By Christina E. Sanchez, The Tennessean
Tennessee's frailest and tiniest infants go to intensive care units to get healthier, but in some cases the feeding tubes and intravenous lines designed to heal them actually make them sicker, a new state report shows.
High-risk babies in Tennessee are 40 percent more likely than the national average to get blood infections from central lines, the state found in its first detailed look at bacterial blood infections in neonatal intensive care units.
Among the tiniest infants, born weighing 1.65 pounds or less, infections were even higher - 70 percent above the national rate.
Health officials said improperly inserted or poorly maintained lines could be driving the high rates. In infants, the lines are put into the umbilical area or in veins in the upper arm.
Related: Tennessee's Report on Healthcare Associated Infections (July 2008-June 2009)
A year-old statewide initiative aims to cut Tennessee's infection rate by more than half in the next five years by bringing together people across the health-care industry, including rival hospitals, to share best practices.
"This is not where we want to be, but it is important to know where we need to focus our efforts so we can really have an impact," said Dr. Marion Kainer, infectious-disease physician for the Tennessee Department of Health. "We have work to do."
Tennessee lawmakers mandated in 2006 that hospitals collect and report data on bacterial blood infections in adult and pediatric intensive care units. The initial report in January on adult intensive care showed that bacterial blood infections for that group were 20 percent higher than the national average. In this updated report, that margin dropped to 19 percent.
Twenty-eight states require hospitals to publicly report their infections to help identify what is causing so many people to get sick.
There are more than 1.7 million health-care-associated infections in the United States each year, and about 99,000 people die from them. They are among the top 10 causes for death annually, according to the Centers for Disease Control and Prevention.
A health-care-associated infection happens when a patient gets sick while being treated in a health-care setting for another condition. Common infections occur in the urinary tract, in the lungs and blood, and at surgical sites, and the financial result is $35 billion to $45 billion a year, the CDC says.
Hospitals cut infections
Nashville's hospitals that often care for the sickest infants, including Baptist Hospital, Monroe Carell Jr. Children's Hospital at Vanderbilt and Centennial Medical Center, overall had zero infections or were within normal range compared with the national average. Vanderbilt was within normal range overall but had higher infection rates among infants with low birth weights.
The Tennessee hospitals with infection rates significantly above the national average were Regional Medical Center in Memphis and the University of Tennessee Medical Center in Knoxville.
The pediatric infection data were collected from July 2008 to June 2009, and hospitals said they have improved since then.
"This is something neonatal intensive care units have been working on for years," said Dr. Peter Grubb, medical director of the Tennessee Initiative for Perinatal Quality Care, the statewide collaborative effort to reduce infections and infant mortality. "Any one step is simple, but if you take all the steps that have to happen in one day, it's a fairly complex process."
For Centennial, the tips learned from the state project have helped reduce infections by 43 percent for the start of 2010 compared with the year-earlier period.
Most of Centennial's blood infections were related to handling of tubes and lines, and bacteria such as staph probably were introduced, said Diana Moses, manager of the neonatal intensive care unit.
"We came up with a strict process that all nurses have checked off on and are committed to do," Moses said.
At Vanderbilt, the process includes washing hands, wearing head-to-toe protective outfits, sterilizing the insertion area on the patient and knowing how long a line should stay in.
Vanderbilt set a goal to cut its infection rate for adult and pediatric intensive care units in half by June 2011. During the start of 2010, the neonatal ICU went 100 days without an infection, the longest ever.
As a rule, the hospital posts how many days each unit - adult or pediatric - has gone with no infection.
"Our mantra is that we are chasing zero (infections)," Dr. Tom Talbot, chief hospital epidemiologist. "I know that if I were a patient or had a neonate in ICU, that's what I would expect."
Baptist Hospital in Nashville was among the few facilities in the state to report zero infections in the adult and pediatric ICUs. Sharing what works and doesn't work with others has helped the hospital, said Gail Fraine, infection prevention director.
"Hospitals identify with each other because we have been there or are dealing with it," Fraine said. "We are all just trying to make additional improvements."