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Originally published Tuesday, November 30, 2010 at 10:58 AM

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Having surgery? Website shows hospital infection rates

For the first time, hospital-specific infection rates for several common surgical procedures are publicly available on a new website.

Seattle Times health reporter

Tracking hospital infections and performance:

Washington State Hospital Association hospital-specific infection rates: www.wahospitalquality.org

State Department of Health sites: www.doh.wa.gov/EHSPHL/HAI/HAI_Default.htm and

www.doh.wa.gov/EHSPHL/HAI/HospPerf.htm

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Patients who had knee-replacement surgery at Highline Medical Center got infections more than 11 times as often as those who underwent the same surgery at Swedish Medical Center on First Hill.

On the other hand, women undergoing abdominal hysterectomies at Swedish got infections almost three times as often as similar patients at Northwest Hospital & Medical Center.

For the first time, infection rates for several common surgical procedures at hospitals across the state are publicly available on a new website, as mandated by a state law passed in 2007.

Airing these numbers isn't always comfortable for the hospitals, but they believe such transparency — and the ability to compare themselves with others around the state — will help them all improve, said Cassie Sauer, spokeswoman for the Washington State Hospital Association, which released the data in a report Tuesday morning.

Carol Wagner, the hospital association's vice president for patient safety, said the hospitals were enthusiastic participants in providing the information.

"We believe that public reporting offers information that helps hospitals improve, assists consumers in making good decisions about hospital care, and creates the opportunity for collaboration between hospitals and quality experts," Wagner said in a statement.

The surgeries included in the new data, available at www.wahospitalquality.org, include:

• Knee replacement

• Hip replacement

• Abdominal hysterectomy

• Vaginal hysterectomy

• Heart bypass

• Other cardiac surgeries

• Heart transplant

The website also rates compliance with processes known to help control infections, such as correct use of antibiotics, safe hair removal (clipping, not shaving) and keeping patient blood-sugar levels under control.

It also gives the rates of pneumonia infections acquired by patients on ventilators and bloodstream infections in patients with central lines (tubes inserted into large blood vessels near the heart), the two types of infections hospitals have already been reporting under the 2007 law.

The website allows sorting hospitals by city, county, alphabetically or infection rates. The hospital association expects to update the data, which cover the first six months of this year, quarterly.

Variations — and some caveats

The data show no hospital is perfect; hospitals that did well on one measure often fell down on another.

For example: Virginia Mason reported no abdominal hysterectomy infections but had a higher-than-average rate for hip-replacement surgery infections.

And different hospitals cater to different patient populations, including patients with more complicated medical problems.

The report on the hospital association's website doesn't adjust for the difficulty of patient, noted Will Shelton, director of infection control for Swedish, who said half the approximately 100 hysterectomies Swedish does every month are "people with very complicated cancer, very complicated surgeries."

The infection-rate report, except in the case of cardiac surgery, also does not differentiate between deep and superficial infections.

In the case of cardiac surgery, a secondary page sorts out whether the infections reported were "deep bone" — a much more serious infection — or superficial.

"All of our infections are superficial — no bone infections," Shelton noted. "It's very different if you get a minor superficial skin infection versus a deep bone infection."

But Swedish, like other hospitals, is working toward a big-picture goal, Shelton said. "We want to avoid all infections — our goal is zero." Toward that end, Swedish recently formed a team to address infection issues in ob-gyn surgeries, Shelton said.

Spies check for handwashing

Dyanne Lane, nurse executive for Highline, said that of the 55 patients who had knee surgery there during the review period, one got an infection.

"We review every infection case to determine where we need to improve in our clinical care," she said. "We take all clinical outcomes very seriously and safety is our top priority."

For all hospitals, the focus on infections has changed a culture that once accepted them as just part of being in a hospital. Now, handwashing reminders and checklists have become commonplace, as have a whole list of processes known to reduce infections and post-surgical complications.

At the University of Washington Medical Center, the infection-control effort includes Katy Folk-Way, whose husband died in 2005 after two liver transplants and multiple infections. She appears on a poster designed to highlight hand hygiene, which reads: "We all help keep patients safe. Please clean your hands."

Northwest Hospital & Medical Center, like others in the UW Medicine Health System, uses "secret shoppers"to observe hand hygiene, sanitation practices and infection precautions and report back to hospital departments about how they're doing.

While the data released Tuesday providea baseline, it isn't yet clear whether the public will be able to know — or wants to know — whether specific hospitals infection rates are improving or worsening over time.

Hospitals will get regular "trend" reports from the hospital association, Sauer said, so they will know how they're doing relative to statewide averages.

"Our rates are relatively low compared to the national average, but we want them to be lower," she said. "We want people not to get infections in the hospital."

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

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