California public health authorities who reviewed 100 hospitals found that the facilities failed to report as many as a third of the bloodstream infections they should have reported in 2011 under the state’s public reporting law. California’s review is one more in a series of reviews throughout the nation that shows just how difficult it is for hospitals to take the first step: identify the extent of the problem.
State authorities say the findings align with reviews completed in other states. The Department of Public Health took the results on the road for educational forums in 17 Californian cities this summer, hoping to explain common mistakes that lead to under or over reporting of bloodstream infections.
“We have room for improvement, but that’s why we do validation so providers can … improve the quality of the data,” said Debby Rogers, deputy director of the Center for Health Quality at the Department of Public Health.
The reviews, completed last year, consisted of one to two-day examinations by public health authorities at 100 hospitals that volunteered; there are more than 400 hospitals in the state. Reviewers examined infection data that was reported in 2011 and compared that with medical lab findings and patient records. Results for individual hospitals were not tracked.
Reviewers took a close look at hospital reporting practices of infections including VRE, or vancomycin-resistant enterococci, C. diff, or Clostridium difficile, and MRSA, or methicillin-resistant Staphylococcus aureus. Each of those germs can be difficult to treat with conventional medicines. They can also be deadly to fragile or elderly people in hospitals.
Reviewers also looked at central line infections, which occur when catheters are implanted in a vein near the heart of a patient to deliver needed fluids. In worst-case situations, they can deliver germs that trigger sepsis, or bloodstream infections that can then spread throughout the entire body.
Reviewers found that hospitals failed to report about one-fourth, or 150 out of 577 C. difficile infections. Among central-line infections, hospitals missed reporting more than a third, or 68 out of 180 verified infections. For VRE, hospitals also missed about a quarter of the 149 reportable cases, and for C. diff, hospitals missed nearly 10 percent of 2,338 reportable cases.
Underreporting was often a result of confusion about complex instructions on identifying which infections were caused by hospital practices.
Dave Perrott, chief medical officer for the California Hospital Association, said a major component in improving reporting will be updated computer systems that keep data to pinpoint when, where and how infections appear. Overall, he said the review helped clarify the definition of each hospital-acquired bloodstream infection, meaning hospitals could identify a baseline of how many infections they’re seeing.
California performed the review of infection reporting with federal stimulus funds from the Centers for Disease Control and Prevention. While ongoing reviews are not expected, Rogers said the state recently got additional funding to review reports of surgical-site infections.
Other states have also performed extensive reviews and found unreported infections. Colorado authorities found that 34 percent of that should have been reported by hospitals were not, according to a state report. In Connecticut, researchers concluded that about half of the central-line infections that should have been reported were missed.
New York authorities routinely double-check the central-line reports by hospitals and appear to have a worse – but perhaps more accurate – rate of such infections compared the national average.
Lisa McGiffert, director of the Consumers Union Safe Patient Project, said the CDC has issued reports showing apparent national declines in 2010 of central-line infections. However, she said the repeated findings of underreporting by states call for a closer look before conclusions are reached.
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