Infection control & quality in the US: 2015 mid-year report

It has been a busy start to 2015 for infection control and prevention professionals and patient safety experts, with several big stories dominating the news cycle so far this year.

The following are five of the biggest happenings in the infection control and clinical quality arena through June of this year, as chosen by members of the Becker's Hospital Review editorial staff. They are listed in no particular order.

Superbug infections linked to duodenoscopes

One infection control story capturing headlines this year was the superbug outbreaks associated with duodenoscopes at multiple hospitals. Duodenoscopes are specialized endoscopes used in a procedure known as endoscopic retrograde cholangiopancreatography. In January, news broke that at least 35 patients at Seattle-based Virginia Mason Medical Center fell ill from infections linked to duodenoscopes over a two-year period. Then other reports broke of similar infections at Ronald Reagan UCLA Medical Center in Los Angeles, where two patients died after contracting infections from the scopes. Cedars-Sinai Medical Center in Los Angeles also reported that six patients contracted carbapenem-resistant Enterobacteriaceae infections from such endoscopes.

The infections were in large part blamed on the complicated design of the scopes that make them difficult to clean. One expert even said it was "almost impossible" to clean the scopes correctly. In April, it was discovered that Olympus, one of the companies that manufactures duodenoscopes, sent warnings to hospitals in Europe two years ago about the risk of infection posed by the scopes but never warned hospitals in the U.S. The Department of Justice has since subpoenaed Olympus and two other manufacturers to provide documents relevant to the investigation of the superbug outbreaks.

The Centers for Disease Control and Prevention, as well as other professional organizations, issued updated protocol for how to safely reprocess the scopes to attempt preventing infections, and other hospitals moved away from reprocessing the scopes to sterilizing them instead.

Hospital Compare star ratings

CMS launched its Hospital Compare star ratings in April, which assigned a rating out of five stars to hospitals based on their HCAHPS patient satisfaction scores. The agency launched the star ratings to "make it easier for consumers to use the information on the Compare websites and spotlight excellence in healthcare quality," according to the HCAHPS website.

As of April 16, CMS assigned star ratings to 3,553 hospitals. Hospitals had to have at least 100 completed surveys in a 12-month period to receive a star rating. Just 251 hospitals, or 7 percent, earned the highest rating.

There was some backlash from healthcare leaders about the Hospital Compare star rating system, however, mostly because the stars are based on patient satisfaction and not patient outcomes. For instance, Jean Chenoweth, an executive with Truven Health Analytics, told Kaiser Health News that it "would be very unfortunate and misleading if a hospital marketing department could claim to be a CMS five-star hospital and fail to mention it only reflected a patient's perception of care."

Risk of low-volume surgeries

A U.S. News & World Report investigation released in May found that when surgeons at a hospital perform a low volume of a certain case, patients are at a higher risk of suffering a serious complication than if the surgeon and hospital have more experience. The publication found that as many as 11,000 deaths in the U.S. in a two-year period could have been prevented if patients went to hospitals with a higher volume of five common procedures.

As a result of this report, three major academic health systems — Dartmouth-Hitchcock Medical Center in Lebanon, N.H., Baltimore-based Johns Hopkins Medicine and Ann Arbor-based University of Michigan — announced plans to bar member hospitals from performing certain low-volume procedures. Those procedures and surgeries include bariatric staple surgery, esophagus cancer, lung cancer, pancreas, rectum, carotid artery stenting, complex abdominal aortic aneurysm repair, mitral valve repair, hip replacement and knee replacement.

These changes, if adapted elsewhere, could have a major positive effect on patient safety and the rate of surgical errors and complications suffered by patients in the U.S.

Ebola treatment and prep in the U.S.

The 2014 Ebola outbreak spilled into this year as well, as Guinea and Sierra Leone still had widespread transmission of the deadly virus as of June 24, according to the CDC.

A hospital in the United States also treated an Ebola patient this year who was airlifted to the U.S. from West Africa: In March, an American was flown from Sierra Leone to the National Institutes of Health Clinical Center in Bethesda, Md. The patient had been volunteering in an Ebola treatment center and was successfully treated and released from NIH after about a month of treatment.

Also this year, five American healthcare workers were flown from Sierra Leone to the Nebraska Medical Center in Omaha to be observed for possible Ebola symptoms. After being quarantined there for 21 days, all five were found to be Ebola-free.

Several hospitals in the U.S. have also took giant leaps in preparing for a possible Ebola patient or a patient suffering from another highly infectious disease. For instance, the nation now has 55 CDC-designated Ebola treatment centers, up from the initial count of 35 in December 2014. Additionally, in June, HHS named nine hospitals as regional treatment centers for patients with Ebola or other severe illnesses, meaning the hospitals have "enhanced capabilities" to handle such patients and pathogens.

Antibiotic resistance still in focus

The Obama administration shined light on the issue of antibiotic resistance this year in several ways. In June, the administration convened the White House Forum on Antibiotic Stewardship. The event brought together key constituents involved in the issue, including hospitals and health systems as well as stakeholders from food companies, retailers and the animal health industry. Health systems like Ascension in St. Louis, Carolinas HealthCare System in Charlotte, N.C., HCA Healthcare in Nashville, Intermountain Healthcare in Salt Lake City and Kaiser Permanente in Oakland, Calif., were all a part of the event.

In March of this year, the administration released the National Plan for Combating Antibiotic-Resistant Bacteria, which identified critical actions for federal departments and agencies to take to enhance diagnosis and treatment and limit the spread of antibiotic-resistant bacteria. Experts in the field called the plan "sweeping and comprehensive."

All this serves to elevate the importance of antibiotic stewardship. According to the CDC, at least 2 million people become infected with antibiotic-resistant bacteria each year, and at least 23,000 will die as a result of such an infection.

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