published Monday, May 7th, 2012

Infections acquired during hospitalizations declining in Tennessee

A VNUS Closure catheter is inserted into a vericose vein through a small opening in the skin.
A VNUS Closure catheter is inserted into a vericose vein through a small opening in the skin.
Allison Kwesell
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FAST FACT

Hospital-associated infections kill 99,000 people every year and are one of the top 10 causes of death in the nation, according to the CDC.

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Although Tennessee frequently ranks in the bottom tier of health measurements, a new report praises the state for dramatically reducing hospital-associated infection rates.

The U.S. Centers for Disease Control and Prevention report commended Tennessee for reducing infections by 34 percent from 2009 to 2010 and also for having the second-largest decrease in the country in its overall standardized infection ratio for bloodstream infections from central IV lines.

In addition, the CDC praised the state for its work to ensure that the data reported by hospitals is accurate.

Officials involved in the project say figures for the first six months of 2011, which have not yet been released, show even greater improvement.

Tennessee is one of 21 states that showed a significant decrease in IV-associated bloodstream infections and one of only six states that implemented a method of ensuring accuracy in reporting the 2010 data, the report shows. Additional states have since implemented similar measures.

"We really have made very significant improvements," said Dr. Marion Kainer, director of health care-associated infections and antimicrobial resistance program at the Tennessee Department of Health.

Nationally, about 99,000 people die every year from hospital-associated infections, one of the top 10 causes of death in the nation, according to the CDC. The infections cost an estimated $28 billion to $34 billion a year, according to a 2009 agency estimate.

Tennessee's improvements in 2010 mean 20 lives saved, 2,310 fewer hospital days and a cost savings of more than $4.8 million, the 2010 annual report form the Tennessee Center for Patient Safety says.

The statewide initiative is a collaborative between the Tennessee Center for Patient Safety -- primarily funded by the BlueCross BlueShield of Tennessee Health Foundation -- the Tennessee Hospital Association, the Tennessee Department of Health and various other groups across the state.

Dr. Inga Himelright, vice president and chief medical officer at BlueCross BlueShield of Tennessee, said the collaborative in Tennessee is unlike any in the nation.

"This fundamentally supports our mission of improving the health of individuals in the state of Tennessee," Himelright said.

Central line infections in 2010

Changes in central line-associated bloodstream infections represent an important measure of hospital quality and patient safety, according to the Tennessee Center for Patient Safety. A central line is a catheter or tube that is placed in a major vein close to or leading directly to the heart, such as the neck, chest, arm or groin. Central lines are used to give fluids, medications and/or draw blood. They can be left in place for weeks or more.

State / Observed / Predicted / Facilities reporting

Tennessee 772 / 868 / 91

Georgia 274 / 349 / 36

Alabama 280 / 255 / 69

Source: Centers for Disease Control and Prevention

A cultural change

Kainer said her team works closely with hospitals across the state to get feedback and implement evidence-based practices, in addition to verifying hospitals' reporting numbers by reviewing medical charts.

"These numbers are real. We know people are not gaming the system," Kainer said.

Some of the things they emphasize is washing hands, creating a maximum barrier of protection between the patient and person when an IV is put in and having all the equipment needed within reach.

"You have to create a culture of safety and to make it as easy as possible to do the right thing," Kainer said.

The groups involved also have monthly conference calls to discuss methods and share success stories. If one hospital has found a certain method that works for it, other hospitals can use it to address similar problems, Kainer said.

Local hospitals said they are excited to see the numbers trend down every year as they work together.

At a March board meeting, former Erlanger Chief Medical Officer Cy Huffman provided an update about the changes Erlanger Health System has made. Its goal is to make sure best practices are followed for every patient every time, he noted.

Gwen Davis, director of infection prevention at Memorial Health Care System, said that, among other things, it has worked to improve making sure an IV is needed and placing the line in a place other than the groin, which is more prone to infections.

Despite the dramatic improvements, Tennessee's numbers are still below the national average benchmark. Members of the collaborative say they're committed to continuing improvements until there are zero hospital-associated infections.

Making the data public and sharing information are key factors for continued improvement, Himelright said.

Chris Clarke, senior vice president for clinical services at the Tennessee Hospital Association, said it is looking ways to improve providing information to the public.

"The question now is: How do we take those lessons learned and continue to change the culture?" Clarke said.

Contact staff writer Mariann Martin at mmartin@timesfreepress.com or call 423-757-6324.

about Mariann Martin...

Mariann Martin covers healthcare in Chattanooga and the surrounding region. She joined the Times Free Press in February 2011, after covering crime and courts for the Jackson (Tenn.) Sun for two years. Mariann was born in Indiana, but grew up in Pennsylvania, Tennessee and Belize. She graduated from Union University in 2005 with degrees in English and history and has master’s degrees in international relations and history from the University of Toronto. While attending Union, ...

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