Wednesday, December 22, 2010 | Two of Orange County’s largest hospitals serving some of its sickest patients say a five-year-old infection control program has produced dramatic results among those most vulnerable.
In fact, said Dr. James Cappon, medical director for quality and patient safety at Children’s Hospital of Orange County, one critical area of the hospital has gone almost a year without one type of infection.
“We’re particularly pleased our pediatric ICU [intensive care unit] is over 330 days” without a central line infection, he said. “That’s just crazy good.”
An estimated 13,500 California hospital patients die each year of infections they acquire in the hospital, according to a 2009 report. That’s more than four times the number of people killed in state traffic accidents last year.
A total of 240,000 patients statewide are estimated to contract infections in hospitals each year, and the extra care required to treat them costs $3.1 billion.
But until the signing of a 2008 law — called Nile’s Law after 15-year-old Nile Moss, whose mother, Carole, spearheaded the drive to get it passed — the state had no power to require hospitals to say how many patients contracted infections each year.
California will release its first infection report Jan. 3. It will cover four types of infections: central line, vancomycin-resistant Enterococci, clostridium difficile, and MRSA (methicillin-resistant Staphylococcus aereus).
Hospitals will be listed in one of four categories: teaching, pediatric, trauma, and none of the above. Not all hospitals have the same infection risks, according to hospital officials. A community hospital with no intensive care unit, for example, doesn’t treat the concentrations of critically ill patients that a large, regional center might.
All are extremely serious, but central line infections have the longest history of health professionals nationwide using checklists and bundling a series of best practices to prevent infections.
Mandatory checklists and additional best practices for the three other infections on the state reporting list are in various stages of development said Linda Dickey, infection control officer and assistant director of epidemiology and infection prevention at UC Irvine Medical Center.
Central Line Infections
Central line infections occur in patients who have catheters inserted for an extended period of time into large veins near the center of their body, normally the neck, chest or groin.
Dickey said across the country and at UCI, infections from central lines began to drop when everyone started following the same practices.
For example, the checklist requires anyone touching the patient’s central line to wash their hands ahead of time, wear a full gown and mask, and make sure the area is disinfected.
And it is important, she said, for the central line to be removed as soon as possible. The longer it remains in the patients, the higher the odds that germs will find a way to start an infection.
Once UCI started using this system, she said, “we saw our [central line infection] rates go down, and they stayed down.”
In the hospital’s neonatal unit, Dickey said, UCI on three occasions has gone 150 days without a central line infection.
“That’s pretty remarkable when you consider how vulnerable these kids are,” she said.
It is rigorous commitment to following the checklists and procedures that makes the system work, according to a variety of medical specialists.
CHOC, which has 238 beds, fills half of them with children in intensive care, said Cappon.
“Many of these patients are going to have central lines,” he said, especially premature babies who virtually all have them.
Like other major children’s hospitals across the country, Cappon said CHOC sees many of the region’s sickest kids because of its specialized abilities. CHOC was part of the national program in 2006 that created the checklist program for children.
Children with cancer face the additional problem of chemotherapy suppressing their immune systems, often for months.
Given the special challenges of dealing with such sick children, Cappon said, following the central line checklist and protocols has shown “we’re definitely on the right track.” He added: “Rigid attention to a standardized process is known to work.”
Will hospitals ever be able to get rid of central line infections permanently?
Five years ago, said Cappon, “they would have said ‘no.'”
The thinking then was that hospitals could go for certain periods without an infection, but they couldn’t sustain it.
But now, he said, “given the success” that’s being recorded at various hospitals — even those that treat such high risk patients as CHOC — “people are beginning to wonder how far you can go.”
UCI’s Dickey noted that anytime you’re inserting something through a patient’s skin, there is a risk of germs.
“What we’re shooting for is zero” infections, she said. But, she added, when one does occur, it’s important to study what happened and what could have been done to prevent it.