Hospital infection rates down, state reports

The latest data on infection rates from the state Health Department have been released, and the resu
Joseph Apruzzese, Ellis Medicine Supervisor Environmental Services, and Rossana Howe, Infection Prevention Improvement Leader, talk about a UV machine that eliminates infectious diseases in a ICU room at Ellis Medicine.
Joseph Apruzzese, Ellis Medicine Supervisor Environmental Services, and Rossana Howe, Infection Prevention Improvement Leader, talk about a UV machine that eliminates infectious diseases in a ICU room at Ellis Medicine.

The latest data on infection rates from the state Health Department have been released, and the results are good: Hospital Acquired Infections are down across the state.

HAIs affect 4 percent of hospital patients in the state, and result in “longer hospital stays, antimicrobial resistance, increased healthcare costs, unnecessary deaths and greater emotional and personal costs to patients and their families,” according to the most recent report.

Infections from the life-threatening bacteria of the colon, known as a Clostridium Difficile Infection, a CDI, or more commonly as C. diff, are also down.

There were 8,890 cases of hospital onset C. diff in the state in 2014, which is a 32 percent decrease since 2010, according to the department’s recent data.

With a 32 percent decline, it is estimated 10,380 C. diff infections were prevented, for a direct cost savings of $98 to $139 million.

The report states the rate of Surgical Site Infections, or SSIs, following colon, abdominal hysterectomy, hip replacement and coronary artery bypass graft surgeries were also down.

SSIs following an abdominal hysterectomy have declined 15 percent since 2012, hip replacement or revision surgery infections are down 10 percent since 2008 and coronary artery bypass graft SSIs have declined 34 percent since 2007.

Infection rates are down across the state, but at some local hospitals they are still higher than the state’s average.

In 2014, Albany Medical Center saw a decrease in most types of SSIs, but was still 44 percent above the state’s average with 42 cases of patients acquiring an SSI out of 446 colon procedures.

In 2014, Albany Med had an adjusted rate of 14.6 hospital onset CDIs per 10,000 patient days at risk for infection, which was 38 percent higher than the state’s rate of 10.6, according to the Department of Health’s most recent numbers.

In 2013, Albany Med had a rate of 11.5 CDIs per 10,000 patient days at risk.

Jeffrey Gordon, a spokesman for Albany Medical Center, said patients are admitted to the hospital in a variety of conditions, from healthy to situations where their immune systems are compromised.

“At an academic medical center like Albany Med, we get the sickest of the sick,” Gordon said. “We get people who are transferred in from other hospitals who don’t have the expertise, technology or procedures to handle certain kinds of conditions. We get people who are more highly compromised than typical hospitals.”

Gordon said the hospital’s increase of C. diff in 2014 paired with a rising number of patients each year is to be expected.

“The numbers the Health Department just released are also already two years old, because it takes the department so long to collect it all,” Gordon continued. “We’re seeing substantial improvements … the rates for 2015 have greatly decreased, and we expect a further decline this year.”

Albany Medical Center’s trauma center serves 25 counties from the Canadian border down to Westchester County, the spokesman said, so the hospital continues to get more and more people from other institutions.

“The most complex cases we see are sent here from other regional hospitals,” Gordon said. “People can come to use with an infection that doesn’t present itself yet when they arrive from another hospital, and then after they’re here, they start showing symptoms.”

To combat Hospital Acquired Infections, Gordon said Albany Med follows stringent protocols and actively follows the guidelines set by the Centers for Disease Control and Prevention.

The hospital uses a vaporized hydrogen peroxide room disinfection process with a system of UV lights targeted at infection in a patient’s room post-discharge.

“When you go to a hotel, you check out in the morning, and before another guest comes in that evening, the staff changes the sheets, we hope, and thoroughly cleans the bathroom and other areas,” Gordon said. “In the hospital, we do the same thing, but with a more strict process — making sure whatever pathogens the previous individual had aren’t carried, and any remaining pathogens are killed.”

Rossana Howe, the infection prevention improvement leader for Ellis Medicine, said the Schenectady hospital also uses the ultraviolet light cleaning strategy to prevent the spread of infection.

“Clostridium difficile is a hardy spore that can last in the environment,” Howe explained. “It’s difficult to kill. Hand hygiene is important to prevent the spread, as the spore is so hardy, alcohol sanitizer does not work.

“The mechanical action of washing hands with soap and water is necessary to help it flow off,” she added. “Cleaning has to be done perfectly well.”

Howe said the hospital cleans a room with bleach to kill infection and has used the UV light machine since 2012, which hospital staff use in two positions at the end of the bed for two, five-minute cycles after a patient is released.

“The light destroys the bacterial cell wall viruses,” Howe said. “It’s the final strategy we use to make sure we’ve killed all the organisms in the environment.”

Ellis has a significantly low amount of SSIs, Howe said, as the state’s data show only four cases of an SSI out of 180 colon procedures in 2014, and zero for hip procedures.

In 2014, Ellis had 83 cases of hospital onset C. diff out of 84,565 patient days, or a rate of 14.5 hospital onset CDI cases per 10,000 patient days at risk.

In 2013, Ellis had 51 cases of C. diff of 90,656 patient days, or a rate of 7.7 cases per 10,000 patient days.

The local hospital’s 2014 rate of C. diff cases was 38 percent higher than the state’s average that year, but Howe said things have improved greatly since the 2-year-old data was collected.

Despite, the CDI spike in 2014, Howe said the hospital’s rates dropped dramatically in 2015, with a 38 percent decline.

“We’ve gotten better with more thorough testing to catch the infection earlier,” the local infection prevention leader explained.

Ellis Medicine also has a multi-disciplinary task force to come up with strategies for early identification of patients that have infection and placing them in isolation and taking the correct treatment measures immediately after being diagnosed, which have also decreased infection rates.

“We have an ICU staff that’s very engaged in identifying patients with an infection right away, which is key,” Howe said. “That patient is put on precautions until the test results come back.

“It’s better to be safe than sorry.”

The task force also works to combat C. diff that comes in from the community and environmental antibiotic usage, which can cause the infection to proliferate in the gastrointestinal tract.

“We need to focus more on the infection in the community and antibiotic usage,” Howe said. “We really want to get to zero — that’s our goal with all HAIs, and we are getting closer to it. It requires a lot of focused efforts continuously, but we have a very strong focus on making sure we are doing everything necessary to make sure we can secure the safety of our patients while they are in our care.”

Reach Gazette reporter Kate Seckinger at 395-3113, [email protected] or @KateSeckinger on Twitter.

Categories: News, Schenectady County

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