Report: Surgical infection prevention falls short
Monday, April 27, 2009
The Right Infection Prevention Care During Year Studied
Measures, But Too Many Patients Remain At Risk
A new report released today by Consumers Union found that hospitals have made progress following certain surgical infection prevention practices, but that too many patients aren’t getting the right care needed to keep them safe. At a minimum, almost 100,000 patients were left vulnerable to developing surgical infections during the year studied because hospitals failed to follow practices proven to reduce the risk of infection, according to a Consumers Union estimate.
The number of patients who did not receive the correct care is likely much higher because the estimate is based on a patient sample reported by hospitals and not the total number of patients who undergo surgery each year. Consumers Union found that 445 hospitals across the country were in low compliance of following a critical infection prevention measure.
“We’ve known for nearly 50 years that the appropriate use of antibiotics before surgery can dramatically reduce the risk of infection,” said Lisa McGiffert, Director of Consumers Union’s Stop Hospital Infections Campaign. “But too many hospitals are not protecting their patients by following these proven infection control practices consistently. As a result, patient experiences can vary widely within each state depending on where they have surgery.”
Consumers Union’s Cutting Surgical Infections web site enables users to check on how well each hospital in the country has followed three key surgical infection prevention measures and is based on data collected by the Centers for Medicaid and Medicare Services (CMS). Consumers Union’s new web site provides a more detailed look at each hospital’s record than what is currently available at CMS’ Hospital Compare web site, including compliance data collected since 2005, which allows users to track progress over time.
Research shows that the risk of surgical infections can be reduced if patients are given an antibiotic within one hour before surgery begins and if the appropriate antibiotic is given, depending on the type of surgery and patient characteristics. Discontinuing antibiotics within 24 hours after surgery ends is critical to reducing antibiotic resistance, a major problem in treating infections. An estimated 40-60 percent of all surgical infections could be prevented by following these and other infection prevention measures.
Consumers Union analyzed the most recent data posted on the Hospital Compare web site, which covers surgeries conducted between July 1, 2007 and June 30, 2008, to determine how well hospitals were following these infection prevention measures. Hospitals that followed the recommended infection prevention measures with 95% or more of patients were considered to be in high compliance. Hospitals that followed them for 79% or fewer of their patients were considered in low compliance.
Antibiotic Given Within One Hour Before Surgery Begins: Giving patients antibiotics right before surgery helps boost their ability to fight off contamination during surgery that could lead to infection. The timing is critical. Patients given antibiotics either more than one hour before or after the first surgical incision is made experience higher rates of infection than those given antibiotics within one hour before surgery. Consumers Union’s analysis found:
• 90.8% of surgical patients across the U.S. received antibiotics within one hour before surgery.
• 1,099 hospitals had high compliance on this measure.
• Hospitals reported that 96,750 patients did not receive the correct care; the actual number is likely much larger since this number is based on a sample of patients reported by hospitals.
• Nationwide, 445 hospitals (13.7% of all reporting hospitals) were low compliers.
• The states with the highest percentage of low complying hospitals were Washington, D.C. (43%), Alaska (38%), New Mexico (35%), Nevada (30%), Oregon (27%), and Idaho (25%).
Appropriate Antibiotic Given to Surgical Patients: Choosing the appropriate antibiotic is critical because it must be effective in preventing infections caused by bacteria likely to be present around the surgical site. Antibiotic selection varies depending on the surgery. Consumers Union’s analysis found:
• 95.4 percent of surgical patients across the U.S. who received an antibiotic within one hour before surgery received the appropriate antibiotic.
• Nationwide, 2,095 hospitals (65% of all reporting hospitals) were high compliers.
• Hospitals reported that 49,230 patients did not receive the correct care; the actual number is likely much larger since this number is based on a sample of patients reported by hospitals.
• Nationwide, only 97 hospitals (3% of all reporting hospitals) were low compliers.
• The states with the highest percentage of low complying hospitals were Louisiana (14%), West Virginia (10%), and Oregon (10%).
Antibiotic Stopped Within 24 Hours After Surgery Ends: Continuing antibiotics beyond 24 hours after surgery does not offer any additional protection. But the prolonged use of antibiotics can cause other complications and contribute to antibiotic resistance. Consumers Union’s analysis found:
• Antibiotics were stopped within 24 hours of surgery for 87.1% of all surgical patients in the U.S.
• Nationwide, 629 hospitals (19% of all reporting hospitals) were high compliers.
• Hospitals reported that 129,420 patients did not receive the correct care; the actual number is likely much larger since this number is based on a sample of patients reported by hospitals.
• Nationwide, 720 hospitals (22% of all reporting hospitals) were low compliers.
• The states with the highest percentage of low complying hospitals were Nevada (57%), Louisiana (46%), Idaho (44%), and Wyoming (40%).
More than 290,000 surgical infections occur in U.S. hospitals each year, according to the Centers for Disease Control and Prevention (CDC). CDC researchers have found that surgical infections occur in 2 out of every 100 surgeries and account for 20 percent of all hospital-acquired infections. Patients who develop infections from surgery spend, on average, an additional 6.5 days in the hospital, are five times more likely to be readmitted after discharge, and twice as likely to die. The CDC has noted that 8,205 patients die from surgical infections annually and that these infections account for up to $10 billion in additional healthcare expenditures each year.
“Every year millions of Americans get infections while hospitalized and progress towards eliminating these infections is too slow,” said McGiffert. “As lawmakers in Washington work to reform our healthcare system they should require all hospitals’ to report their infection rates so consumers will be better informed and hospitals will work harder to improve patient care. And Medicare payments should be tied to how well hospitals follow these critical infection prevention measures.”
Twenty-five states now require public reporting of hospital infection rates. So far, only a handful of states have issued reports. More information on hospital infection reporting efforts can be found at: http://www.consumersunion.org/campaigns/stophospitalinfections/learn.html
Lisa McGiffert: 512-477-4431, ext 115
Michael McCauley: 415-431-6747, ext 126