PORTLAND – Intensive care patients at Maine Medical Center experienced twice the national rate of dangerous blood infections from large intravenous catheters during the 18 months ending in June, according to state data.
Its infection rate earned the Portland hospital a dubious mention in the March issue of Consumer Reports magazine, which ranked it first among the state’s larger hospitals. On the other hand, the magazine cited St. Mary’s Regional Medical Center in Lewiston as one of the Maine hospitals with no central-line infections in 2008.
Such infection rates, now public record in Maine and some other states, can help patients compare hospitals’ performance and have helped drive improvements in the way hospitals insert catheters and keep them clean, health experts say.
Maine Medical Center, the state’s largest hospital, has reduced its infection rate 70 percent in the past four years, said Doug Salvador, chief medical officer and patient safety officer. However, patients there experienced 60 central-line infections during the most recent 18-month reporting period, giving the hospital a rate of 4.2 infections for every 1,000 catheter days, according to data collected by the state.
“We’re not satisfied,” Salvador said. “We’re going to continue to try to make that rate as close to zero as we can.”
There is no disputing Maine Med’s above-average infection rate. The national average was about 1.8 from 2006 through 2008, or 2.1 among comparable large teaching hospitals, data show.
But comparing it with other Maine hospitals in general is unfair because Maine Med’s intensive care patients have a higher risk of infections, said Salvador and state health officials.
“They do have the sickest patients of all,” said Susan Schow, epidemiologist for the Maine Health Data Organization, which compiles hospital statistics. “If you are really sick and nobody knows what to do with you, they’re going to send you to Maine Med.”
WORKING TO CONTAIN INFECTIONS
Unlike a simple intravenous line, a central-line catheter is a tube that’s inserted through a large central vein to a blood vessel near the heart.
The lines are used to deliver medications, fluids and nutrition to seriously or critically ill patients. They can be inserted through the neck, shoulder area or arm, and they can stay in place for prolonged periods.
Infections from central-line catheters can be life-threatening and can take various forms, including sepsis, an often-fatal bloodstream infection.
In recent years, as infection rates have drawn more attention, hospitals around the country have adopted new procedures, ranging from where and how to insert catheters to how to keep them clean.
Kathy Day, a retired nurse from Bangor who has campaigned against hospital-acquired infections, said hospitals have made big strides with central-line infections, but infection rates such as Maine Medical Center’s are still too high.
“If you go into a hospital without an infection and you end up with an infection, that’s the hospital’s responsibility,” she said. “Hospitals are doing a lot, but I do believe that there’s a whole lot more that they can be doing.”
Aggressive efforts by physicians and nurses at St. Mary’s over the past several years have brought down the hospital’s infection rate, said Dr. Ralph Harder, chief quality officer at the hospital.
“When we started, we certainly had infections, and recently our infection rate has, knock on wood, gone away,” he said. “But you always can get an infection, even if you’re following all the protocols. These practices are the way to try to minimize these problems.”
PATIENTS’ LEVELS OF RISK VARY
St. Mary’s was the only Maine hospital with more than 1,000 catheter days to report no infections from January 2008 through June 2009.
But infection rates can’t be used to compare hospitals such as St. Mary’s and Maine Med without taking into account varying levels of risk, experts said.
“You have to look at the patient mix,” said Dr. Dora Anne Mills, director of the Maine Center for Disease Control and Prevention. “A place like Maine Med is going to have a lot more patients with central lines and a lot more patients who are predisposed to infections.”
Critically ill patients and those being treated for cancer may be less immune to infections. Sicker patients also are more likely to need catheters for longer periods and may need to be fed through their catheters, which increases the infection risk, officials said.
Mills said it would be more reasonable to compare Maine Med with the state’s three other major medical and surgical hospitals, although there are still differences.
Maine Med’s infection rate — 4.2 per 1,000 catheter days — was more than twice the rate at Eastern Maine Medical Center in Bangor, Central Maine Medical Center in Lewiston and MaineGeneral Medical Center in Augusta and Waterville from January 2008 through June 2009.
(Mercy Hospital in Portland, which is classified with smaller hospitals, had a rate of 3.1 infections per 1,000 catheter days.)
Maine Med’s rate was twice the national rate of 2.1 per 1,000 catheter days for major medical/surgical teaching hospitals from 2006 through 2008.
INCREASING PREVENTION EFFORTS
State data also indicate that Maine Med may not have been as aggressive with infection prevention as the three other major Maine hospitals were in 2008 and the first half of 2009.
Maine Med documented that it took all of the new precautions about 70 percent of the time during the 18-month period, while the others did so at least 80 percent of the time, according to the data. St. Mary’s reported taking all of the precautions 100 percent of the time.
Salvador attributed Maine Medical Center’s lower precaution rate to lapses in recordkeeping, and he said the precautions are now followed routinely by doctors and nurses. Because of those efforts, the hospital’s infection rate continues to fall, he said. It was about 2.7 per 1,000 catheter days in 2009, closer to the national average.
It may not be possible for a high-risk hospital such as Maine Med to eliminate all infections, say Salvador and others. But, he said, it is trying.
Staff Writer John Richardson can be contacted at 791-6324 or at: jrichardson@pressherald.com
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