NYC Public Hospital ICUs See Big Drop in Infection Rates
Mar 11, 2009
The New York City Health and Hospitals Corporation today announced that infection rates in the intensive care units of its 11 hospitals are down for the third year in a row and have dramatically dropped since HHC launched a patient safety program to reduce preventable deaths and unnecessary hospital stays. HHC achieved a 90% percent reduction in the rate of ventilator-associated pneumonia (VAP) and a 65% reduction in the rate of central line bloodstream infections among adult patients in intensive care units.
HHC President Alan D. Aviles said the new 2008 rates were posted today on the HHC In Focus section of the website, www.nychealthandhospitals.org, as part of the public hospital system’s transparency initiative to voluntarily share information on hospital quality and safety with the public.
“Our results are evidence that we are now winning the battle against common hospital acquired infections through increased vigilance, strict adherence to best clinical practices and our relentless focus on optimal hand hygiene. The decline in infection rates represent more than 1,000 infections prevented and a savings of nearly $16 million in healthcare costs.” said Aviles. “With the transparent and public reporting of these and other performance measures, we are demonstrating our willingness to be held accountable for doing our best to render safe, high quality care to each and every patient.”
Hospital-acquired infections are a nationwide problem. It has been estimated that each year nearly two million patients get an infection while being treated in our nation’s hospitals, and almost 100,000 of them die. The U.S. Centers for Disease Control estimates the cost of hospital-acquired infections to be as high as $27.5 billion each year.
HHC attributes the dramatic reduction in infection rates to the adoption of proven, lifesaving interventions, including a series of independent steps, called bundles, that when done together typically result in significantly better outcomes.
Central Line Infections
Central line infections at HHC hospital ICUs dropped to 2.7 infections per 1,000 patient days in 2008 from 7.6 in 2005. Central lines, also called central venous catheters, are necessary for many patients in ICUs for both treatment and monitoring purposes. Patients who need central lines are often very sick and are more vulnerable to infections, and remain in the hospital longer. Preventing central line infections is especially crucial for these patients. To reduce central line infections, HHC hospitals follow a bundle of interventions that begins with hand washing, followed by the use of a better-acting skin antiseptic, the selection of the optimal catheter site, and the prompt removal of unnecessary lines, among other measures.
Ventilator Associated Pneumonia (VAP)
Over the last four years, the rates of VAP in HHC hospital ICUs dropped to 1.5 in 2008 from 10.5 in 2005. Ventilator-Associated Pneumonia is a particular risk for patients who are on mechanical ventilation for more than 48 hours. It is an infection of the lung which makes oxygen exchange difficult for patients. To reduce VAP rates, HHC follows a bundle of interventions that includes elevating the head of the bed, performing oral hygiene daily for ventilator patients and screening for blood clots and ulcers.
“Remarkably, six ICUs in four hospitals — Coney Island, Elmhurst, Kings County and Lincoln — went without a central line infection during all of 2008. And ICUs at Bellevue, Coney Island, Elmhurst, Harlem, Kings County, Lincoln and Woodhull went the full year without a VAP infection,” Aviles said.
Following common industry practice, the rate of infection during a period is based on the number of infections that occur for every one thousand patient days of possible exposure, which includes patient days on a ventilator or patient days involving central lines.
In addition to the progress in preventing hospital-acquired infections, the 2008 data posted on HHC’s web site show that its system-wide mortality rate continued to stay below national benchmarks despite a significant increase in the average acuity of patients. HHC mortality rates decreased by 13% from 2003 to 2008, representing approximately 1,830 lives saved during that period.
A Commitment to Transparency
HHC was the first hospital system in New York to make a range of previously confidential quality and patient safety performance measures publicly available via its website, www.nychhc.org/hhc. In addition to infection rates, the information available to the public also includes corporate-wide and hospital-specific data reported to the federal government on how often HHC facilities follow best clinical practices in treating heart attacks, heart failure and pneumonia, and in preventing surgical site infection; how well HHC nursing homes are doing in providing quality care, including preventing falls; and how HHC hospitals and nursing homes fare against established state and national standards.
Contact: Ian Michaels (HHC)
The New York City Health and Hospitals Corporation (HHC) is a $6.7 billion integrated healthcare delivery system with its own 420,000 member health plan, MetroPlusHealth, and is the largest municipal healthcare organization in the country. HHC serves 1.4 million New Yorkers every year and more than 475,000 are uninsured. HHC provides medical, mental health and substance abuse services through its 11 acute care hospitals, five skilled nursing facilities, six large diagnostic and treatment centers and more than 70 community based clinics. HHC Health and Home Care also provides in-home services for New Yorkers. HHC was the 2008 recipient of the National Quality Forum and The Joint Commission’s John M. Eisenberg Award for Innovation in Patient Safety and Quality. For more information, visit www.nychhc.org/hhc or find us on facebook.com/NYCHealthSystem or twitter.com/NYCHealthSystem.