Is Your San Francisco Bay Area Hospital Prone to Infections

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.

New Research Confirms Diabetics at High Risk of Surgical Infection

I'll never forget the day that Mrs. Williamson looked me in the eye, waving her finger and said, "I want you to promise me that you won't cut off any of Warren's toes."

Warren Williamson was the father of my sister's best friend when I was growing up. And he was a diabetic who had developed neuropathy (numbness in the feet from diabetes). He had a "spot" on his foot he was concerned about and wanted me to make a housecall to check his feet. But Mrs. Warren was fearful. An uncle of hers had died after a toe infection led to an amputation. All she new about that episode was that her uncle was diabetic, he got a minor toe infection, then he needed a toe amputation and now he is dead.

As a longtime friend, and a diabetic foot surgeon, I was taken aback by her fear. So I looked her in the I and said, "I promise I will do everything in power to make sure you husband leaves this world with all of his toes." I could see the relief, as her expression changed.

As it turns out I kept my promise. But unfortunately Warren did ultimately die of a post-operative infection. Only it was after back surgery. The growing population of diabetic patients is leading to more and more surgical infections.

This month a new study was published in the Journal of Bone and Joint Surgery which shows that diabetic patients are significantly more at risk for surgical infections than non-diabetic patients. The article is entitled "Postoperative Infection Rates in Foot and Ankle Surgery: A Comparison of Patients with and without Diabetes Mellitus."

The researches set out to determine whether or not patients with diabetes are really at increased risk for infection following foot and ankle surgery, or not. To find out they reviewed the charts of 1000 patients who had orthopaedic foot and ankle surgery. The recorded whether or not any of those foot surgery patients had a diagnosis of diabetes mellitus, if they had a postoperative foot infection and information about the severity of infection. They also recorded whether the surgery was inpatient surgery or outpatient surgery, whether or not they used of internal fixation (like screws or plates to hold the bones together) or external fixation (like rods attached on the outside of the foot or ankle), history of tobacco use, history of organ transplantation, history of rheumatoid arthritis, the total length of surgery, follow-up time in weeks, and other medical conditions that might contribute to the foot surgery infection.

What they discovered was that 52% of all foot and ankle infections occurred in diabetics. But diabetics accounted for only 19% of all patients who had foot surgery or ankle surgery. They found that of those patients having foot and ankle surgery, those that had diabetes were about 4 times more likely to develop a post-operative infection following foot or ankle surgery.

Even worse, we know that diabetics get more severe infections. The study confirmed this and showed that diabetic patients were 5 times more likely to develop the sort of severe infection that might lead to prolonged hospitalization, a foot amputation or death from the infection.

Interestingly, there was no real difference in foot infection rates between those without diabetes and someone with uncomplicated diabetes (a mild case of diabetes). However, those with complicated diabetes (a bad case of diabetes) did have much higher rates of surgical foot infections than those with uncomplicated diabetes (a mild case of diabetes).

So, if you or someone you love has diabetes and is going to have foot surgery, make sure the surgeon understands all of the implications is taking precautions to prevent the infection. Ask questions. Ask whether or not the patient will get antibiotics at the beginning of the surgery. Ask in the surgeon covers the toes with ioban. Ask the surgeon for a scrub brush with surgical soap to scrub the foot the night before surgery. Ask the surgeon how often his diabetic foot surgery cases go bad.

It is your foot and you have the right to know. If your diabetic foot surgeon thinks he or she doesn't need to take the time to answer all of your questions, find another surgeon.

Dr. Christopher Segler is a podiatrist and award-winning podiatrist who practice in the San Francisco Bay Area. He provides 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 in San Francisco as a solution to foot problems at www.DocOnTheRun.com and www.AnkleCenter.com.