Deadly, drug-resistant bacteria are becoming more common in Kentucky hospitals; key lawmaker wants to require public reporting

Nightmarish, drug-resistant bacteria that cause deadly infections are becoming more common in Kentucky hospitals, and a leading legislator on health issues says they should be required to report each case.

The state Department for Public Health and hospital officials are investigating the presence of carbapenem-resistant Enterobacteriaceae, or CRE, at Kindred Hospital Louisville, right, a long-term and transitional care facility.

“Since July, we have identified about 40 patients in whom we have cultured the organisms from one or more body fluids,” Dr. Sean Muldoon, chief medical officer for Kindred, told Laura Ungar of The Courier-Journal.

These superbugs kill about half of the patients who get infected. They have become resistant to nearly all the antibiotics available today, including drugs of last resort. CRE infections are caused by a family of germs that are a normal part of a person's healthy digestive system but can cause infections when they get into the bladder, blood or other areas where they don't belong, says the federal Centers for Disease Control. The presence of CRE in bodily fluids doesn’t mean someone is infected by the bacteria, because the patient could also be “colonized” by the bacteria without developing an infection, said Muldoon. CRE may be present in a patient before he or she is admitted to the hospital, or it can be transmitted from patient to patient at the hospital, Ungar notes.

Officials at several Louisville-area hospitals told The Courier-Journal last month that they have seen a growing number of CRE cases in recent years, reports Ungar. The CDC issued a warning report about the bacteria last month, but there has only been one "outbreak" of CRE listed for Kentucky. (Read more)

Given the threat of this bacteria, the CDC has called for quick action to stop these deadly infections, and the chairman of the House Health and Welfare Committee wants to tighten up CRE reporting requirements.

Rep. Tom Burch, D-Louisville, sent a letter to Gov. Steve Beshear proposing a new regulation that would mandate immediate reporting of CRE infection or colonization to the state. Burch said he plans to introduce a bill that would require such reporting by health-care facilities, and he is working with Dr. Kevin Kavanagh of the Somerset, Ky.-based watchdog group Health Watch USA, reports Ungar.

“If it gets in the community and spreads, we’re in trouble,” Kavanagh told Ungar. Burch emphasized this level of risk in his letter to the governor, saying that health-department involvement is crucial to preventing this deadly bacteria from "developing a foothold in Kentucky."

Nightmare, drug-resistant superbugs, including one that kills half the people who get it, are a big threat

"Nightmare bacteria" leading to deadly infections that are difficult and sometimes impossible to treat are on the rise in American hospitals, and threaten to spread to otherwise healthy people outside of medical facilities, according to a federal Centers for Disease Control Vital Signs report published Tuesday.


These superbugs, carbapenem-resistant Enterobacteriaceae, or CRE, have become resistant to nearly all the antibiotics available today, including drugs of last resort. According to the report, CRE infections are caused by a family of germs that are a normal part of a person's healthy digestive system, but can cause infections when they get into the bladder, blood or other areas where they don't belong.

The report says almost all CRE infections are found in patients receiving serious medical care, and they kill up to half of patients who get bloodstream infections from them. In addition to spreading among people, CREs easily spread their antibiotic resistance to other kinds of germs, making those potentially untreatable as well.

Only 10 years ago, such resistance was hardly ever seen in this group of germs. Although these superbugs are uncommon, their prevalence has quadrupled in the past decade in medical facilities in 42 states, the CDC says.

The report calls for immediate action to stop the spread of these deadly infection; it is a critical time for U.S. doctors, nurses lab staff, medical facility leaders, health departments, states, policymakers and patients to help fight the spread through coordinated and consistent efforts.

The report asks patients to do three things: Tell your doctor if you have been hospitalized in another facility or country, take antibiotics only as prescribed, and insist that everyone wash their hands before touching you. For more details, click here for the Vital Signs report.

Kentucky hospitals score mostly Bs and Cs on hospital safety scorecard; most in U.S. earned an A or B

In an analysis of the nation's hospitals and their safety records, many of Kentucky's health care facilities have some shortcomings. A study by the Leapfrog Group finds that the vast majority of the state's hospitals score a B or C in overall patient safety, a term defined here by analysis of data on accidents, errors and infections as kept by the Centers for Disease Control, the Centers for Medicare and Medicaid Services and the Agency for Healthcare Research. At least a dozen of the state's hospital earned an A rating. To check the grade of your own hospital, go here.

In this data analysis and grading system, 26 different points of criteria were used. Of the 2,618 hospitals reviewed, about 56 percent of the hospitals earned an A or B, and an additional 38 percent passed with a C grade. Only 6 percent of hospitals -- 146 total -- received a D or F. According to CBS News, at least 180,000 Americans die in hospitals every year from incidents that occur because of their stays there. (Read more)

Infections, other safety issues plague hospitals, maybe more so when nursing is cut; here's a good series on it

The Centers for Disease Control has reported that nearly 1 million patient-safety incidents, including infections that patients acquired in hospitals, occurred among Medicare patients over the years 2006, 2007, 2008. In all, the incidents -- which represented 2.3 percent of Medicare admissions -- were associated with $8.9 billion in costs. One of every 10 patients involved died as a result, the "HealthGrades Patient Safety in American Hospitals" study reported.

Financially squeezed hospitals should be careful about reducing nursing staff, because the fewer such staff they have, the more likely they are to have a patient-safety incident, says Kevin Kavanagh, a Somerset doctor and board chairman of Health Watch USA, in "Moving Healthcare Quality Forward with Nursing-Sensitive Value-Based Purchasing," an article in the Journal of Nursing Scholarship. Kavanagh explains that research has shown that adverse events in hospitals and any subsequent mortality "are highly dependent on nurse staffing levels and skill mix." He cites studies in which nurse staffing levels were a clear indicator of whether or not patient-safety accidents or "sentinel" events occurred. (Examples of "sentinel" events include falls, pressure ulcers, urinary tract infections, postoperative infections, pneumonia, upper gastrointestinal bleeding, shock and cardiac arrest.)

Kavanagh's article notes that nursing is at serious risk from being cut in cost-driven healthcare delivery systems. He is quick to point out the dangers and financial costs of making that cut. (To read the study, go here.)

So, how to report on this issue? In 2011, The Las Vegas Sun revealed that during the second half of 2009 area hospitals had reported 44 preventable hospital injuries or hospital-acquired infections when, in fact, those facilities had experienced 342 such events. That revelation led the paper's staff to take on the issue of hospital accountability in an award-winning five-part series, "Do No Harm: Hospital Care in Las Vegas." When all was said and done, the newspaper not only unearthed repeated incidences where the hospitals' own records did not reconcile with what they reported to the state, but showed lawmakers and health-care professionals how to properly disclose the incidence of patient infection and accidents. Their work eventually forced Nevada lawmakers to pass legislation that requires hospital records in two of the state's largest counties to be transparent, consumer-friendly and readily available on the state's Health and Human Services Department website. (To read their remarkable work, go here.)

Health Watch USA will host its annual conference in Lexington on Nov. 9 at The Four Points Sheraton, 1938 Stanton Way. Cost is $35 including lunch. Over 6 hours of continuing education credits have been approved for doctors, nurses, physical therapists, occupational therapists and human resource managers  For more information or registration, go to www.healthconference.org.

Hospitals can learn from revealing account of the attack of a superbug; sequencing germ's DNA seems to be key

Dr. Tara Palmore, deputy hospital epidemiologist at the
National Institutes of Health Clinic Center, left, and Dr.
Julie Segre, a geneticist with the National Human
Genome Research Institute. Both were integral in
pinpointing the spread of a superbug at NIH.
Associated Press photo by Patrick Semansky.

A candid account of how a superbug was contained at one of the nation's leading research hospitals indicates that fast sequencing of a germ’s full DNA can make all the difference.

Over a six-month period, Klebsiella pneumonia, or KPC, a germ that cannot be treated by most antibiotics, sickened 18 people at the National Institutes of Health. Six of them died and another five, though they survived the effects of the germ, died from the disease that originally brought them to the facility.

Infections at health-care facilities kill about 100,000 Americans each year. But, fearful of lawsuits, hospitals generally don’t reveal to the public when infections outfox control measures, reports Lauran Neergaard for The Associated Press. That changed this week when government researchers published the story of what happened at NIH.

Dr. Julie Segre, a senior investigator at NIH’s National Human Genome Research Institute, was in charge of the “genetic sleuthing that found the bug hiding in sink drains and, most chilling, even in a ventilator that had been cleaned with bleach,” Neergaard reports. A multidrug-resistant strain of Klepsiella bacteria has emerged that spreads easily between patients who are very ill, and it kills half of whomever it sickens.

On June 13, 2011, a research nurse checked the medical records of a study participant who was being transferred from a New York City hospital and was critically ill with a rare lung disease. She found the patient had KPC, prompting the hospital to put her in strict isolation. “Everyone entering her room donned a protective gown and gloves and rigorously washed their hands,” Neergaard reports. “Her medical equipment got special decontamination. All other patients in the intensive care unit had their throats and groins tested regularly to see if the bug was spreading.” All seemed to be clear and the woman was sent home two days later.

But three weeks later, a patient with cancer was found to have KPC, though he was never in the presence of the first patient. Ten days later, a woman with an immune disease also got sick with KPC. Both died from the infection.

Researchers wondered if the cases were related or if the patients were arriving already infected with KPC. Segre turned to DNA for answers. "As bacteria multiply, mistakes appear and are repaired in their genetic codes," Neergaard reports. "Sequencing that genome allowed Segre to follow differences in single genetic letters like a trail of the germ’s transmission and evolution." Using this method, Segre discovered the KPC appearing at NIH was the same strain that came from the New York patient. "Testing bacteria from the 17 additional patients who ultimately caught it shows the KPC was transmitted three separate times from Patient No. 1 and then spread more widely," Neergaard reports.

NIH completely overhauled its decontamination practices, but the bacteria continued to spread. By November, the bacteria appeared in two patients who were not even in intensive care. Finally, the hospital built a new isolation room and all 200-plus patients in the hospital were subject to rectal testing.

The contamination is now contained, but the account of it is giving pause to infection-control specialists around the country. “Absolutely this could happen in any hospital,” said Dr. Deverick Anderson, co-director of a Duke Universityinfection control network. (Read more)

More hospital-acquired infections are reported in patients cared for nurses who are overworked, study finds

Getty Images stock photo.

Overworked nurses dealing with heavy patient loads are associated with increases in hospital-acquired infections, say researchers with the Center for Health Outcomes and Policy Research at the University of Pennsylvania School of Nursing.

"For each 10 percent jump in the proportion of nurses who logged high levels of burnout, there was roughly one additional catheter-associated urinary tract infection per 1,000 patients and almost two extra surgical site infections per 1,000," reports JoNel Aleccia for NBC News.

Researchers conducted a survey with 7,000 registered nurses at 161 Pennsylvania hospitals and matched that data with hospital infection rates and characteristics of hospitals nationwide. The study found more than a third of nurses said they feel high levels of burnout. They cared for an average of 5.7 patients each, and "when even one patient was added to that load, the result was an additional 1,351 infections within the hospital population studied," Aleccia reports.

The study, published in the American Journal of Infection Control, also found cutting down on burnout not only reduces infections but saves money. Cutting it by 30 percent decreased urinary tract infections by 4,000 and surgical site infections by more than 2,200, resulting in a savings of between $28 million and $69 million each year, researchers found.

When it comes to nurse-to-patient ratios, no one seems to be tracking the averages, Aleccia reports. They can range from one nurse for every one or two patients in intensive care units or a one-to-five ratio, as mandated in surgical units in California. (Read more)

Revealing patient safety issues and medical errors are goals of Facebook page set up by ProPublica

Photo by iStockphoto.com/selimaksan

Interested in creating a venue for those who have been harmed while undergoing medical treatments, ProPublica, the nonprofit, investigative news organization, has set up a Facebook page on the issue.

"Group members have already shared stories of personal disability or the death of a loved one due to surgical mistakes, becoming infected with deadly drug-resistant bacteria and dental mishaps — including cases they claim were not properly addressed by health care providers," Daniel Victor and Marshall Allen report. The page will be moderated by Victor and Olga Pierce.

The page is also open to doctors, nurses, regulators, health-care executives and others interested in discussing medical errors, their causes and solutions. Question-and-answer sessions with experts will be posted, along with links to the latest reports and policy proposals. (Read more)

100 Kentucky hospitals join network to improve patient safety, fight hospital-acquired conditions such as infections

To help hospitals reduce preventable readmissions and hospital-acquired infections, 100 of Kentucky's 131 hospitals have joined the Kentucky Hospital Association's hospital engagement network. The group's goal is to help hospitals find ways to improve patient safety, reduce readmissions and hospital-acquired conditions such as infections, and share learning among hospitals.

The network hopes to reduce the incidence of adverse drug events; catheter-associated urinary tract infections; central-line-associated bloodstream infections; injuries from falls and immobility; obstetrical adverse events; pressure ulcers; surgical site infections; venous thromboembolisms or deep vein clots; ventilator-associated pneumonia; and preventable readmissions.

The two-year project is supported by a contract with the federal Centers for Medicare and Medicaid Services as part of the "Partnership for Patients" campaign, launched earlier this year by the U.S. Department of Health and Human Services. The goal for the project is to reduce preventable  readmissions that occur within 30 days of discharge by 20 percent and hospital-acquired infections by 40 percent (compared to 2010) by the end of 2013.

"The commitment to patient safety and quality by hospitals across Kentucky has resulted in lives saved, fewer complications and reduced costs," said Mark J. Neff, chair of the KHA board of trustees and president and CEO of St. Claire Regional Medical Center in Morehead. For a list of hospitals participating in the network, click here.

Hospital employees report only 1 of 7 medical errors, study finds

In keeping with other studies on the subject, a new report shows hospital employees only report and recognize one out of every seven medical errors, accidents or other events that harm Medicare patients. "Yet even after hospitals investigate preventable injuries and infections that have been reported, they rarely change their practices to prevent repetition of the 'adverse events'," reports Robert Pear of The New York Times.

While hospitals serving Medicare patients are supposed to track and analyze the cause of medical errors and most hospitals do have a system in place to inform administrators about adverse events, "Hospital staff did not report most events that harmed Medicare beneficiaries," said Daniel R. Levinson, inspector general of the Department of Health and Human Services and author of the report.

Levinson said more than 130,000 beneficiaries were subject to one or more adverse events in hospitals in one month. An adverse event includes medical errors, severe bedsores, hospital-acquired infections, delirium as a result from too many painkillers, or excessive bleeding because blood thinners were used improperly.

The study involved the input of independent doctors, who reviewed 293 cases in which patients had been harmed. Forty of the cases were reported to hospital managers and 28 were investigated by hospitals, "but only five led to changes in policies or practices," Pear reports.

One of the major issues is that hospital employees don't recognize when a patient is harmed, Levinson said. In some incidents, "employees assumed someone else would report the episode, or they thought it was so common that it did not need to be reported," Pear reports. In other cases, employees thought an event was so unusual it wouldn't be likely to recur.

In answer, Medicare officials said they will come up with a list of "reportable events" for hospitals and employees to use. Hospitals, in turn, should give detailed instructions to employees about what kinds of events should be reported. (Read more)

Health Care Transparency and Patient Advocacy Conference to be held Nov. 11 in Lexington

Focusing on issues like hospital- and health care-acquired infections, the impact of medical errors and infections on patients, and the importance of transparency, the Health Care Transparency and Patient Advocacy Conference will be held Nov. 11 in Lexington.

Speakers include John Santa, director of the Health Ratings Center for Consumer Reports, who will discuss the principles of transparency; author Maryn McKenna, who will present the history of MRSA; Dr. Keith Sinclair, medical director of Bluegrass Oakwood in Somerset, who will speak of how transparency has nearly eliminated pressure sores at his institution; and Frances Griffin, a faculty member at the Institute for Healthcare Improvement, who will present on the IHI global trigger tool.

The gathering is from 8:30 a.m. to 5 p.m. at Embassy Suites in Lexington. Registration is $50 and includes a box lunch. Physicians, physician assistants, nurse practitioners, nurses, physical therapists and human resource managers attending the conference will receive 6.5 hours of continuing education credits. To register, click here.

UK Hospital gets below average marks on patient satisfaction, infections; data on your local hospital are available online

Despite $900 million being invested in expanding the University of Kentucky Chandler Hospital, its patients at do not seem all that happy with the care they receive there.

In an op-ed piece in the Lexington Herald-Leader, Dr. Kevin Kavanagh of Somerset highlights the results of a survey on patients' hospital experiences. That survey ranked UK's hospital below state and national averages in nine of 10 measures. "Especially disturbing, only 66 percent said they would definitely recommend the institution, and only 56 percent stated their room and bathroom were 'always clean'," writes Kavanagh, chairman of Health Watch USA.

The UK hospital also did not fare well when it came to its assessment by the Centers for Medicare and Medicaid Services on hospital-acquired conditions. "UK had the highest reported rate of deadly vascular catheter infections in the state," Kavanagh writes. "UK also had an unacceptably high rate of falls and deep bed ulcers. These latter conditions should be zero."

Kavanagh concluded, "If there are quality problems at UK, it is of paramount importance that they are corrected since not only current patients are at risk but also the quality of the training experience of our future clinicians, which can affect care for years to come." (Read more)

Newspapers can access information about their area hospitals by clicking here. Viewers can choose up to three hospitals and see how they compare to one another in categories like: how well nurses communicate with patients; how quiet the areas around patients are; if patients would recommend the hospital; and if patients always received help as soon as it was wanted.

Newspapers can also see the results of the CMS assessment on hospital-acquired conditions for their area hospitals by clicking here and downloading the Hospital-Acquired Condition Rates zip file (scroll down to Kentucky hospitals). The file contains data on eight hospital-acquired conditions reported between Oct. 1, 2008 and June 30, 2010. Among the conditions reported are air embolism; blood incompatibility; catheter-associated infections; falls and trauma; foreign objects left in the body after surgery; pressure ulcers; uncontrolled blood sugar levels; and urinary tract infections.

At Nov. 11 conference in Lexington, Health Watch USA will focus on health-care transparency, patient advocacy

Health-care transparency and patient advocacy will be the focus at the 2011 Health Watch USA 2011 conference Nov. 11 in Lexington. Topics will include hospital-acquired infections and the importance of reporting them; the impact of transparency on an institution; barriers in the control of healthcare-acquired infections; and principles of transformational leadership will be among the topics discussed.

Speakers include Frances Griffin, a faculty member at the Institute for Healthcare Improvement, will be one of the many conference speakers and will speak about the IHI global trigger tool. Dr. Keith Sinclair, medical director at Bluegrass Oakwood in Somerset, will speak of how transparency has almost eliminated pressure sores at his facility. Award-winning author Maryn McKenna will speak of the history of MRSA and Dr. John Santa from Consumers Union will speak of the principles of transparency.

The registration fee is $50. The conference, which runs from 8:45 a.m. to 4:45 p.m., will be at Embassy Suites on Newtown Pike in Lexington. To register, click here.

CDC hands out $49 million in public health grants; Kentucky gets more than $800k

The Centers for Disease Control and Prevention have issued $49 million in grants to improve public health, $815,000 of which is earmarked for Kentucky.

The Kentucky Cabinet for Health and Family Services will use the funds to expand its epidemiology, lab and health information systems and to detect and prevent healthcare associated infections. Each year, about 100,000 people die nationwide because of these infections, which are often acquired in hospital settings. The funds are meant to help states coordinate HAI prevention, implement multi-facility prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting.

Every state in the country will receive a portion of the $49 million pot, which is double the size that was handed out in 2010. "This funding will be used to create jobs, enabling the hiring and training of epidemiologists, laboratory scientists and health information specialists in the field of infectious diseases," said Thomas Frieden, director at the CDC. "These grants will also make it easier for health departments to better manage and exchange important information." (Read more)

Data on hospital-acquired infections, other conditions online

The federal Centers for Medicare and Medicaid Services (CMS) has posted information about hospital-acquired conditions on its website, and The Courier-Journal not only has a story about it today, it has an easily searchable database of Kentucky hospitals.

This is not information that the Kentucky Hospital Association or the American Hospital Association wants online, at least in its current form. “You have to look at the totality of the care. And these little snapshots that CMS wants to pick out are very misleading,” KHA Senior Vice President Nancy Galvagni told C-J reporter Patrick Howington. She said the data don't allow for differences between hospitals, such as specialities, that may cause higher rates of acquired conditions.

However, Doug Leonard, president of the Indiana Hospital Association, told Howington that the industry needs to “embrace transparency. Sometimes we don't like the results of that, but I think transparency is good for us and good for the public.” Dr. Kevin Kavanagh of Somerset, chairman of the nonprofit group Health Watch USA, "said the data's greatest value may be to help hospitals spot areas that need improvement, rather than to help patients choose between hospitals," Howington writes. "In fact, a hospital shown as having a high complication rate 'may be the safest hospital to go to, because they were under pressure to get the problem corrected.'" (Read more)

The conditions tracked are trauma such as falls, infections from catheters, bedsores, poor blood-sugar control for diabetics, foreign objects left in bodies, air or gas bubbles in blood vessels, and transfusions of the wrong blood type.

Kentucky needs system to track hospital infections, doctor says

Kentucky is in need of a single, accurate system that tracks hospital-acquired infections in order to improve health care and receive state and federal funding, an op-ed piece in The Courier-Journal contends. (Hospitals call these "healthcare-associated infections," keeping the HAI acronym but spreading the blame. --Editor)

"The need for accurate data cannot be overstated," writes Dr. Kevin Kavanagh of Somerset. "Data on infections is vital to address epidemics, to direct research, to develop antibiotics and for the state to receive grants and devise prevention protocols."

But Kentucky's reporting system is "duplicative and broken," Kavanagh contends, with no standardized system. "Facilities can make the same report to the Centers for Disease Control and Prevention, the [state] health department and to the hospital's Patient Safety Organization," he said. Though HAIs should be reported in Kentucky, only four outbreaks were conveyed by hospitals last year. "As of December, the definition of an 'outbreak' was not agreed upon, which makes data collection and grant funding difficult," Kavanagh writes.

To combat the problem, 22 states are using The National Healthcare Safety Network run for free by the CDC to collect their data, which Kavanagh advises. He also encourages transparency and commended Norton Healthcare for posting information about treatment of catheter- and ventilator-associated infections. Because of this transparency, the provider received an award from the National Quality Forum. But "the problem of hospital-acquired infections and conditions is too big, too important and has gone on far too long to depend solely upon hospitals to correct the problem," Kavanagh argues. (Read more)