. difficile infection, which causes hundreds of thousands of infections and tens of thousands of deaths every year.

HAIs occur during or after treatment for other medical conditions. HAIs are potentially life-threatening, and are preventable. About one in every 25 patients in the hospital will develop an HAI, according to the Centers for Disease Control and Prevention.

To address HAIs, OHA implements a mandatory HAI reporting program that raises awareness of HAIs, promotes transparency of health care information and helps hospitals reducing and prevent HAIs. The HAI Program supports numerous committees and networks working to detect and contain HAIs in Oregon. It also works to prevent spread of antibiotic-resistant organisms during patient transfers between health care facilities by ensuring communication between medical providers, and works to raise awareness among patients and health care providers about infection control practices that save lives.

Helpful links:
· OHA HAI website: http://www.healthoregon.org/hai.
· CDC HAI website: http://www.cdc.gov/hai/
· 2016 report: http://www.oregon.gov/oha/PH/DISEASESCONDITIONS/COMMUNICABLEDISEASE/HAI/Documents/Reports/2016_HAI_Annual_Report.pdf

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News release from Association of Oregon Hospitals:

Oregon hospitals continued their improvement towards eliminating health care-associated infections that are reported to the state, according to a report released Wednesday by the Oregon Health Authority. The Oregon Association of Hospitals and Health Systems said the report highlights the continued success Oregon hospitals have had in improving clinical quality and patient safety. Supporting that assertion was the release of a national report on hospital safety by the Leapfrog group on Tuesday, which showed Oregon’s hospitals moving the state from 48th best in their hospital safety rankings in 2012 to 8th best in the most recent edition.

Oregon hospitals are better than the national baseline for all reported infection types. They also met or exceeded targets set by the Department of Health and Human Services in nine of the reported infection types.

“Oregon hospitals are committed to provide safe care for every patient,” said Cheryl Wolfe, chair of the OAHHS Quality Committee. “Today’s OHA report and the Leapfrog scorecard demonstrate that hospitals have maintained that commitment as a priority for quality patient care. Consistent and sustained effort is required, along with a relentless focus on incorporating best practices and learning from the data to achieve these sorts of results.”

In an effort to spread a culture of safety, Oregon health care providers have participated in initiatives that address accountability and improved practices. For instance, fifty-two of Oregon’s 62 hospitals took part in the Centers for Medicare and Medicaid Services (CMS) Partnership for Patients (PfP) initiative, which aimed to reduce preventable harm by 40 percent and readmissions by 20 percent. Since beginning their Partnership for Patients work, hospitals working with OAHHS achieved a 40 percent or greater reduction in CAUTI, CLABSI, surgical site infections, ventilator-associated complications, and early elective deliveries. The PfP work was accomplished primarily during 2014-2016 and helped lay the foundation to maintain sustained efforts in Oregon hospital patient safety.

“This report is a testament to the ongoing infection prevention efforts by our Oregon healthcare facilities.” said Rebecca Pierce, Ph.D., manager of OHA’s Healthcare-Associated Infections Program. “In this era of mounting antibiotic resistance, we need to work together to prevent the transmission of dangerous organisms both between and within healthcare facilities, to track and prevent antibiotic overuse, and to reinforce the infection control practices that keep our patients safe. This report is an important milestone as we work to better understand where Oregon is doing well and where we can improve to prevent infections.”

Patients are important partners in helping to keep themselves well. They can reduce the risk of infection by taking all the pre-hospitalization infection prevention steps their doctors recommend, such as a pre-surgical antibacterial shower or bath, not shaving before surgery, and stopping smoking. They should also take antibiotics and other medications exactly as directed by their doctors, and ask their visitors to clean their hands before visiting and to stay home if they are sick.

The Oregon Healthcare-Associated Infections Report stems from legislation passed in 2007 to create a mandatory reporting program to raise awareness, promote transparency for health care consumers, and motivate health care providers to prioritize prevention.

The OHA report, completed by the Healthcare Associated Infections (HAI) Program, is available at http://www.oregon.gov/oha/PH/DiseasesConditions/CommunicableDisease/HAI/Pages/index.aspx

The Leapfrog Group report is available at http://www.leapfroggroup.org/news-events/five-states-make-dramatic-strides-patient-safety-finds-latest-leapfrog-hospital-safety