Minnesota's hospital germ fighters report progress

Hospitals are reporting progress in their fight against infection-causing germs — from fungus in the bedsheets to bacteria on whiteboard markers — and against one another in their competitive race to avoid federal penalties for infecting their patients.

They gained motivation to clean up their acts in 2014, when the U.S. Centers for Medicare and Medicaid Services started tracking rates of hospital-acquired conditions and financially penalizing those with the worst rates.

While Minnesota hospitals as a group had lower rates of these conditions, seven in the state were penalized this year for being in the lowest quartile — including Fairview Ridges Hospital in Burnsville. Douglas County Hospital in Alexandria and Rice Memorial Hospital in Willmar have been penalized two years in a row.

At a conference that starts Wednesday in Minneapolis, leaders from the Association for Professionals in Infection Control and Epidemiology (APIC) said they'll highlight progress that has occurred in hospitals across the country.

"Fifteen years ago, the common understanding was that, 'Hey this is a natural consequence that you might get an infection from this lifesaving stuff we're doing to you and for you,'" said Janet Haas, APIC president. "We don't see it that way anymore."

Leaders with the Minnesota Hospital Association said they expect progress when Medicare releases the latest hospital data later this year, particularly in reducing the urinary tract infections that can occur in patients due to the overuse of urinary catheters.

Those are one of the hospital-acquired infection types included in Medicare's rankings, along with infections that occur during surgery and as a result of the placement of central lines into the bloodstream. The rankings also account for hospital-related falls, pressure sores and other conditions.

Cutting catheter-related infections has many benefits, said Dr. Rahul Koranne, the hospital association's chief medical officer. "First of all, those patients have a better experience of care — they're less sick and able to leave the hospital earlier," he said. "They do better overall. But we also can cut the overall costs of health care."

Even so, changes to prevent infections can be hard because they require doctors, nurses and other caregivers to adjust long-standing practices. At Hennepin County Medical Center in Minneapolis, data clearly showed more infections when urinary catheters remained in patients for five or more days, but doctors and nurses worried about the consequences of removing them any earlier.

"Nobody wants to cause patient harm," said Dr. Dan Hoody, HCMC's chief medical quality officer.

But many worried about removing catheters too quickly and then putting patients through the discomfort of reinserting them.

The hospital nonetheless ordered discussions at five days, and urged doctors and nurses to try faster removal of the catheters, which drain urine from people who suffer bladder dysfunction due to surgery, medication side effects or injuries.

HCMC's infection rate had been worse than average — though not bad enough to draw a Medicare penalty — this year. But the rate has since declined 67 percent in intensive care and 39 percent hospitalwide, Hoody said.

This week's conference in Minneapolis will include a review of progress by an infection control expert from the U.S. Centers for Disease Control and Prevention, but also tales from around the country of how hospitals tried to reduce and prevent everything from staph infections passed along by mothers to their fragile premature babies, to drug-resistant infections caused by the overuse of antibiotics.

Minnesota hospitals also will be featured for the steps they took during the 2017 measles outbreak to prevent the spread within hospitals.

Infection control officials said progress has been so widespread that they perceive a future problem with the Medicare rankings — that they will penalize hospitals at the bottom who improve but don't overtake others.

Regardless, Koranne said there is now a mind-set that infections are preventable and not just the cost of hospital business.

"What is the number that will make you happy?" he said. "The only answer for that is zero, knowing that we will likely never get there."