SALT LAKE CITY — The Utah Department of Health released data this week about the frequency of several types of serious infections suffered by patients in Utah in connection with their hospital stay or other medical care, showing mixed results.
Karen Singson, manager of the Department of Health's health care-associated infection program, said there is great reason to be encouraged about Utah's lowering rate of "central line-associated blood stream infections," often referred to as CLABSIs.
"I am absolutely thrilled that we are seeing fewer CLABSI infections. … CLABSIs are very costly, they're associated with high mortality," Singson told the Deseret News. "We're saving lives and saving health care dollars."
The Centers for Disease Control and Prevention describes a central line as a catheter tube "that doctors often place in a large vein in the neck, chest or groin to give medication or fluids or to collect blood for medical tests." The agency says infections associated with central line placements are considered preventable, but "result in thousands of deaths each year and billions of dollars in added costs to the U.S. health care system."
The number of such infections that occurred in Utah in 2016 were 107, compared to 104 in 2015.
Though all infections can become serious, a central line-associated blood stream infection "would be the one that is probably the most catastrophic or potentially catastrophic," said Dr. Bob Pendleton, chief medical quality officer for University of Utah Health.
"Health care-associated infections have been recognized as a major national problem for a couple of decades now," Pendleton said. "(Before that), there was a lot of feeling that infections like these are an inevitability rather than something that can be completely prevented."
Utah is doing particularly well in preventing "newborn ICU-related CLABSIs," according to the Department of Health, reporting 46 percent fewer cases in 2016 compared to the national rate.
The state also reported significantly positive data with incidents of methicillin-resistant Staphylococcus aureus (MRSA) infections. Such infections are caused by a bacteria "that's become resistant to many of the antibiotics used to treat ordinary staph infections," according to the Mayo Clinic.
"I think our health care facilities have been absolutely dedicated in preventing antibiotic resistance," Singson said, noting that Utah is consistently better than the national average for MRSA infection rates. "I think that this lower rate reflects this implementation of those good practices."
The frequency of "surgical site infections" within 30 days of colon surgery was 28 percent above the national rate in 2016, while that number was 32 percent for surgical site infections within 30 days of an abdominal hysterectomy, according to the Department of Health report.
In all, those infections following colon surgery numbered 138 in Utah in 2016, compared to 123 in 2015. Surgical site infections following an abdominal hysterectomy were also up to 57 in 2016 compared to 51 the year prior.
"It is not a new trend. … We have seen a sustained increase in our colon surgery site infections and we have seen a little bit of a trend of increasing infections post-abdominal hysterectomy," Singson said.
Utah also hovers at 18 percent above the national average for catheter-associated urinary tract infections, with 73 such infections being reported statewide in 2016. Singson said the higher than average numbers of surgical site and urinary tract infections mean there is reason to be "concerned."
"More work needs to be done to implement best practices to prevent infections," she said.
Pendleton said health care-related infections have caught the attention of the industry and the U.S. government in part because of their sheer scope.
"In total (they) impact more people than certainly things like highway fatalities," he said. "It's a common problem and one of the most common complications of getting health care and so it affects lots of families. For some it can be a minor annoyance, but for many it can be catastrophic."
Although the Utah Department of Health releases data on the topic, it is ultimately the federal Centers for Medicare and Medicaid services that hospitals account to through regular reporting.
Both Pendleton and Singson said the Utah Department of Health fits into more of an advisory role, while the Centers for Medicare and Medicaid Services ultimately holds disciplinary power for health providers believed to be falling egregiously short of safety standards.
"Facilities are not accountable to the (Utah) Department of Health to decrease their health care associated infections," Singson explained. "In the Department of Health we serve as a resource (for them)."
Pendleton praised the openness of the Utah Department of Health report as a tool for health providers to know how the state stacks up nationally. He said Utah was the first state to require such a detailed report, beginning in 2012.
"We were an early adopter in making this data transparent to the public," Pendleton said. "The hospitals and health systems in the state have been at the leading edge of trying to make that better (as well)."
The full report additionally goes into detail about data for specific hospitals, which it lists by name. But adequately comparing hospitals' performances is difficult to do from that data because it "does not reflect variabilities of patient acuity (burden of care) experienced in different facility settings," the report states.2 comments on this story
In addition, "facilities with small numbers of patients may not have enough (infection) events to reliably compare to the standard population," and are excluded from some data sets. Even for hospitals that do qualify for inclusion in a data set, specific numbers of infections are not provided, but instead an arrow indicating whether or not infection incidents are higher or lower than the national rate by a statistically significant margin.
Singson also cautioned the Department of Health report is not all inclusive in that it does not collect data from hospitals about infections that are either less serious, more difficult to attribute to any one factor, rarer or not required to be reported by the federal government.
Health care facilities "may or may not choose to even track those infections," she said.