Last night I saw a news story on televsion about reported infection rates in San Francisco Bay Area Hospitals. Given that I am a foot surgeon who is always worried about patients getting dangerous infections during or after foot surgery in the hospital, it seems it is worth reiterating the findings reported in the news.
This past week www.ConsumerReportsHealth.org provided a detailed analysis of central line infection rates in the San Francisco Bay Area. The results vary, but are worth examining if you or a loved one needs surgery or hospitalization.
Three hospitals in San Francisco had zero (0, zip, zilch, none!) central line infections. St. Mary's Medical Center, St. Luke's Hospital and Saint Francis Memorial Hospital were the only ones in San Francisco with none of these costly and often deadly infections. California Pacific Medical Center-Pacific Campus and Kaiser - San Francisco also had high marks with a rate of infection 43% and 40% better than the national average, respectively. The big surprise was that the city's highly aclaimed academic medical center (UCSF Medical Center) was the worse performer with a rate of infected central lines 80% higher than average.
Also in the Bay Area, Kaiser Foundation Hospitals in Hayward, Santa Rosa, Vallejo, and South San Francisco all also reported no incidences of central line infections for the study period.
It should be noted that not all Bay Area Hospitals reported how many central line infections they had. A law has been passed in California to disclose this information, but facilities aren't actually required to report until 2011.
Many people will be suspicious of the hospitals that have refused to report their data.
So why is this important to you?
If you have surgery or become ill and end up in the ICU (Intensive Care Unit), you have a good chance of getting a central line. A "central line" is basically like a big I.V. (intravenous catheter) placed in one of the large veins of the neck or sometimes the chest or arm. They are very important if you are very ill. A central line is the best way to get medications, I.V. fluid, and antibiotics into your system as quickly as possible. If you need it, you can't do without it.
The problem is that central line catheters are also a way for bacteria to get into your bloodstream. A bloodstream infection is referred to as "sepsis" by doctors. Sepsis often leads to septic shock and is frequently fatal. So obviously you would prefer to avoid getting a deadly infection.
People at risk of central line infections are usually very sick. Many of these people are in the ICU because they have been seriously injured, have been battling a prolonged illness or have had a complication following surgery.
For example, if you are diabetic and develop gangrene, you need surgery. The foot surgeon MUST surgically remove all of the infected tissue, or it will spread. If it spreads, you could get sepsis and die.
So off to the operating room you go for emergency diabetic foot surgery. If you are in poor health, you still go to surgery, because the risk of not doing surgery is that you might die anyway. If you are in very poor health, you might need to go to the ICU for monitoring after your foot surgery. If you have trouble waking up from anesthesia you might need to go to the ICU after your foot surgery.
And in the ICU, the surgical team might need to place a central line to deliver enough fluids to keep your blood pressure up, deliver powerful antibiotics, etc. But you don;t want that central line delivering any germs.
So if you choose to have foot surgery in a San Francisco area hospital, what do you do? The fact is that Hospitals that perform foot surgery in San Francisco, Hayward, Santa Rosa, Vallejo, and South San Francisco have reported zero central line infections. But that doesn't exactly mean a guarantee. On the flip-side, if your hospital reports very high rates of infection, there may be a higher risk that you may get one of these infections.
Regardless of which hospital you choose, you (as a patient) can and should, ask the doctor, surgeon and nursing staff what steps they are personally taking to make sure that you don't get a central line infection.
Here is a list of some of the Northern California hospitals who didn't "choose" to report their infection rates. I am not saying that their infection control practices are any better than UCSF or any worse that St. Mary's Medical Center. I'm just sying they didn't seem to think it is important that you as a patient know...
Alameda County Medical Center - Highland Hospital, Oakland, CA
Alameda Hospital, Alameda, CA
Alta Bates Summit Medical Center - Alta Bates Campus, Berkeley, CA
Alta Bates Summit Medical Center- Summit Campus, Oakland, CA
Community Hospital Of Los Gatos, Los Gatos, CA
Community Hospital Of The Monterey Peninsula, Monterey, CA
Contra Costa Regional Medical Center, Martinez, CA
Dameron Hospital, Stockton, CA
Eden Medical Center - Eden Campus, Castro Valley, CA
Eden Medical Center - San Leandro Hospital Campus, San Leandro, CA
Hazel Hawkins Memorial Hospital, Hollister, CA
Northbay Medical Center*, Fairfield, CA
Northbay Vaca Valley Hospital*, Vacaville, CA
Novato Community Hospital, Novato, CA
Petaluma Valley Hospital, Petaluma, CA
San Francisco General Hospital Medical Center, San Francisco, CA
San Mateo Medical Center, San Mateo, CA
Santa Rosa Memorial Hospital, Santa Rosa, CA
Valleycare Health System, Pleasanton, CA
Washington Hospital Healthcare System, Fremont, CA
Sutter Solano Medical Center, Vallejo, CA
Sutter Warrack Hospital, Santa Rosa, CA
Sutter Medical Center Of Santa Rosa, Santa Rosa, CA
Sutter Delta Medical Center, Antioch, CA
St. Rose Hospital, Hayward, CA
A complete list can be found at http://www.leapfroggroup.org/decline
Dr. Christopher Segler is a podiatrist and award-winning podiatrist who practices in the San Francisco Bay Area. He offers House Calls for Diabetic Foot Exams, Diabetic Foot Emergencies, and Diabetic Foot Wound Treatment. Serving San Francisco, Marin, Palo Alto, and Walnut Creek. You can learn more about house calls as solution to foot pain at www.DocOnTheRun.com and www.AnkleCenter.com.
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