By Linda Blackford | Lexington Herald-Leader

Kentucky’s two biggest hospital systems had some of the country’s highest instances of an often deadly bacterial bloodstream infection known as MRSA in fiscal year 2017.

The University of Kentucky Chandler Hospital and Norton Healthcare in Louisville each had 40 MRSA bloodstream infections between July 1, 2016 and June 30, 2017, according to federal data from the U.S. Centers for Medicare and Medicaid Services.

Officials from both hospitals said they followed Centers for Disease Control and Prevention precautions, and that using the raw number of cases could be misleading because it did not take into account how many patients were admitted each year and how long they stayed.

Norton contends that looking at the MRSA blood infection rate is the most accurate way to compare a hospital’s performance because it is adjusted for volume and risk.

“The ‘observed cases’ number from the Centers for Medicare & Medicaid Services combines all five Norton Healthcare hospitals and does not reflect the overall number of patients treated at a facility or the number of high-risk patients treated,” the hospital said in a statement to Insider.

UK’s MRSA number was deemed “no different from the national bench mark,” which considers a hospital’s size and mission, according to a report by the CDC that compares hospitals.

Still, UK’s number was higher than many comparable teaching hospitals, such as the University of Cincinnati hospital, which had 27, or the University of North Carolina, with 33.

Of the 3,800 hospitals reporting, the highest number of cases belonged to Jackson Memorial Hospital in Miami, Fla., which had 61. Norton and UK ranked sixth and 7th in the nation, respectively.

Norton and the bottom six hospitals were deemed “worse than the national bench mark.”

MRSA (methicillin-resistant Staphylococcus aureus) is resistant to many antibiotics. It usually attacks soft tissue, but is considered most dangerous as a bloodstream infection.

“This is very alarming to patients, and you want to make sure hospitals are following the latest protocols from the CDC,” said Kevin Kavanagh, who heads Health Watch USA, a patient advocacy group in London.

A spokeswoman for UK HealthCare said, “We take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe.”

The spokeswoman, Kristi Willett, added, “Our large patient volumes and high level of patient complexity make us unique in the state of Kentucky as those things are known risk factors that can increase the risk of infection.”

UK’s most recent data shows that the “standardized Infection ratio” for the last quarter was down 55 percent compared to 2016, when UK added protocols for ICU patients, such as washing them with antibacterial soap, and using nose antiseptic swabs, said Derek Forster, UK’s medical director for Infection Prevention and Control. MRSA can live in the nostrils, then transfer to the skin.

MRSA infections in UK’s Intensive Care Units have fallen 51 percent in that same time period, Forster said.

UK takes in many of the most complex medical cases in the state, which means patients stay for longer, Forster said.

“I think the complexity of cases seen at UK does contribute to an increased number of (MRSA) cases,” Forster said. “I think we’re unique in that complexity.”

Norton’s cases come from its five hospitals, which average about 70,000 patients a year. Most other case numbers in the report are for single stand-alone hospitals that treat an average of 5,600 inpatients a year, the hospital noted.

“Patient safety is of the utmost importance at Norton Healthcare, and our goal is zero infections,” said Steven T. Hester, chief medical officer for Norton Healthcare. “The most current data we have indicates our MRSA rate is half of the national average, though we continue working to reduce this.”

Hester said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue.

Dr. Steven Hester

“Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse,” Hester said. “We had concerns that our increase in MRSA could be related to the increased incidence and risk with substance dependent patients, specifically intravenous drug users.”

Since then, protocols include special skin baths and antimicrobial nasal swabs and standardized room cleaning to reduce risk.

Nationally, MRSA bloodstream infections dropped 60 percent between 2005 and 2013, said Cal Ham, a medical officer with the CDC. In 2015, there were 72,852 cases. About 12,000 of those started in hospitals.

“Bloodstream infections are very, very serious and associated with high mortality,” Ham said.

The most important controls are “contact precautions,” including patient isolation and the use of gowns and gloves with those patients.

“We think most hospitals do that, but we are aware that some have stopped using contact precautions,” he said.

UK and Norton officials both said they follow all CDC recommendations.

Among other hospitals in Kentucky, the University of Louisville Hospital had 17 MRSA cases, Pikeville Medical Center had 12 and Hazard ARH had 10 cases. Hazard’s number was deemed to be “worse than the national bench mark.”

Most of Kentucky’s small, regional hospitals had fewer than five cases.

This post has been updated with more information from Norton. The headline has been changed to reflect these are hospital systems not single hospitals.



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