Part two of two.

Hospitalization too often puts patients at risk.

They can contract infections from the insertion, maintenance and removal of urinary catheters as well as central line catheters that are placed in large veins to make it easier to administer medicine and fluids.

They can also get sick from a variety of antibiotic-resistant bugs, including Clostridium difficile and Methicillin-resistant Staphylococcus aureus (MRSA).

An estimated 12,000 Californians die annually from these preventable infections, according to state Department of Public Health statistics.

State and federal statistics show that UC Davis Medical Center struggles more than most other local hospitals with high infection rates, especially those related to catheters.

Officials at a range of medical centers said comparing infection data is unfair because hospitals are so different in size, patient population, specialized treatment units and severity of illnesses – and even the way they chart contacts with their patients.

Behind the statistics are lessons to be learned. Consider two local medical facilities, UC Davis Medical Center and Sacramento's Veterans Affairs Hospital – one a tale of trying to overcome trouble, one a tale of success.

UC Davis

In UC Davis' eerie-looking Center for Virtual Care simulation suite, filled with soft plastic upper torsos and disembodied mannequin heads, Dr. Jonathan Pierce instructed four pediatric residents on proper central line insertion.

"You've got it, but look at your angle of attack," he told one resident, feeding a needle into a torso. "If you miss the vein, where are you going? You're going to go into the chest."

The class is part of the hospital's plan to reduce infections, a problem acknowledged by hospital officials and reflected in the California Department of Public Health data collected from more than 300 hospitals for infection rates for 2009 and the first quarter of 2010.

The data indicate that among the 38 Level 1 and Level 2 trauma centers listed in the report, UC Davis Medical Center had the second-highest rate of intensive care unit central line-related bloodstream infections. And it had the third-highest rate among the state's 56 hospitals listed in the report as teaching facilities.

According to federal data for fee-for-service Medicare patients collected from October 2008 to June 2010, the medical center was the sixth-highest among the nation's large hospitals (10,000 or more discharges for the time period) in both its central line and urinary tract infection rates.

For the sprawling 645-bed acute-care hospital – the region's only Level 1 trauma center, with 11 ICUs, a burn unit and a National Cancer Institute-designated cancer center – the issues are complex.

"I'm not defensive. I'm extremely proactive," said the center's chief medical officer, Dr. Allan Siefkin. "If we have one infection, we want to have zero."

Among the reasons he offers for UC Davis' high numbers: Because it's a teaching hospital, more people make notations in each patient's chart, leading to the possibility of incorrect documentation.

And the medical center tends to see the region's sickest, most grievously injured patients. Its highest number of central line infections occurs in the burn unit, he says. Almost one quarter of UC Davis' patients transfer in from other hospitals, requiring higher levels of care.

Hospital officials said the medical center has long maintained a rigorous program for preventing infections, including procedures such as hand hygiene and appropriate draping, as well as the use of gowns and gloves.

A team of nine registered nurses and a manager reviews every hospital-acquired infection case, Siefkin said, and a quality-of-care committee analyzes patient safety concerns each week.

The Center for Virtual Care, which opened in 2003, helps standardize nurse and physician training on how central lines are inserted and their dressings changed. In the past, most American doctors learned the process by watching it once or twice.

"We're a long way from the old philosophy of 'See one, do one, teach one,' " said the center's operations director, Betsy Bencken.

Because most catheter infections occur more than a week after insertion, Siefkin said, the hospital urges its medical staff to remove them sooner. Without documentation of ongoing need, for example, nurses can now remove urinary catheters after 48 hours without waiting for doctors' orders.

Amid this change in medical culture, the center said it has made progress. In the past two years, its own statistics show that its rate of laboratory-confirmed urinary tract infections has decreased by half, from 4.5 infections to two per 1,000 catheter device days. And its central line infection rate dropped from four per 1,000 in 2007 to 2.25 per 1,000 last year.

In comparison, national Medicare statistics – for a population that's elderly and frail – indicate rates for both infections of less than .4 per 1000.

Next year, Siefkin said, UC Davis' medical staff will receive a paid incentive to remove central lines more quickly. "Will that work?" he said. "I don't know if it'll have any impact. The truth is, they do it for the patients, but this will remind them."

Sacramento VA

On a smaller scale, a local hospital has found answers. The 190-bed Sacramento VA Medical Center has taken aggressive steps that have lowered its rates of MRSA and central line-associated bloodstream infections to zero.

"The time of more aggressive infection control is here," said Dr. Harold Burger, the epidemiologist in charge of the hospital's infection control committee. "The public rightly demands this."

The local efforts are part of a four-year, systemwide Veterans Affairs campaign to wipe out potentially deadly bugs, which has resulted in a 62 percent drop in the VA's MRSA rate across the country. (Because VA hospitals are federal facilities, their data aren't compiled in state statistics.)

The VA's success – in Sacramento and its 152 other hospitals – has wide implications for care at other hospitals. The campaign's primary measure? Getting people to wash their hands.

The Centers for Disease Control and Prevention considers hand hygiene – a health care basic yet one that can be overlooked – to be the cornerstone of reducing all hospital infection rates.

The Sacramento VA consistently markets good hand hygiene to its employees, patients and visitors, said spokeswoman Robin Jackson.

Posters urge families to tell medical staff to wash their hands. A "secret shopper" surveillance effort encourages observers to monitor fellow employees' hand-washing and even provides a script for reminding them to do so.

A 2009 infection control fair included a poster and slogan contest, and a campaign that year recognized individual employees' good hand hygiene. A newer campaign encouraged staff, patients, families and visitors to be aware of hand-washing and included a brochure entitled "Hand Hygiene Saves Lives."

Like other VA hospitals, the Sacramento center also swabs patients for MRSA as they enter the hospital, isolating those who test positive.

Simple measures, but they're working. "You've got to understand this is part of the medical scene today," Burger said. "If you put in the resources to decrease infections, everybody benefits. It's the obvious thing to do."

ABOUT THIS SERIES

This two-part series was researched and reported in partnership with the California HealthCare Foundation Center for Health Reporting, a journalistically independent organization devoted to reporting on California health care issues.

SUNDAY: Deborah Schoch, senior writer for the center, chronicled the death of Tony Lewis, who had surgery for a broken leg and succumbed to infection eight days later. Read it at sacbee.com.

TODAY: The Bee's Anita Creamer examines efforts by UC Davis Medical Center and Sacramento VA Medical Center to combat infection.

DATABASE

Our newest database shows infection rates at each California hospital. sacbee.com/datacenter

TELL US YOUR STORY Have you or someone in your family experienced a hospital-related infection? Contact Anita Creamer, acreamer@sacbee.com, or Deborah Schoch, mdschoch@usc.edu.

WASH YOUR HANDS

An estimated 2 million U.S. hospital patients get infections annually. Patients are being urged to do their part to help stop infections.

Hand-washing: Hospital patients and visitors should wash their hands frequently, especially after eating, using restrooms, coughing or sneezing, or touching surfaces such as bed rails, door knobs and remote controls.

Soap: When using soap and warm water, rub hands and fingers for at least 15 seconds or as long as it takes to sing "Happy Birthday" twice. Some hospitals suggest patients ask doctors, nurses, even friends and relatives, if they've washed their hands.

Alcohol-based rubs: Many hospitals have added dispensers in lobbies and hallways. Rub with liquid for at least 15 seconds until hands feel dry, but do not rinse or dry with a towel. Those people visiting or treating patients infected with Clostridium difficile should stick with soap and water, because alcohol sanitizers don't kill C. difficile spores.

Gloves and gowns: Visitors may be instructed to wear disposable gowns and gloves before coming in contact with an infected patient. They should wash their hands before donning gloves to avoid transferring bacteria onto the gloves.

Equipment: Patients should ask their doctors to wipe the flat surface of stethoscopes with alcohol before use, patient advocates suggest. They can monitor the use of their own urinary tract catheters and intravenous feeding tubes, making sure they are removed as soon as possible and that health care workers changing tubes or dressings are wearing gloves, advocates say.

Education: Ask surgeons for their infection rates.

The California Department of Public Health now posts infection rates for 383 hospitals in two reports at 1.usa.gov/imqfdw. (See first two links under "HAI Program Reports").

Also, new federal data for Medicare patients show vascular and urinary tract catheter infection rates at some of California's largest hospitals between October 2008 and June 2010. You can find the information at sacbee.com/datacenter under "Hot Topics" on our Data Center page.

Sources: Federal Centers for Disease Control and Prevention; California Department of Public Health; Society for Healthcare Epidemiology of America; Consumers Union Patient Safety Project; Committee to Rid Infection Deaths.

© Copyright The Sacramento Bee. All rights reserved.

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Call The Bee's Anita Creamer, (916) 321-1136. Bee staff writer Phillip Reese contributed to this report.

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