California declines national infection-fighting program

Dr. Peter Pronovost spearheaded a program that sharply reduced potentially deadly infections at Johns Hopkins Hospital in Baltimore and has created a much-acclaimed model that has since spread to 46 states in the nation.

California is not among them. Leaders of the state's hospital industry, calling their own infection-fighting programs superior, turned down an invitation to join the program two years ago, along with as much as $70,000 in federal funding.

"It wasn't the right fit for us," said Rory Jaffe, executive director of a patient safety group tied to the California Hospital Association, who initially applied for and won the federal grant money, only to turn it down. "I wouldn't say we're turning our back on the (Pronovost) program rather than doing more and better."

A collaborative of 38 hospitals, for instance, has sharply reduced infections in the Bay Area, and a similar program is being designed for facilities in the Sacramento area and the Central Valley.

Even so, California's decision to opt out of the national initiative has puzzled Pronovost and other leaders.

"It's worrisome for us," said James B. Battles, who leads the program from his post at the Agency for Healthcare Research and Quality, part of of the federal Centers for Disease Control and Prevention's patient safety arm.

"Our goal is to have this in every state in the country – or give us the reason you're not taking this opportunity we're making available to you," Battles said. "That includes every hospital in the country."

The California Hospital Association has not entirely ruled out joining the program, said spokeswoman Jan Emerson Shea.  Another association official praised the program, saying its techniques are being followed by collaboratives in California.

 “The tools that Peter Pronovost has developed are the very things we’re using.  The only difference is that we haven’t signed up with program,” said Debby Rogers, vice president of quality and emergency services.

 

Almost 100,000 people die annually of such infections in the United States. In California, 12,000 people die each year, state officials say.

In the past decade, the health care industry and government agencies have recognized not only the high death toll, but that many or most such infections can be prevented.

The most high-profile physician leading the charge is Pronovost, a professor of anesthesiology and critical care medicine at Johns Hopkins University School of Medicine.

His campaign began nearly a decade ago after Josie King, an 18-month-old girl, was infected during treatment at Johns Hopkins. Her death stunned the hospital staff, which mobilized to fight the type of infection King suffered – one caused by a central line used to feed and medicate her. Such infections, among the most deadly, are common in hospitals nationwide.

With Pronovost's leadership, Hopkins reduced the central line infection rates in its intensive care units nearly to zero.

One key tool was a checklist designed to make sure that medical workers inserted lines properly and removed them promptly, with clean hands and proper equipment.

The other tool is a more amorphous one: changing the hospital culture so that nurses and other workers feel safe to question, say, a doctor's failure to follow a checklist. That meant changing the traditional top-down structure in which physicians are rarely challenged and many infections are considered an inevitable part of hospitalization.

Staff members took on the responsibility of fighting them.

"We changed the social norms to view these infections as preventable – and that they're my problem now," Pronovost said.

Next up was the state of Michigan. Pronovost worked with the state's hospital association to develop a Hopkins-style program for 75 facilities statewide. The central line infection rate dropped dramatically.

The Michigan program generated more headlines this winter and spring with the publication of three studies in prominent medical journals.

One documents a 70 percent decrease in pneumonia in Michigan among patients on ventilators. Another shows a 10 percent decrease in deaths among central line patients in intensive care units. The third, published three weeks ago, shows that 60 percent of Michigan hospitals went a year without a single infection.

The Hopkins model went national with backing from the powerful American Hospital Association. What resulted was the effort now under way in 46 states.

Some state governments have gotten involved, too.

"We wrote into our contracts that we wanted the state collaboratives to involve the state departments of public health," Battles said. "Those states that seem to be doing the best are where there's strong collaboration with state health departments, state hospital associations. We like to see that strong collaborative nature."

In a March interview, California Department of Public Health officials were asked if they had considered asking the California Hospital Association to sign on to the effort.

"We weren't asked. The department was not invited," said Jon Rosenberg, chief of the department's program on hospital-acquired infections. "It's the hospitals who have to participate in that process."

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