Is your local hospital doing a good job stopping infections? Start with these reporting tips

The infections that patients pick up inside hospitals, which can be hotbed for germs, are ghastly, debilitating and sometimes even deadly. They can manifest in different forms, including unsightly skin wounds, persistent diarrhea or fever and nasty coughs.

Last year, on June 17, Rob Driggers, of Laguna Niguel, Calif., developed what’s called a surgical site infection. A bacteria from the gut (either his or someone else’s) had landed in his incision wound following a hip replacement surgery at Mission Hospital Regional Medical Center in Mission Viejo. In treating the infection, doctors had to remove his new artificial joint, which required he spend the night without a hip, gripping his bedrail in pain.

The story seems at odds with the setting. The 61-year-old was being treated inside a beautiful hospital. Orange County boasts a handful of renowned hospitals, gleaming facilities with excellent reputations and special certifications. But they still have trouble controlling ugly infections. And they are not alone – infections plague every hospital, where bacteria, fungus and other dangerous pathogens thrive.

It’s not a topic that has been ignored.

Government agencies track rates for some types of infections at each hospital in the U.S. in public databases, comparing them to national and, sometimes, state averages. (Federal data is available here; California data is available here.) Hospitals with the highest infection rates face financial penalties. (Kaiser Health News compiled a full list of hospital penalties here.)

Yet, many hospitals still fail to follow simple protocols that would keep patients safe, and access to most case-specific information is limited.

Four months after Driggers was operated on, the hospital temporarily closed its operating rooms because of a small outbreak of infections of the same type he had contracted. In reporting the story, I had to rely on the hospital’s administrators for information about what had gone wrong. A tipster had told us that representatives from the Centers for Medicare and Medicaid Services and the nonprofit accrediting agency the Joint Commission were on site, but neither of those agencies would disclose what they had found.

It wasn’t until the next year, in May, that CMS released its inspection reports. It was those reports that detailed all of the infection control protocols Mission Hospital had violated. They include this level of detail: “The portable x-ray film holder that was rolled from one trauma bed to another was noted to have a rusty body, surface, and arms. The original light khaki paint on the equipment had become rusty brown with chipped edges.”

I analyzed the inspection report for Mission Hospital, along with inspection reports for four other large county hospitals, for a series of stories that gave readers in Orange County a more intimate picture of infection control issues at their local hospitals. Reporting on multiple facilities showed readers that infections are a nagging problem for every health care facility, not just Mission Hospital.

Here are five tips for obtaining these inspection reports:

• The Joint Commission, a nonprofit that certifies most U.S. hospitals for Medicare funding, does routine inspections every three years, but its surveys are not public record. The commission is funded primarily by the hospitals through survey fees and annual dues.

• CMS, the federal agency that reimburses health care providers for treating Medicare and Medicaid patients, will conduct surveys but only in response to complaints.

• There are three CMS documents you can request: cover letters, survey reports and plans of correction. The cover letter is pretty general, but it’s important because it will state whether there are violations that warrant a revocation of Medicare funding. The reports detail the violations. The plan of correction is the hospital’s response to the findings.

• Each of these documents is available under the Freedom of Information Act, but it’s more efficient to ask the document release officer at CMS directly. (For California reporters, the person currently in that position is Karen Fuller in San Francisco, reachable at 415-744-3741.)

• CMS will release the cover letter as soon as it confirms the facility has received it. The full survey report does not become public until CMS approves the plan of corrections – a process that can take several months.

The Association of Health Care Journalists published a Q&A with CMS about its inspection process, and it’s really helpful.

Because the reports are anecdotal, quantifying the violations at each of the hospitals posed challenges. I created categories for the different types of violations – bad hand hygiene, cleanliness, aging or broken equipment, personal protective equipment misuses, and improper instrument sterilization – and entered them into a spreadsheet. Then, I sent the spreadsheet to an infectious disease expert who ranked each violation for its risk of harm to patients and likelihood of being found at other hospitals. Eventually, I used those rankings in determining which violations to highlight in my stories.

I shared that spreadsheet with each of the hospitals, giving them full access to my findings and the opportunity to respond to each violation.   

One of my biggest reporting frustrations was that hospital employees – who know the conditions better than anyone – would only speak anonymously, due to fears of losing their jobs. The stories would have been more powerful with their voices.

On the other hand, after the stories published, several other employees were outraged by what I had reported. Some felt the information should never have been released to the public, because it would scare people.

Hospital acquired infections kill an estimated 75,000 patients each year. Arming patients with better information about the mistakes hospitals make empowers them to not only make smart decisions about where to get care, but also to question a nurse who does not wash her hands or a doctor who carries an unwrapped syringe in his coat pocket. It also puts pressure on hospitals to improve — and that can save lives.

Read Jenna Chandler’s fellowship stories:

Federal inspection report finds Mission Hospital in crisis

Top O.C. hospitals battle infections among patients

[Photo by Jebb Harris/Orange County Register]