Infection rates in Boston hospitals vary substantially, says Consumer Reports Health

Hospitals in the Boston area vary dramatically in terms of how well their intensive care units (ICUs) prevent central-line bloodstream infections, a cause of death, disability, and expense in our nations' hospitals that is largely preventable. 

On February 2, www.ConsumerReportsHealth.org will post hospital infection rates for 25 Boston area hospitals, along with other critical patient safety and satisfaction information for consumers.  Bloodstream infections cause at least 30 percent of the estimated 99,000 annual hospital-infection-related deaths in the U.S. and add on average $42,000 to the hospital bills of each ICU patient who gets a central-line infection.

Five hospitals in the Boston area reported zero central line infections: Southcoast Hospitals Group-Charlton Memorial Hospital, Faulkner Hospital, Newton-Wellesley Hospital, and Signature Healthcare Brockton Hospital.  Other hospitals reporting lower than average infection rates include Beth Israel Deaconess Medical Center, which reported a rate that is 76 percent better than the national average, meaning there were 76 percent fewer infections reported than the U.S. average for its mix of ICUs. Caritas Good Samaritan Medical Center reported 73 percent fewer infections than average and Mount Auburn Hospital reported 70 percent fewer infections than average.  The infection rates are for 2008.

Several of Boston's major teaching hospitals fell in the middle of the pack: Massachusetts General Hospital reported a rate that was 51 percent better than average and Brigham and Women's Hospital reported a rate that was 29 percent better than average.

Boston had several hospitals with high infection rates. Some of the hospitals with the highest infection rates include: MetroWest Medical Center reported an infection rate that was 346 percent worse than the national average for its mix of ICUs; Morton Hospital and Medical Center reported a rate that was 151 percent worse than average; Caritas Carney Hospital reported a rate that was 147 percent worse than average; and Cambridge Health Alliance reported a rate that was 78 percent worse than average.

In Boston, variation among hospitals is true across the board and even within the same system of Caritas-owned hospitals and medical centers, which range from 73 percent better than average to 147 percent worse than average.   "Infection rates can vary widely from hospital to hospital and even within the same hospital chain or system," said John Santa, M.D., M.P.H., director of the Consumer Reports Health Ratings Center.  "Providing patients with infection rate information enables them to identify which hospitals are making patient safety a priority and which ones are not."  According to a related investigative report in the March issue of Consumer Reports, of the 926 U.S. hospitals whose infection rates were analyzed by Consumer Reports Health, 105 hospitals tallied zero central line infections (listed online at www.ConsumerReportsHealth.org).  

"All hospitals should be aiming for zero infections," said Santa.  "The procedures needed to eliminate ICU infections are simple, low-tech, and inexpensive, requiring a change of mindset and culture. All ICUs should be able to dramatically reduce if not eliminate these infections."      

The Consumer Reports online ratings are based on hospitals that publicly report their infection rates as a result of state laws and hospitals that voluntarily report to the Leapfrog Group, a Washington D.C. based nonprofit, works with large employers and purchasers of health care to measure and publicly report on hospital safety and quality in 41 states in the U.S. (www.leapfroggroup.org).  Citizen activists, including those working with Consumers Union, the nonprofit publisher of Consumer Reports, have helped enact laws in 27 states, forcing hospitals to publicly disclose their infection rates.  To date, 17 of those states have made that information publicly available.  

A Massachusetts state law passed in 2008 requires hospitals to report infection rates and prohibits payment for some hospital acquired conditions. The state is collecting the information from hospitals now but has not yet issued its first report disclosing infection rates by hospital. Consequently, the Consumer Reports ratings for Massachusetts hospitals are based on Leapfrog data.  "We are making progress toward safer care, as more and more states, including Massachusetts, require hospitals to account for infections," said Lisa McGiffert, director of Consumers Union's Safe Patient Project (www.SafePatientProject.org ).  "Still, almost two million patients each year suffer from hospital acquired infections, including central-line bloodstream infections, and there are thousands of hospitals whose infection rates fail to see the light of day."

 "It is important to recognize that many hospitals demonstrate commitment to their communities by willingly reporting safety data — warts and all. Consumers should be most wary of hospitals that are asked to report by their patients (or customers), and refuse," said Leah Binder, CEO of the Leapfrog Group.   Binder noted that several hospitals in the Boston area declined to provide their data to Leapfrog during the reporting period, including Boston Medical Center, University of Massachusetts Memorial Medical Center, and Emerson Hospital.  A complete list of non-reporting hospitals can be found at www.leapfroggroup.org/decline.

A Central Line Associated Bloodstream Infection (CLABSI) is a type of infection caused by the presence of a central line catheter.  A "central line" or "central catheter" is a tube that is placed in a large vein in the neck, chest, or arm to enable the rapid administration of fluids, blood, or medications.   These long, flexible catheters empty out in or near the heart so that the circulatory system can deliver what's put in them within seconds.  A bloodstream infection can occur when bacteria or other germs travel down the central line and enter the bloodstream, making the central line's biggest virtue as a quick pathway for delivering the essentials into its biggest vice.  

Since the risk of infection varies substantially across different types of ICUs, the Consumer Reports ratings are using what is known as a "standardized infection ratio," taking into account the unique mix of ICU types in a given hospital by comparing the hospital infection data for each ICU to the national average for each such ICU type published by the federal Centers for Disease Control and Prevention (CDC).   For instance, the average infection rate for cardiac ICUs nationwide is 2 per 1000 central line days (that's the total number of days that patients are on central lines), while surgical ICUs average 2.3 infections per 1000 central line days.  So an infection rate 100% above average would be 4 per 1000 days for a cardiac ICU, but 4.6 per 1000 days for a surgical ICU.