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Which hospital highest in infections?

Orlando Regional is disputing the results of a Medicare study that found an exceptionally high rate of life-threatening bloodstream infections -- a hospital-acquired illness that health officials say should never happen.

The hospital's rate for the infection was 1.48 infections per 1,000 patient discharges, four times the national average. (See chart of highest rates in Florida.)

Medicare is making the information publicly available in the hope that public opinion will speed up hospitals’ attempts to eradicate the infections.

“Hospitals tend not to change unless they have to,” said Rich Ma, a hospital-acquired conditions expert at Saints Medical Center in Massachusetts. “Data like this let people know they really should question their doctors and hospitals.”

The study covered “vascular catheter-associated infections,” or infections that occurred after a tube was inserted into a blood vessel. While this could happen with an ordinary intravenous line, more commonly it strikes a “central line” -- the insertion of a catheter or port into the neck, chest or groin, to provide easy entry for chemotherapy drugs, dialysis chemicals, and the like.

The study showed Orlando Regional had 47 cases of the bloodstream infections between October of 2008 and June of 2010, more than any hospital in Florida and tied for third in the nation.

But as Orlando Regional officials point out, the number of cases is not a good measure to compare, since the system reports its five hospitals as a unit. It therefore has more patient discharges than any other hospital covered by the study.

The rate per 1,000 patient discharges is a fairer measure, they say. About 70 of the 167 Florida hospitals in the study had higher-than-average rates, but not as high as Orlando Regional’s.

The data, drawn from Medicare claims, were released as a part of the Affordable Care Act initiative to try to save billions in federal health care costs by stopping preventable hospital-acquired conditions.

The Centers for Disease Control and Prevention estimate that 78,000 patients were infected in 2009, about 25 percent of whom died as a result. Treating the extra infection adds about $25,000 to the cost of a patient’s stay.

Hospitals have had to absorb the cost since 2008, when Medicare stopped paying for what it calls “hospital-acquired conditions.”

The Medicare study tracked eight preventable injuries or illnesses that occurred after a patient entered the hospital, from a fall to a sponge left inside the body after surgery.

Hospitals that improve the most or do the best job of preventing hospital-acquired conditions will get a boost in pay for patients treated after October of 2011.

Kena Lewis, spokeswoman at Orlando Regional, said the hospital's trauma center is a Level One -- the best-staffed and equipped -- and treats more patients than any of the state's six other such centers.

The medical center also treats a disproportionate load of patients with acute illnesses and long stays, Lewis said.

Level One trauma centers do tend to have more catheter-associated bloodstream infections than hospitals that treat lesser problems because patients stay longer and are more vulnerable to infection, said Ma, the expert on hospital-acquired conditions from Massachusetts.

Shaheen Halim, director of the Division of Hospitals & Medication Measurement for CMS, said that hospitals don’t have an excuse for high infection rates.

“This condition was defined (by CMS) as reasonably preventable regardless of acuity at different hospitals,” she said. “I think everyone who goes to a hospital is concerned about safety, and this could help them make better choices.”

Although the goal is to make the infections ‘never events,’ some hospitals may never reach zero, Ma said. But most hospitals should be able to get close through cleanliness, good training and a standard protocol for handling the vascular catheters, he added.

“Any time you open somebody up, there's a risk of infection,” he said. “But there's also a lot that's in the control of the hospital.”

For example, since the CDC released a checklist on preventing central line infections in 2002, the number has decreased about 60 percent, saving an estimated 27,000 lives and $1.8 billion, according to the agency.

The checklist requires health-care providers dealing with a central line to wash their hands, clean a patient's skin with chlorhexidine, avoid placing a catheter in the groin where infection rates are higher, wear a mask, hat, gown, and gloves and put sterile drapes over the patient, and remove the catheter as soon as possible.

In Michigan, the checklist has virtually eliminated the infections, according to the CDC.

Lewis said Orlando Regional has made improvements since the data were collected more than a year ago, such as requiring the catheters to be inserted under the same protocols in all parts of the hospital.

The hospital is also disputing 29 of the 47 claims, which Lewis said were miscoded by inexperienced billers.

She said the hospital has decreased the number of infections by 81 percent, but is not ready to release more specific data to the public.

“More than anyone else, we want to understand the root causes of these conditions and work to ensure they do not recur,” she said.

--Independent reporter Dave Gulliver contributed to the research for this report. Brittany Davis can be reached at 954-239-8968 or Brittany.Davis@HealthNewsFlorida.org.