Surgical-site infection rates changed little at hospitals in Western New York from 2008 through 2011 and exceeded rates in other regions of upstate New York, a report by Univera Healthcare shows.
An estimated 99,000 deaths associated with infections occur in hospitals alone each year, according to the federal Centers for Disease Control and Prevention. Hospitals, insurers and government policy-makers have in recent years pushed to reduce hospital-acquired infections, but Univera's report is one of many indicators that the potentially fatal problem remains a difficult challenge.
The health insurer analyzed data on infections at surgical sites and central-line bloodstream infections that the state requires hospitals to track and that it releases to the public each year.
A “central line” refers to the thin tubes known as catheters that are placed into a patient's vein to draw blood, give fluids or medications. A bloodstream infection can occur when bacteria travel down a central line and enter the blood.
Western New York's infection rates were among the highest in 2011 compared with other regions in upstate New York – 2.34 surgical-site infections per 100 procedures and 1.52 central line-associated infections per 1,000 days the lines were in place in patients.
However, Western New York hospitals also saw improvements from 2008 through 2011. The surgical-site infection rate declined 0.4 percent, and the central-line rate dropped 13.6 percent during that period.
The report also found:
• The overall surgical-site infection rate in upstate New York declined 7.9 percent, from 2.14 per 100 procedures in 2008 to 1.97 per 100 procedures in 2011. Statewide, the infection rate decreased 3.2 percent, from 2.17 infections per 100 procedures to 2.10 infections per 100 procedures.
• Each year, surgical-site infection rates in upstate New York hospitals as a whole were lower, compared with statewide infection rates.
• The largest rate of decline – 32.9 percent – over the period examined for surgery-related infections occurred in Finger Lakes hospitals. The rate increased the most – 10.8 percent – in Central New York.
• Central line-associated bloodstream infections decreased in all upstate regions, and the rate was lower as a whole upstate compared with the statewide rate.
• In upstate New York, the central-line infection rate dropped 45.9 percent, from 2.07 infections per 1,000 days to 1.12 per 1,000 days. It declined 42.4 percent statewide, from 2.38 infections per 1,000 days to 1.37 per 1,000 days.
“What stood out most is that we're seeing fewer infections overall at hospitals as they make improvements, but that there is also regional variation,” said Carolyn Whitcher, director of provider performance improvement analytics for Univera.
She cautioned that a limitation of the report is that it didn't account for the differing demographics and severity of illness of patients. However, she said the findings suggest that hospitals across the state are in varying stages of adopting safety programs and having varying levels of success at changing their work cultures to reduce adverse events, including infections.
Experts say that such simple steps as using checklists and ensuring employees, including doctors, wash their hands before touching a patient will lead to improvements.
Univera, for instance, is experimenting with a program in Central New York and the Southern Tier to elicit very basic recommendations from front-line staff for eliminating infections, she said.
“A lot of this is not rocket science,” she said.
The health plan estimated that there were 7,754 hospital-acquired infections in 2010 at Western New York hospitals, leading to 349 deaths. It estimated 108,050 infections statewide that year with 4,862 deaths.
Univera's analysis also estimated that treating hospital-acquired infections added about $344 million to $670 million to hospital spending Upstate in 2011, and as much as $3 billion in additional costs statewide.
Bruce Boissonnault, president of the Niagara Health Quality Coalition, said there is an inherent weakness in addressing infections one hospital at a time because many patients shift from facility to facility, including nursing homes.
The coalition publishes an annual hospital report card that includes ratings on infections.
“We need a cooperative system of surveillance for the most dangerous infections that is implemented equally at all facilities,” he said. “Safety programs for infections are no stronger than their weakest link.”