HHS sees little progress on healthcare-related infections

Apr 14, 2010 (CIDRAP News) – The latest data show little progress in eliminating healthcare-associated infections, with several types increasing, according to a report released yesterday by the US Department of Health and Human Services.

The 2009 National Healthcare Quality Report shows increases in postoperative sepsis (bloodstream infections), postoperative urinary tract infections (UTIs), and a mix of other infections. On the positive side, rates of postoperative pneumonia dropped almost 12%.

The figures, the latest data available, mostly date to 2007. Released with the healthcare quality report was HHS's annual National Healthcare Disparities Report. Both were produced by the Agency for Healthcare Research and Quality (AHRQ).

"Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access," AHRQ Director Carolyn M. Clancy, MD, said in a news release.

The agency estimated that the rate of postoperative sepsis increased 8.0%, the worst showing of any of the quality measures assessed. The sepsis rate in adult elective surgeries in 2006 was 15.1 per 1,000, the report says.

The rate of postoperative catheter-associated UTIs in Medicare beneficiaries increased 3.6%, the AHRQ said. About 4.9% of such patients had a catheter-related UTI in 2007.

Also rising is the rate of "selected infections due to medical care," up 1.6%, according to the report, which does not list the infections included.

The agency found no change in the rate of bloodstream infections linked to central venous catheters (tubes placed in a large vein in the neck, chest, or groin to give medication or collect blood samples) from 2005 to 2007. These occurred in about 3.5% of patients in 2007, according to a chart in the report.

The lack of improvement in several types of healthcare-related infections may partly reflect improving detection, the report states.

The rate of postoperative pneumonia in Medicare patients dropped an estimated 11.6%, the AHRQ said. Overall from 2002 to 2007, the proportion of adult surgical patients who had either pneumonia or a thromboembolic event after surgery dropped from 3.4% to 1.4%.

The agency found an improvement in the use of a recommended measure for preventing surgical wound infections: administration of appropriate antibiotics within 1 hour before surgery. The proportion of adult patients who received appropriately timed antibiotics improved from 74.9% in 2005 to 86.4% in 2007, the report states.

However, elderly patients were less likely to get this treatment than those younger than 65. Also, says the news release, "Although rates are improving incrementally, blacks, Hispanics, Asians, and American Indians are less likely than whites to receive preventive antibiotics before surgery in a timely manner."

Clancy said AHRQ-funded research in Michigan has shown that healthcare-related infections can be sharply reduced. "We are now working to make sure that happens in all hospitals," she said.

By adopting standardized procedures, more than 100 intensive care units in Michigan have kept the rate of central catheter–associated bloodstream infections near zero for 3 years, the agency said. It said it has expanded this project nationwide with new funds that became available last year.

See also:

Apr 13 AHRQ press release
http://www.ahrq.gov/news/press/pr2010/qrdr09pr.htm

Full text of the 2009 National Healthcare Quality Report
http://www.ahrq.gov/research/findings/nhqrdr/nhqr09/Key.html

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