Ore. hospitals score well as feds prep infection-treatment changes

Ore. hospitals score well as feds prep infection-treatment changes

SALEM, Ore. – Oregon hospitals perform better than the national average on two out of three healthcare-acquired infections studied in the first report of national healthcare infections.

Results were released Monday by the Oregon Health Authority, a new state agency created out of the health programs administered through the Oregon Department of Human Services.

The news comes at a time when, under federal health reform, all hospitals will be required to report infections as of 2011. At the same time, Medicare will stop reimbursing providers for costs associated with treating those infections, according to a press release distributed Monday from the Oregon's DHS.

"The tie between this reporting program and the federal reform is that it really sets up our hospitals well to make sure they ... will be ready when Medicare flips the switch," said Sean Kolmer, deputy administrator at the Office for Oregon Health Police and Research in the Oregon Health Authority.

Medicare already does not pay for some healthcare-acquired infections and "physician caused" costs in Oregon, such as cutting on the wrong side of a patient. Without Medicare reimbursement, the hospital must pick up the cost.

Starting July 1, 2011, Medicaid will adopt those same measures. In 2014, Medicare will follow by requiring infection reporting, already being done in Oregon to meet future Medicaid requirements, nationwide to make its annual payment adjustments.

Hence, Oregon's lowered rate of healthcare infections is being called a "good sign" for those using Oregon hospitals in a time of federal health reform. However, state officials said more still can be done to reduce infections sometimes contracted after being treated by healthcare providers. 

"This first report illustrates that, although Oregon is ahead of national averages in terms of reducing healthcare acquired infections, there is still much more work to be done," said Dr. Steve Gordon, member of the OAHHS Quality Committee and chief quality officer for PeaceHealth Oregon, in a prepared statement Monday. "Addressing HAI is a top priority of every hospital in this state."

Oregon is one of 10 states in the country with a mandatory statewide public reporting program for healthcare acquired infections. All hospitals are required to report three of the most common infections: central line-associated bloodstream infections, those that occur after knee replacement surgery and those connected with coronary bypass grafts.

In 2009, there were 199 reported infections from 50 hospitals. The infection rate breaks down as follows:

  • The Oregon infection rate for central line-associated bloodstream infections is 1.2 infections per 1,000 central line days, approximately 38 percent lower than the national average of 1.92. (A central line is a catheter inserted directly into a large vein, which enables rapid administration of fluids, blood or medications.)
  • The Oregon coronary bypass graft infection rate is 2.01 percent, approximately 30 percent lower than the national rate of 2.86 percent. 
  • The Oregon knee replacement infection rate is 0.82 percent, which is similar to the national rate of 0.89 percent. 

"Healthcare acquired infections can be serious and costly. They are also largely preventable," said Tina Edlund, deputy director of the Oregon Health Authority, in a prepared statement Monday. "This information gives us a place to start as we improve patient safety. We are working closely with our partners in the healthcare community and patient advocates to do as much as possible to eliminate these infections."

Healthcare-acquired infections are among the top 10 leading causes of death in the United States and cost roughly $33 billion per year nationally. In Oregon, hospital costs for patients who experience healthcare-acquired infections increases an average of $32,000 per stay.

Preventing these infections has become a key element in improving patient care and lowering costs in the healthcare system. "Addressing the issue takes effort on two fronts, improving patient care and improving patient education," Edlund said.

Healthcare providers are increasing improvement and awareness of the issue. Several Oregon hospitals are participating in projects that address training and practices for hand hygiene, peer accountability and improved practices. The Oregon Association of Hospitals and Health Systems coordinates several patient-safety clinical projects to specifically address hospital infections with its hospital members.

Patients can reduce the risk of infection by taking all the pre-hospitalization infection prevention steps their doctors recommend, such as pre-surgical chlorhexidine baths, not shaving before surgery and stopping smoking. They also should take antibiotics and other medications exactly as directed by their doctors, and ask their visitors to stay home if they are sick.

The first Oregon Healthcare Acquired Infections Report stems from legislation passed in 2007 to create a mandatory reporting program to raise awareness, promote transparency for healthcare consumers and motivate healthcare providers to prioritize prevention. The Oregon Health Authority's Health Care Acquired Infection Advisory Committee is working to expand the program in hospitals and is collecting information in other surgical facilities beyond hospitals.

With continued quality improvement, come 2014 Oregon hospitals "will continue to get the same payments they're already getting for Medicare," Kolmer said.

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