How your hospital can make you sick

Consumer Reports’ new Ratings of more than 3,000 U.S. hospitals show which do a good job of avoiding MRSA, C.diff, and other deadly infections

www.consumerreports.org / Published: July 29, 2015

In the ongoing war of humans vs. disease-causing bacteria, the bugs are gaining the upper hand. Deadly and unrelenting, they’re becoming more and more difficult to kill. You might think of hospitals as sterile safety zones in that battle. But in truth, they are ground zero for the invasion.

Though infections are just one measure of a hospital’s safety record, they’re an important one. Every year an estimated 648,000 people in the U.S. develop infections during a hospital stay, and about 75,000 die with them, according to the Centers for Disease Control and Prevention (CDC). That’s more than twice the number of people who die each year in car crashes. And many of those illnesses and deaths can be traced back to the use of antibiotics, the very drugs that are supposed to fight the infections.

Terry Otey appears to be one casualty in that ongoing battle. Three years ago, a few weeks after an overnight stay for back surgery at Providence Regional Medical Center in Everett, Wash., he went to the emergency room vomiting, dizzy, and with excruciating back pain. Bacteria known as MRSA (methicillin-resistant staphylococcus aureus) had taken hold in his surgical incision and quickly spread to his heart. He died in the hospital about three months later, following a cascade of serious health problems. “He just wanted to ease his back pain enough to play golf,” says his sister, Deborah Bussell.

Kellie Pearson, 49, a farmer in northern California, says she encountered a different kind of bug after having heart surgery last April. Her doctors prescribed an antibiotic in the hopes that it would prevent a postsurgical infection. Instead the drug killed off healthy bacteria in her body, and another germ, C. diff (clostridium difficile), swooped in, causing diarrhea so severe that she had to stay in the hospital an additional five days until doctors could rein in the potentially deadly infection.

She recovered but soon realized that she wasn’t the only patient suffering. “When I was able to walk down the hall in the hospital,” she says, “I was horrified to see room after room with C. diff caution signs on their doors warning that the patients inside, like me, had been infected.”

In the danger zone

“Hospitals can be hot spots for infections and can sometimes amplify spread,” says Tom Frieden, M.D., director of the CDC. “Patients with serious infections are near sick and vulnerable patients—all cared for by the same health care workers sometimes using shared equipment.”

Making the situation even more dangerous is the widespread, inappropriate use of antibiotics that’s common in hospitals, which encourages the growth of “superbugs” that are immune to the drugs and kills off patients’ protective bacteria.

It’s “the perfect storm” for infections to develop and spread, says Arjun Srinivasan, M.D., who oversees the CDC’s efforts to prevent hospital-acquired infections. “We’ve reached the point where patients are dying of infections in hospitals that we have no antibiotics to treat.”

But there’s hopeful news: Some hospitals are taking steps to reduce infections and end inappropriate antibiotic use. “But others have made little effort,” Srinivasan says.

'Be your own advocate'

Kellie Pearson recovered from a life-threatening case of C. diff caused by antibiotics she got in the hospital. But shortly after, she says, her doctor wanted to prescribe a broad-­spectrum antibiotic to prevent infection in her incision. “I was shocked because that could trigger the C. diff all over again,” she says. Her takeaway: “You have to be your own advocate.”

Red flags for bad bacteria

Methicillin-resistant staphylococcus aureus (MRSA)

We are focusing on C. diff and MRSA for two important reasons.

First, the infections are common and deadly. More than 8,000 patients each year are killed by MRSA; almost 60,000 are sickened by the infections. The bacteria often find their way into patients’ bodies through the lines and tubes that doctors use to deliver medication and nutrition to patients, or via surgical incisions, as happened to Terry Otey.

C. diff is an even bigger concern. Kellie Pearson is one of the 290,000 Americans sickened by the bacteria in a hospital or other health care facility each year. She was lucky: At least 27,000 people in the U.S. die with those infections annually.

Second, poor MRSA or C. diff rates can be a red flag that a hospital isn’t following best practices in preventing infections and prescribing antibiotics. That could not only allow C. diff and MRSA to spread but also turn the hospital into a breeding ground for other resistant infections that are even more difficult to treat.

For example, as dangerous as MRSA is, an infection can be cured if it is treated promptly with vancomycin, long held out as an “antibiotic of last resort.” But, in part because that drug is now so often used in hospitals, another resistant strain of bacteria—vancomycin-resistant staphylococcus aureus, or VRSA—is emerging. “VRSA infections pose special challenges; they can be even more difficult to treat than MRSA,” Srinivasan says.

Hospitals that rate well

Clostridium difficile (C. diff)

To earn our very top rating in preventing MRSA or C. diff, a hospital has to report zero infections—an admittedly high bar. Still, 322 hospitals across the country were able to achieve that level in our MRSA ratings, and 357 accomplished it for C. diff, showing that it is possible. (Experts say some hospitals might game the system. Read more about how hospitals fudge the numbers, and help us identify those that might not accurately report infections.)

More hospitals were able to earn either of our two highest ratings—indicating that they reported either zero infections or did much better than predicted compared with similar hospitals: more than 623 hospitals received high marks for MRSA, and 917 did so for C. diff.

Hospitals really begin to distinguish themselves when they earn high ratings against both infections: 105 hospitals succeeded in that. Even better, some hospitals excel against not only MRSA and C. diff but also other infections that the CDC tracks and that are in our hospital Ratings. Those include surgical-site infections and infections linked to urinary catheters or central-line catheters, large tubes that provide medication and nutrition.

“Hospitals that do well against infections across the board have figured something out and deserve special mention,” Peter says. Only nine hospitals in the country—those featured in the “Highest-Rated in Infection Prevention” chart earned that high honor. (Note that some of hospitals listed in that chart differ from those in the September 2015 issue of Consumer Reports magazine because new data was released by the federal government after the magazine went to press.)


And hospitals that don't

You won’t find any familiar, big-name hospitals on that top-performing list. In fact, several high-profile hospitals got lower ratings against MRSA, C. diff, or both, including the Cleveland Clinic in Cleveland, Johns Hopkins Hospital in Baltimore, Mount Sinai Hospital in New York City, and Ronald Reagan University of California Los Angeles Medical Center.

Those are all large teaching hospitals in urban areas, which in our analysis did not do as well as nonteaching hospitals of similar sizes in similar settings. That could be because teaching hospitals may do a better job of reporting infections. Or, as a representative for Ronald Reagan UCLA Medical Center told us, they may see sicker patients or have more patients undergoing complex procedures.

Although the CDC adjusts the data to account for some of those factors, teaching hospitals tend to perform worse. For example, only 6 percent of teaching hospitals received one of our two top scores against C. diff, compared with 14 percent of similar nonteaching hospitals.

“Yes, teaching hospitals face special challenges. But they are also supposed to be places where we identify best practices and put them to work,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. “Obviously, that is not happening as well as it should.”

Larger hospitals also tended to do worse in our Ratings. That could be because patients in smaller hospitals are less likely to be exposed to infections. But some larger hospitals managed to do a good job avoiding infections. Case in point: Harlem Hospital Center in New York City earned high ratings against MRSA and C. diff. Or consider Northwest Texas Healthcare System in Amarillo, Texas. It made it onto our list of top hospitals in the prevention of all of the infections included in our Ratings.

What safe hospitals do

Good hospitals focus on the basics:

Use antibiotics wisely

Almost half of hospital patients are prescribed at least one antibiotic, Srinivasan says, but “up to half the time the drug is inappropriate.” To combat antibiotic misuse, many good hospitals have “antibiotic stewardship” programs, often headed by a pharmacist trained in infectious disease, to make sure that patients get the right drug, at the right time, in the right dose.

Such programs often monitor the use of broad-spectrum antibiotics. Doctors at some hospitals use three times more of those all-purpose bug killers than others. Reducing broad-spectrum prescriptions by 30 percent would “cut hospital rates of C. diff by more than 25 percent, plus reduce antibiotic resistance,” says Clifford McDonald, M.D., a CDC epidemiologist.

Keep it clean

C. diff and MRSA can live on surfaces for days and can be passed from person to person on hospital equipment or the hands of health care workers. To prevent that, hospitals must be kept scrupulously clean. “Infection control is all about the basics, starting with hand hygiene,” says Christine Candio, president and CEO of St. Luke’s Hospital in Chesterfield, Mo., which earned higher Ratings against both MRSA and C. diff.

She reminds patients, “it’s your right to ask” staff to wash up. In fact, fastidious hand washing slashes rates of C. diff, MRSA, and other infections. St. Luke’s also “prioritizes cleanliness,” in some cases exceeding infection-control guidelines—cleaning the rooms of C. diff patients twice daily, for example, and replacing curtains between patients.

What more needs to be done

Steps such as those, plus federal mandates for some public reporting of infections data, have already led to reduced rates of certain infections. Still, McGiffert says hospitals need to do more:

• Consistently follow the established protocols for managing superbug infections, such as using protections including gowns, masks, and gloves by all staff.
• Be held financially accountable. Already, hospitals in the bottom 25 percent of the government’s data at preventing certain complications now have Medicare payments docked 1 percent. But they should also have to cover all costs of treating infections patients pick up during their stay.
• Have an antibiotic stewardship program. That should include mandatory reporting of antibiotic use to the CDC.
• Accurately report how many infections patients get in the hospital. And the government should validate those reports.
• Be transparent about infection rates. For instance, Cleveland Clinic acknowledges its below-average performance in C. diff prevention on its website. “That’s refreshingly candid,” Peter says.
• Promptly report outbreaks to patients, as well as to state and federal health authorities. Those agencies should inform the public so that patients can know the risks before they check into the hospital.

Germ warfare: Protect yourself against superbugs

First step: Check our Ratings to see how hospitals in your community compare in preventing infections and other measures of hospital safety. 

But bad things can happen even in good hospitals. For example, Terry Otey developed his infection after a 2012 surgery in a hospital that now gets one of our higher ratings against MRSA. Our experts say there are several things you can do when you’re in the hospital and after you’re discharged to minimize your risk and spot symptoms of possible infection early:

In the hospital

Consider MRSA testing. A nasal swab can detect low levels of MRSA and allow medical staff to take precautions, such as having you wash with a special soap before your procedure.

Insist on cleanliness. Ask to have your room cleaned if it looks dirty.

Take bleach wipes for bed rails, doorknobs, and the TV remote. Insist that everyone who enters your room wash his or her hands.

Keep your own hands clean, washing regularly with soap and water.

Question antibiotics. Make sure that any anti­biotics prescribed to you in the hospital are needed and appropriate for your infection.

Watch out for heartburn drugs. Medications such as Nexium and Prilosec increase the risk of developing C. diff symptoms by reducing stomach acid that appears to help keep the bug in check. So ask whether the drug is needed and request the lowest dose for the shortest possible time.

Ask every day whether ‘tubes’ can be removed. The risk of infection increases the longer items such as catheters and ventilators are left in place. If you’re not able to ask, be sure a friend or family member does.

Say no to razors. If you need to be shaved, use an electric hair remover, not a razor, because any nick can provide an opening for infection.

At home

If you’ve been in the hospital, “assume you’ve been exposed to potentially dangerous bacteria,” says Lisa McGiffert, director of the Consumer Reports Safe Patient Project. Here’s what to do when you get home to keep yourself and your family safe:

Watch for warning signs. They include fever, diarrhea, worsening pain, or an incision site that becomes warm, red, and swollen. People at particular risk include adults older than 65 as well as infants, anyone on antibiotics, and people with a compromised immune system.

Practice good hygiene. If you or someone you live with receives a diagnosis of a hospital-acquired infection after being discharged from the hospital, take extra precautions to make sure that it doesn’t spread. Steps you should consider take include cleaning frequently touched surfaces with 1 part bleach mixed with 10 parts water and reserving a bathroom for the infected person. If that’s not possible, use the bleach solution to disinfect surfaces between uses. And don't share toiletries or towels; use paper towels rather than cloth hand towels.

Editor's Note:
This article also appeared in the September 2015 issue of Consumer Reports magazine.

Note that there are some differences between the print and online versions of the story because new data was released by the federal government after the issue went to press.