61 larger Ky. hospitals get mostly Cs in national patient-safety ratings, and one gets an F; raters warn infection rates remain high

This story has been updated to include Kentucky's healthcare-associated infection rate increases during the Covid-19 pandemic. 

By Melissa Patrick
Kentucky Health News

Most of the Kentucky hospitals graded on a nonprofit group's twice-a-year report card for patient safety again got a C.

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small, so they are not rated by Leapfrog; it rates 61 Kentucky hospitals.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave A ratings to four Kentucky hospitals; Kentucky's percentage of A grades, 6.6%, ranked it 46th among states. That was down 10 slots from the last report, when it ranked 36th. Leapfrog gave Bs to 15 Kentucky hospitals, Cs to 31, Ds to 10 and an F to one, in Hazard.

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections, and whether hospitals have systems in place to prevent them.

A Leapfrog press release draws attention to a significant national increase in healthcare-associated infections, reporting that the average risk of three HAIs – Methicillin-resistant Staphylococcus aureus (MRSA), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) – remain high after spiking to a five-year high in hospitals during the Covid-19 pandemic.

Comparing infection data from late 2021 and 2022 to the safety grades reported in 2021, which covered the period immediately before the pandemic, Leapfrog's analysis found that CLABSI increased 60%, MRSA infections increased 37%, and CAUTI rose 19%. 

During that same timeframe, in Kentucky, the CAUTI rate increased 33.7% and its MRSA infections increased by 65.06%, according to data provided by Leapfrog. The state's CLABSI increase was not statistically significant.  

“The dramatic spike in HAIs reported in this Safety Grade cycle should stop hospitals in their track. Infections like these can be life or death for some patients,” Leah Binder, president and CEO of The Leapfrog Group, said in the release. “We recognize the tremendous strain the pandemic put on hospitals and their workforce, but alarming findings like these indicate hospitals must recommit to patient safety and build more resilience.”

The Leapfrog site offers details on the measures for each hospital under the heading Infections. It also provides detailed information under headings titled Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. The information is provided in an easy-to-read, color-coded scale that indicates how the hospital is performing.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation.

Top Scores

Hospitals getting As were Baptist Health Lexington, Clark Regional Medical Center in Winchester, The Medical Center at Bowling Green, and St. Elizabeth Healthcare-Ft. Thomas.

The Bowling Green hospital moved up to an A after getting Cs on the last 14 reports.

Screenshot of page for The Medical Center at Bowling Green (click to enlarge)

Baptist Health Lexington has received an A grade for 11 consecutive grading periods. Clark Regional maintained its A for two consecutive grading periods and St. Elizabeth Healthcare-Ft. Thomas has maintained its grade for three reporting periods. 

Shifts up and down

Seven Kentucky hospitals moved down to a B after getting an A on the last report, including Advent Health Manchester, Deaconess Henderson Hospital and Spring View Hospital in Lebanon.  

In addition, Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children's Hospital all moved down to a B, after getting As for seven straight periods. 

Three hospitals moved up from a C to a to a B: King's Daughters Medical Center in Ashland, St. Elizabeth Healthcare-Florence and Three Rivers Medical Center in Louisa. 

Other hospitals with B grades are Baptist Health Louisville, Meadowview Regional Medical Center in Maysville, Owensboro Health Muhlenberg Community Hospital in Greenville, St.Elizabeth Healthcare-Edgewood and U of L Health Shelbyville Hospital. 

Three hospitals moved up from a D to a C: Flaget Memorial Hospital in Bardstown, Jackson Purchase Medical Center in Mayfield and Taylor Regional Hospital in Campbellsville. 

Baptist Health Richmond moved down to a C after receiving five straight As. 

Eleven hospitals moved down from a B to a C:Bap tist Health Corbin, Baptist Health Deaconess Madisonville, Ephraim McDowell Regional Medical Center in Danville, Middlesboro ARH Hospital, Leitchfield's Owensboro Health Twin Lakes Medical Center, Lexington's Saint Joseph East and Saint Joseph Hospital, Bowling Green's TriStar Greenview Regional Hospital, University of Kentucky Albert B. Chandler Hospital, UK HealthCare Good Samaritan Hospital, and University of Louisville Hospital.

The remaining 15 hospitals with a C list all got Cs on the last report card too. 

Two Kentucky hospitals moved down from C to a D. Kentucky River Medical Center in Jackson got a D after receiving Cs on the last three reports, and Tug Valley ARH Regional Medical Center in South Williamson got a D after receiving four Cs and one B in the last five reports. 

Other hospitals with D grades are Murray-Calloway County Hospital, Pikeville Medical Center, Saint Joseph Mount Sterling, St. Claire Regional Medical Center and UofL Health-Mary & Elizabeth Hospital. 

The only hospital that got an F was Hazard ARH Regional Medical Center, down from a D on the last report. The last time a Kentucky hospital got an F on the Leapfrog report was in the fall of 2019, when Jewish Hospital received one. It got a C on this report card. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded.

Hospitals agree to follow higher quality standards to get more money from Medicaid, which covers 1/3 of state's population

By Melissa Patrick
Kentucky Health News

With up to 28 rural Kentucky hospitals vulnerable to closure if their finance don't improve, Tuesday's announcement of a new payment model to increase the amount Kentucky's hospitals are paid for Medicaid patients is cause for their celebration.

"Improved reimbursement for Kentucky's hospitals is vital for their survival. Medicaid . . . does not cover the full cost of caring for the patients we serve," Nancy Galvagni, president of the Kentucky Hospital Association, said at Gov. Andy Beshear's news briefing Tuesday. "Every year our state's hospitals see a shortfall from treating Medicaid patients. And with more than a third of the state's population covered by Medicaid, this is an unsustainable model."

Galvagni told Kentucky Health News that the risk of closure is real for many Kentucky hospitals, noting that Our Lady of Bellefonte Hospital in Ashland closed last year, and Jewish Hospital in Louisville likely would have closed if it had not been taken over by the University of Louisville. 

"When you are operating with a majority of your patients who are being paid below cost, they can't reinvest in the facility or the capital requirements," she said.

In order to receive these funds, hospitals will have to abide by higher quality standards that are still being decided by KHA and the Cabinet for Health and Family Services. Quality standards include things like hospital-acquired infections, medication errors and readmission rates.

Friedlander and interpreter Virginia Moore
announced the new hospital payment program.

Health Secretary Eric Friedlander told Kentucky Health News that the new model will allow the state's hospitals to get paid an "average commercial rate," which is what private insurers would pay for health care in hospitals, instead of the current Medicaid rate, which he said is "way below that amount." 

Gov. Andy Beshear said at the briefing that this new Medicaid payment model will send an extra $800 million to $1 billion a year to hospitals. 

Friedlander called the payment model a "creative response" to what is allowed by the Centers for Medicare and Medicaid Services. He said the University of Kentucky and University of Louisville hospitals already have a similar mode of payment.

The next step is for the General Assembly to approve the program by passing House Bill 183, sponsored by Rep. Brandon Reed, R-Hodgenville. It would give the cabinet the authority to spend the money, which will be provided by the hospital association. It also allows for increased flexibility by allowing the state to exempt hospitals that would not benefit from the program.  

Friedlander explained that this new program does not incur any additional cost to the state because Kentucky's hospitals have agreed to cover it.

Further, he said a move to this new payment model will result in more money for the state. Beshear's news release says the Department for Medicaid Services will have access to an additional $50 million to $80 million in funding. 

Calling it a "fantastic win" for everyone, Galvagni said, "This could mean the difference between keeping the lights on and closing the doors to many of our hospitals across the state."

Friedlander added that this increased funding is important for a myriad of reasons. "This is designed to improve quality," he said. "It is designed to improve reimbursement to hospitals so that they're not taking the losses on their Medicaid patients. This will be designed to support financially, keeping all the hospitals in Kentucky open so we won't see more closures. This will go to improve infrastructure. And this ends up not being a cost to the state." 

Further, he said it will decrease uncompensated care at hospitals and will serve as an incentive to get everyone who is eligible signed up for Medicaid, "because the difference between a Medicaid patient now and somebody who is not insured is immense."

Carl Herde, vice-president of financial policy at the KHA, in a phone interview spoke to the importance of keeping hospitals open, not only because of the jobs they bring to a community, but also because studies show that communities without hospitals have higher mortality rates.

"When we get House Bill 183 passed and we move this forward, I think this really does create a path for financial stability, for specifically the small rural hospitals," he said, adding that most of the most financially vulnerable hospitals in the state are the small, rural ones. "And so we do think this creates a sustainable path for financial viability into the future for those communities."

The state plan amendment for these changes was filed Sept. 30, which means the federal government will allow the state to back-pay hospitals at the new rate starting July 1. 

Friedlander added that this new model, which must be approved annually, will help most of the state's hospitals and that the state and KHA has committed to making sure it does not harm any of them.

Friedlander and KHA said they were unsure, but thinks Kentucky is the first state to implement this particular payment model statewide. KHA added that other states have Medicaid payment programs that are funded at this level, but are done differently. 

More Ky. hospitals got As on safety-grade report; most still get Cs

By Melissa Patrick

Kentucky Health News

More Kentucky hospitals than the last time got a grade of A on a nonprofit group's rating of patient safety in hospitals, but for the fifth grading period in a row, most of the 45 Kentucky hospitals got Cs.  

The Leapfrog Group, based in Washington, D.C., rates more than 2,600 hospitals. Most of Kentucky's 126 hospitals were not rated, but those that are have a majority of the hospital beds in the state.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government, nor does it grade specialty hospitals, government hospitals, or hospitals for which there aren't enough publicly reported data. 

Leapfrog gave As to 16 Kentucky hospitals, or about 36 percent of those it graded, up from about 26% getting As on the last report. Based on the number of hospitals with As, Leapfrog ranked Kentucky 21st among the states, up from 33rd in the last report. It gave Bs to eight hospitals, Cs to 19, and Ds to two.

The twice-yearly grades are based on 27 performance measures of patient safety that indicate how well hospitals protect patients from errors, injuries, accidents and infections. The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation, Leapfrog says.

The Leapfrog site offers details on each measures, under headings titled Infections, Problems with surgery, Practices to prevent errors, Safety problems, Doctors, Nurses and Hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing. 

Screenshot of Laepfrog page for Whitesburg ARH Hospital, which got a C, shows detail
for infection issues and tabs for other issues. For a larger version of the image, click on it.

The news release from Leapfrog notes that the data from the report does not yet reflect the impacts of the coronavirus pandemic.

“We see in the news every day the extraordinary courage of clinicians and staff caring for patients stricken by Covid-19,” Leapfrog CEO and President Leah Binder said in a news release. “What’s less apparent — yet equally laudable — are the untold efforts behind the scenes to protect patients. Hospitals’ commitment to the fundamentals have saved lives too, like preventing infection, ensuring universal hand hygiene, and double and triple checking everything to avoid errors.”

High scorers

St. Elizabeth Healthcare-Edgewood has received As on every Leapfrog report card since spring 2014, the first year it was graded.

Other hospitals on the A list are: Baptist Health hospitals in La Grange, Lexington, Madisonville and Richmond; Clark Regional Medical Center in Winchester; Flaget Memorial Hospital in Bardstown; Harrison Memorial Hospital in Cynthiana; Mercy Health Lourdes in Paducah; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children Hospital; Saint Joseph-London; St. Elizabeth Healthcare-Ft. Thomas; and St. Elizabeth Hospital-Florence.

Baptist Health La Grange earned its first-ever A in the patient safety report after receiving only Cs since fall 2018. 

“This rating is a testament to our staff who have been working so hard to provide the high quality, compassionate care for which Baptist Health is known – in the midst of a pandemic,” Clint Kaho, Baptist Health La Grange president, said in a news release. “It is especially meaningful for us to receive Leapfrog’s highest rating in patient safety when we are taking extraordinary measures to protect our patients, our staff and our communities during a pandemic and otherwise.”

Baptist Health Madisonville also moved up to an A after receiving only Cs since fall 2017. The last time it got an A was spring 2016. 

“Baptist Health Madisonville aims for constant and consistent improvement in our processes, using best practices to deliver excellent care to our patients,” Teresa Dillingham, quality director, said in a news release. “This grade reflects the dedication of our staff to high standards of patient care.”

Baptist Health Richmond, Flaget Memorial Hospital, Harrison Memorial Hospital and Saint Joseph London all moved up from a B in the last report. 

Shifts up and down

Baptist Health Corbin moved up to a B after getting three Cs in a row. Baptist Health Louisville moved up to a B after getting four Cs in a row. Baptist Health Paducah regained its B, after getting a C in the last grading period. 

Deaconess Henderson Hospital moved up to a B after getting two Cs, an F and a D in the last four reports.

And after getting four As in a row, Georgetown Community Hospital moved down to a B. 

Other hospitals on the B list are Owensboro Health, Glasgow's T.J. Samson Community Hospital, and Bowling Green's TriStar Greenview Regional Hospital. 

Forty-two percent of the Kentucky hospitals got Cs, and 13 of the 19 hospitals on that list also got a C on the last report. 

All three University of Louisville hospitals, which include recent additions Jewish Hospital and Mary and Elizabeth, got Cs on the report card.

U of L Hospital moved up to a C after getting nine Ds in a row. Mary and Elizabeth moved back up to a C after getting two Ds in a row. Jewish maintained its C after getting an F in the fall of 2019 and seven Ds prior to that.

U of L, which officially took ownership of the former KentuckyOne Health hospitals in November 2019, told Tessa Duvall of the Louisville Courier Journal that the data used for the Leapfrog report still reflects previous ownership.

"Since forming UofL Health in November of 2019, we have seen a consistent improvement in quality metrics," the hospital said. "While the Leapfrog survey is not the scorecard we use to drive improvement throughout our organization, we will never be satisfied with anything other than providing top-quality patient care."

Saint Joseph Hospital in Lexington moved down to a C after getting six Bs in a row. Saint Joseph East, also in Lexington, moved down to a C, after getting Bs on the last two reports. 

Whitesburg ARH Hospital down to a C, after getting six As, one B and one "no score" since fall 2016. 

Frankfort Regional Medical Center moved back to a C, after getting a B in the last report. 

Hazard Regional Medical Center got its fourth D in a row and Highlands Regional Medical Center in Prestonsburg went back to a D, after getting a C in the last report and four Ds prior to that. 

 
Click here for a list of Kentucky hospitals and their Leapfrog safety grades. Click here for a list of frequently asked questions about the report. The group has also provided a playbook titled, "Protecting Yourself During the Respiratory Illness Season: A Playbook for the Community," to serve as a guide for the public on steps to take to decrease the risk of sickness. 

Morehead hospital says covid-19 surge came from patients who delayed treatment for other conditions; telehealth is here to stay

St. Claire Regional Hospital (Youtube photo, from The Daily Yonder)

At the end of 2019, St. Claire Regional Healthcare System restructured its finances after finishing the fiscal year about $9 million in the red. In March, the novel coronavirus hit and basically brought the hospital to a standstill and forced it to make even more changes, Liz Carey reports for The Daily Yonder.

Headquartered in Morehead, St. Claire provides services to eight Eastern Kentucky counties. in addition to its hospital, it hascclinics in Frenchburg, Olive Hill, Owingsville and Sandy Hook. It also provides mental and behavioral health services, palliative care, aesthetics care, dental care, and pharmaceuticals. 

Donald H. Lloyd, II, the hospital system's president and CEO, told Carey that the restructuring had resulted in a positive cash flow by February, but then the pandemic hit Kentucky and Gov. Andy Beshear banned elective surgeries, which account for 90 percent of those at the hospital. This forced them to make more personnel changes, including furloughs.

The first case of covid-19 showed up in Rowan County in March. By then the hospital had been converted into two separate areas, a hot zone for patients suspected of covid-19, and a cool zone for all the rest, Carey reports.  

“You would walk down a corridor and you would see this huge barrier that you had to don and doff protective equipment and then zip through a series of barrier walls in order to enter where the actual patients were,” Lloyd told Carey. “It was just so surreal. It was like from a science-fiction movie.”

Lloyd and his staff found that patients with heart attacks weren't coming into the hospital's emergency room, Carey writes.

“On the video calls with my colleagues, not only here in the commonwealth but across the United States, we were all asking ourselves ‘Where are the heart attacks, where are the strokes?’ We all thought the coroners must be extremely busy,” he said. “My chief medical officer and myself had numerous conversations with our coroners and a realization came that if we did begin to see a spike in deaths in the general population that our coroners would actually be the first to observe them.” 

This realization set the hospital into action to find high-risk patients and a way to care for them. “We aggressively worked to contact these patients, especially those that we knew have chronic conditions, and reminded them that it was imperative that you know they needed their conditions to be monitored and managed,” Lloyd said, estimating that they reached out to more than 25,000 of their 200,000 patients. 

It turned out that the surge caused by covid-19 was indirect: untreated chronic conditions caused by fear of infection. When those patients finally sought medical attention, they had "acute exacerbations," Lloyd said.

This also led to a move toward telehealth, and that led to the realization that many patients did not have access to high-speed internet. So, Carey reports, the hospital set up an area in its empty parking lot where patients could park, use the hospitals' tablet computers, access its wi-fi and visit their health-care provider through telehealth. 

“Our patients have really embraced that, and we perceived that people that, you know, that maybe live at the margins, or that maybe have a lower education level, would be intimidated by the use of that technology. On the contrary, they have embraced it,” Lloyd told Carey. “Many of our patients (in outlying counties) can’t afford to travel to Morehead or they have very limited transportation ability. It is amazing to me how effective this technology and the use of telemedicine has been for us to connect with them now.” 

Since mid-May, Lloyd said, the hospital has started to come back to normal, but telehealth is here to stay. He said, “I think [telehealth] is part of the new reality going forward in the way we deliver care and that there is going to be, for Saint Claire Healthcare and our enterprise, at least 25 percent of our future patient encounters will be virtual."

Most Kentucky hospitals get a 'C' on a twice-a-year safety report card, including Jewish, which got a rare 'F' on the last report

By Melissa Patrick
Kentucky Health News

For the fourth grading period in a row, a nonprofit group that rates patient safety in hospitals has given Cs to most of the 49 Kentucky hospitals it rated.

The Leapfrog Group, based in Washington, D.C., rates more than 2,600 hospitals. Most of Kentucky's 126 hospitals were not rated,. The group does not grade hospitals with  "critical access" status because they don't have to report quality measures to the federal government, nor does it grade hospitals for which there aren't enough publicly reported data or specialty or government hospitals.

Leapfrog gave As to 12 Kentucky hospitals, or about 24 percent of those graded. It gave Bs to 10, Cs to 24, and Ds to 3. Most of the changes from the last report, in November, came from hospitals in the two lowest grades moving into the C category, with only a few swaps in the upper grades.

The only hospital to get a failing grade last fall, Jewish Hospital in Louisville, jumped to a C grade in this one, after having received a string of Ds since the spring of 2016 before getting a failing grade in the last report.

The University of Louisville acquired Jewish Hospital and other facilities from KentuckyOne Health last fall. David McArthur, public relations director for U of L Health, told Chris Larson of Louisville Business First that the system continually strives for patient safety improvements.

"The Leapfrog grade increase for Jewish Hospital reflects improvement by U of L Health for the self-reporting of process data," McArthur told Larson in an e-mail. "U of L Hospital was already meeting the self-reporting standard." That hospital again got a D, as did Sts. Mary & Elizabeth Hospital, which was one of the facilities bought from KentuckyOne.

McArthur said Leapfrog is using the same federal outcome data from fall 2019, so "With no new data, no score improvement was expected there." Because of the coronavirus pandemic, hospitals were allowed to use their survey responses from 2019 in 2020, unless they chose to update it, Leapfrog said.

Hazard ARH Regional Medical Center got a D for the third time in a row, after getting Bs and Cs in prior reports.

Screenshot of Hazard ARH scores shows detail for infection issues and tabs for other issues.

The twice-yearly grades are calculated using 28 performance measures of patient safety that indicate how well hospitals protect patients from errors, injuries, accidents and infections. The report uses data from the federal Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation.

The Leapfrog site offers details on each of the measures under headings titled infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses and hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing. For example, as shown in the graph above, Hazard ARH performed below average in three infection-control categories, but above average on two.

"While many hospitals are good at keeping their patients safe, some hospitals aren't," says Leapfrog. "As many as 440,000 people die every year from preventable errors in hospitals."

High scorers

St. Elizabeth Healthcare-Edgewood has received As on every Leapfrog report card since spring 2014, the first year it was graded.

Other hospitals on the A list are: Baptist Health Lexington; Clark Regional Medical Center in Winchester; Georgetown Community Hospital; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital and Norton Women's & Children's Hospital; St. Elizabeth Heatlhcare-Ft. Thomas; St. Elizabeth Hospital-Florence; Mercy Health Lourdes in Paducah and Whitesburg ARH Hospital.

Mercy Health Lourdes and Whitesburg ARH were the only two on this list to change their status since the last grading period, both moving up from a B.

Saluting the repeated As for all his adult-service hospitals, Norton Healthcare President and CEO Russell Cox called it "a testament to the hard work of our dedicated providers and employees, who consistently strive to deliver safe, high-quality care to our patients. Never has this been more apparent than during the current public health crisis with the covid-19 pandemic.”

Shifts up and down

Flaget Memorial Hospital in Bardstown fell to a B after getting its first-ever A in last fall's report, after getting four Cs in a row. Harrison Memorial Hospital in Cynthiana also dropped to a B, after receiving three As in a row.

Baptist Health Richmond moved up to a B, after getting three Cs in a row, and Frankfort Regional Medical Center regained its B status after a C in the last report.

Other hospitals on the B list are Owensboro Health, Saint Joseph East and Saint Joseph Hospital in Lexington, Saint Joseph-London and Glasgow's T.J. Sampson Community Hospital.

Most of the hospitals got Cs, and most of the changes were to that status.

Hardin Memorial Hospital in Elizabethtown moved to a C after getting a B in the last report; Baptist Health Paducah dropped to a C, after getting three Bs in a row.

Highlands Regional Medical Center in Prestonsburg moved up to a C, after four Ds in a row.

And after getting their first Ds since the spring of 2016, the University of Kentucky Albert B. Chandler Hospital and UK HealthCare Good Samaritan Hospital and moved back up to a C status.

Only a few Kentucky hospitals have ever received a failing grade from Leapfrog. Other than Jewish Hospital last fall, they have been Lexington's Saint Joseph East in fall 2015 (it got a B this time); Methodist Hospital of Henderson, spring 2019; and Campbellsville's Taylor Regional Hospital in spring 2013. Both got Cs this time.

Click here for a list of Kentucky hospitals and their Leapfrog safety grades. Click here for a list of frequently asked questions about the report.

Just as virus was found to be more infectious than first thought, protections for patients, health workers were relaxed, doc writes

Kavanagh (Herald-Leader photo)

By Kevin Kavanagh, M.D.,
for Infection Control Today

Last week there were several revelations which caused grave concerns. The covid-19 virus was found to be more infectious, more dangerous; and at the same time health-care workers and patient protections appear to have been relaxed.

Infectivity of a virus is measured by the R0 (pronounced "R naught"). This is the average number of individuals each infected person will infect. For the flu, this number is approximately 1.3. Initially, many were under the assumption that the covid-19 virus was slightly more infectious than the flu. A few weeks ago it was described as 3 times as infectious, and last week the U.S. Centers for Disease Control and Prevention released a report that the R0 was equal to 5.7. At this level, over 80 percent of the population would have to be immune before herd immunity starts. Part of the infectivity can be explained by the findings that under certain circumstances the virus can spread in aerosol form and spread with talking and singing. The distance of spread from a sneeze has been estimated to be up to 27 feet.

These observations compound the problems with asymptomatic spread, with 25% of covid-19 positive patients being asymptomatic carriers, and another group are presymptomatic carriers. CDC Director Robert Redfield, M.D., has stated that there are “individuals that may not have any symptoms that can contribute to transmission, and we have learned that in fact they do contribute to transmission.”

There have also been a number of reports which indicate that the covid-19 virus is not just a respiratory virus but can affect organs throughout the body. Researchers have found that 19.7% of those hospitalized had heart damage, and of those 51% died. The virus can also affect the liver, kidneys, gastrointestinal tract and central nervous system. The latter can give rise to problems with the sense of smell and in some cases has even been postulated to decreased respiratory effort.

The CDC has replaced guidelines and issued emergency guidance for PPE use, extended use and limited use. The CDC’s recommendation of using a bandana as a last resort to stop the covid-19 virus places our healthcare system at the level of a Third World country and underscores the severity of the current pandemic and erosion of our healthcare system’s infrastructure. Although cotton masks probably help in preventing transmission, questions have been raised regarding surgical and cotton masks effectively filtering SARS–CoV-2 during coughs by infected patients.

The reusing of protective gear has erroneously been viewed as an “acceptable practice.” It is not, nor are facility practices of “only allowing use of N95s with confirmed covid-19 patients, with few exceptions.” Suspected patients need to be treated the same as confirmed patients.

In this backdrop of increased spread, known dangers and already relaxed regulations, the CDC has also outlined guidance for allowing covid-19 confirmed or suspected healthcare workers to return to work. I feel the non-test based criteria should be abandoned, since there are reports of asymptomatic patients having a positive covid-19 RT-PCR after resolution of symptoms.

Until the issue of viral reactivation in covid-19, recovered patients can be clearly delineated, recommendations for restriction of covid-19 recovered healthcare workers’ contact with severely immuno-compromised patients should be extended to all non-covid-19 patients with high-risk co-morbidities, including those with hypertension, heart disease, diabetes, cancer and over 60 years of age; and for an indefinite period of time. In addition, covid-19 recovered healthcare workers should be tested at least weekly. Finally, the use of N95 masks needs to be specified.

The recent CDC recommendations are not intended for maximal safety, they may be necessary but only as a last-ditch effort to do the least harm where proper PPE is not available. There have already been reports of frontline staff sounding the alarm of contamination of patients and staff, along with reports of wearing contaminated masks from patient to patient and reusing the same mask for five days. Health-care workers need to be properly informed of the risks to themselves, their families, and their patients along with being provided adequate healthcare and worker compensation benefits if they acquire covid-19.

Needless to say, additional PPE is desperately needed, hopefully both increased manufacturing and sterilization techniques will relieve the shortage. In addition, the strategy adopted by New York state to designate some facilities to exclusively treat covid-19 patients and others for non-covid-19 patients to help improve patient safety should be adopted in other areas of the nation.

We must make protecting our front-line health-care workers and patients a priority. Rapid testing will go a long way in assuring the safety of patients by identifying asymptomatic carriers in health-care workers and staff.

Dr. Kevin Kavanagh of Somerset is a retired physician and founder of HealthWatchUSA, a group focused on preventing infection in health care.

Oct. 4 Health Watch USA conference in Lexington will focus on health-care transparency and patient safety

Somerset-based Health Watch USA will hold its 12th annual Healthcare Transparency and Patient Safety conference Oct. 4 in Lexington.

This year's conference will look at the importance of nursing in the prevention of adverse events, how infectious disease puts both patients and staff at risk, the importance of patient access to their medical records and the value of patient advocacy.

Christine Pontus, associate director of the Division of Health and Safety for the Massachusetts Nurses Association, and Jonathan Rosen, the principal consultant for AJ Rosen & Associates, which provides occupational-safety and industrial-hygiene services to labor unions, government agencies and organizations throughout the U.S., will review key occupational hazards confronting nurses, including the importance of safe staffing and infection control.

Jayne O'Donnell, USA Today's health-care policy reporter, will discuss what she's learned while covering patient safety and will offer strategies for healthcare workers to use when talking to reporters about medical safety lapses. She will also discuss the roadblocks reporters face when reporting on patient safety.

Dr. Joycelyn Elders, a former U.S. surgeon general, will lead a discussion on the importance of patient advocacy, followed by six patient advocate presentations.

Lisa Danielpour, a marketing, social-media and nonprofit-management consultant, will show how giving patients full access to their records can improve patient safety and health outcomes.

The conference will run from noon to 9 p.m. at the Eastside Branch Library in Lexington and will offer continuing education credits for certain medical professionals. The conference hotel is TownePlace Suites, 1790 Vendor Way, Lexington, KY, Hamburg Shopping Center. Click here for more information and a link to register.

UK and Norton hospitals rank high in resistant bloodstream infections; UK cites complex cases, recent improvements

Lexington Herald-Leader table by Chris Ware, adapted by Kentucky Health News, lists safety ratings and rankings of selected Kentucky hospitals by various rating groups, and number of methicillin-resistant staphlyococcus aureus bloodstream infections in fiscal 2017.

"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 the fiscal year that ended June 30, 2017, Linda Blackford reports for the Lexington Herald-Leader.

The Albert B. Chandler Hospital at the University of Kentucky and Louisville's Norton Healthcare each had 40 bloodstream infections of methicillin-resistant staphylococcus aureus, according to the Centers for Medicare and Medicaid Services. Of the 3,800 hospitals reporting, Norton and UK ranked sixth and seventh, respectively.

"UK's MRSA number was deemed 'no different from the national benchmark,' which considers a hospital's size and mission, according to a report by the CDC that compares hospitals," Blackford reports. "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. . . . Norton and the bottom six hospitals were deemed 'worse than the national benchmark'."

Officials from both hospitals told Blackford that they follow precautions recommended by the federal Centers for Disease Control and Prevention, and that using the raw number of cases can be misleading because it doesn't take into account how many patients are admitted each year and how long they stay.

"At UK HealthCare, we take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe," spokeswoman Kristi Willett told Blackford. "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." MRSA is resistant to most antibiotics, and is most dangerous as a bloodstream infection.

UK handles many of the state's most complex medical cases, which require longer stays, making them more vulnerable to infection, said Derek Forster, UK's medical director for infection prevention and control. He said that since 2016, when it added precautions for patients in intensive care, the hospital's "standardized infection ratio" is down 55 percent, and MRSA infections in its ICUs have been reduced by half.

Norton's chief medical officer, Steven T. Hester, "said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue," Blackford reports, quoting him: "Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse. 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."

Blackford reports, "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 benchmark.' Most of Kentucky's small, regional hospitals had fewer than five cases."

"Hospitals can and must do better," retired Somerset physician Kevin Kavanagh, board chair of Health Watch USA, writes in an op-ed for the Herald-Leader, in which he takes a close look at hospital ratings, especially on safety issues.

National speakers will headline conference on patient safety and health-care transparency in Lexington Nov. 3

The 11th annual Conference for Healthcare Transparency and Safety, sponsored by Kentucky-based Health Watch USA and Consumers Union's Safe Patient Project, will be held Nov. 3 at the Four Points Sheraton in Lexington, off Newtown Pike near Interstates 64 and 75. The cost, including lunch, is $48 ($35 for full-time students).

Lisa McGiffert, Consumers Union

Speakers will include Deborah Nelson, a Pulitzer Prize winning-investigative reporter, speaking on conflicts of interest and infectious-disease policy; Dr. Ivan Oranski, distinguished writer in residence at New York University and co-founder of Retraction Watch, on articles that have been retracted from peer-reviewed medical journals; Lisa McGiffert, director of the Safe Patient Project, on patient safety and health-care accountability. For a full list of speakers and presentations, and information on registration and continuing-education credits, go to www.healthconference.org.

Registration is open for Nov. 3 HealthWatch USA conference in Lexington on health-care transparency and patient safety

Somerset-based HealthWatch USA will hold its annual Healthcare Transparency and Patient Safety conference Nov. 3 in Lexington.

In addition to exploring issues around problems that occur with medical devices and implants, the importance of creating cultures of safety and health-care accountability, this year's conference, "The Setting of Strong Quality Standards and Research Integrity," will include two nationally renowned investigative reporters who will discuss research integrity and how it influences health-care policy.

Deborah Nelson, a Pulitzer Prize-winning investigative reporter and associate professor of investigative journalism at the University of Maryland, will discuss conflicts of interest and how this issue influences infectious disease policy.

Dr. Ivan Oransky, distinguished writer in residence at New York University and co-founder of Retraction Watch, will discuss the characteristics of articles retracted from peer-reviewed academic journals and how research integrity affects health-care policy.

The conference will run from 8:30 a.m. to 4:30 p.m. at the Four Points Sheraton in Lexington and will offer continuing education credits for medical professionals. Click here for more information and a link to register.

Researchers call for better tracking of antibiotic-resistant infections to determine best way to fight them; big issue in Ky.

By Melissa Patrick
Kentucky Health News

If the United States really wants to figure out the best way to fight infections that are resistant to antibiotics, a big problem in Kentucky, researchers say it first needs to create a better system for tracking the infections.

The study, published on BioMed Central, looked at the incidence rate of Methicillin-resistant Staphylococcus aureus (MRSA) by analyzing data from five different reports and determined the data varied so widely between them that any sort of real comparison would be difficult.

Report notes that this MRSA infection
might not be reported, depending on
the data-reporting guidelines. (CDC)

The variances included the types of populations studied (general population, military facilities, medical centers, pediatric patients and different geographic areas); the types of infections measured (total MRSA infections versus bloodstream infections only) as well as variances in how baseline data was gathered. In addition, it said the terminology used to describe the results also varied.

Taking all this into account, the researchers said they did not find any "definitive evidence" that MRSA rates had decreased significantly in health-care facilities or in communities since 2010-2011, and found they had increased between 2014 and 2015. However, the U.S. Veterans Health Administration had over an 80 percent reduction in MRSA.

Dr. Kevin Kavanagh

Why does this matter?

The U.S. Department of Health and Human Services has set a goal of reducing MRSA infections by half by 2020, but lead researcher Dr. Kevin Kavanagh of Somerset, an infection-control activist who leads Health Watch USA, said in a separate opinion piece about the study that the nation "is nowhere near on track to meet this target."

The researchers note that health-care facilities use two main strategies to fight these infections, and one seems to have better results than the other, but they say that until all of the tracking measures are equal, a "best practice" cannot conclusively be determined.

The strategy used by VA hospitals is based on identification and isolation, along with strict hand-washing rules. The other, used by more than 60 percent of U.S. hospitals, is based on the "Reduce MRSA" study and involves a protocol of daily bathing with chlorhexidine along with intranasal mupirocin, an antibiotic.

Many health experts have concerns about the "Reduce MRSA" study because Sage Products, the maker of the chlorhexidine wipes, provided "funding and millions of dollars in wipes for studies" to Rush University Medical Center in Chicago to test the efficacy of the product, and that Rush has since "published 11 articles on six trials that endorse daily washing of patients with Sage's patented wipes, which is an 'off label' use," the Reuters news service reports in an in-depth investigative story. The U.S. Food and Drug Administration has only approved the wipes for cleaning patients before surgery.

"The industry money funding chlorhexidine research muddies the message of the results, in the view of many health experts," Deborah J. Nelson and Ryan McNeill report for Reuters.

They also report that experts have voiced concerns about routine use of such a "potent biocide," and the FDA recently issued warnings about increased "reports of allergic reactions, including a couple of deaths, and other adverse events linked to the chemical." In addition, Sage has also recalled the product twice because the chlorhexidine cloths have been "tied, ironically, to dozens of infections by Burkholderia cepacia, a pathogen that wreaks havoc on hospital patients," they write.

Dr. Robert A. Weinstein, an infectious-disease specialist at Rush and senior researcher on the chlorhexidine wipe studies, told Reuters that the maker funding his research has not influenced his findings. He has published one negative report on the product.

Reuters, in another investigative story, also found that infections and deaths from antibiotic-resistant infections are not reported or tracked routinely, saying that the federal Centers for Disease Control and Prevention estimate that 23,000 Americans die each year from an antibiotic-resistant infection is "mostly guesswork" and that the real number is likely much higher.

In its analysis, Reuters looked at health-department records and compared them to death certificates during the same time period and found that while health departments reported about 3,300 deaths from antibiotic-resistant infections in 2003-2014, death certificates reported 180,000 such deaths. In the same time frame, Kentucky's health departments reported nine such deaths, but the Reuters investigation found 3,027.

Comparing national ratings that compare Kentucky hospitals

A federal agency, magazines and a consulting group have compiled ratings that allow comparison of hospitals. Now Dr. Kevin Kavanagh of Somerset-based Health Watch USA has compiled the ratings, allowing comparison of hospitals across rating methods.

"It needs to be stated on the front end that the hospital industry is not happy with the current quality measurements," Kavanagh writes for the Lexington Herald-Leader. "However, the vast majority of these measures were derived from, or had extensive input from, the health-care industry. The industry criticizes these measures as not being accurate. Of course, the exception is when a facility scores No. 1; then there seems to be no limit to marketing the result."

Kavanagh does not include the often-advertised ratings of the Joint Commission, explaining, "This accreditation organization was forged out of the health-care industry and all too often gives a gold star of approval." He uses the "star system" of the Centers for Medicare and Medicaid Services; and ratings by the Leapfrog Group, a purchasing alliance that mainly measures safety; Consumer Reports, which primarily measures safety by readmissions, complications, communication, overuse of CT scans and infections; and U.S. News and World Report, "which uses a variety of measures, including reputation, to determine quality. This score not only reflects safety but also the ability to handle complex problems. Thus, larger hospitals and educational institutions often do better with this ranking system. The University of Louisville exemplifies this dichotomy."

Comparing the ratings with prior years, Kavanagh writes: "In the Lexington region, they overall have improved and are doing rather well. St. Joseph and St. Joseph East both showed marked improvement. Overall, these safety-ranking systems measure different aspects of care and will give different results. However, if a hospital performs in the lower tier of several systems, one needs to take notice. This appears to have happened with several facilities in Louisville, which had dismal results." He says the publicized problems of the U of L Hospital are "a testament to the accuracy and usefulness of these quality-ranking systems."

Kavanagh's comparison chart also includes data on hospital complaint investigations by CMS. It does not include most hospitals in Kentucky; CMS, for example, does not rate "critical access" hospitals, which are in rural areas. For the Kentucky Health News reports on the CMS ratings of 82 hospitals, click here; on Leapfrog Group's ranking of 52 hospitals, go here; on the U.S. News rankings, here.

SELECTED KENTUCKY HOSPITAL RANKINGS ON QUALITY AND SAFETY

As patient-safety penalties hit hospitals, expert wonders why they aren't improving more; could be eliminated by Obamacare repeal

This is the third year federal government will apply penalties to hospitals that fall short of patient safety standards, leading one Consumers Union leader to wonder why hospitals aren't working harder to eliminate the infections and complications that are causing them to loose money, Trudy Liberman writes in her column for the Rural Health News Service.

“What I am most frustrated about is the lack of urgency in the country and at the agencies for eliminating these infections," Lisa McGiffert, head of the Consumers Union Safe Patient Project, told Liberman. "They are aware of them, but there’s not a sense of urgency to stop them."

"The penalties, along with the entire program to eliminate hospital-acquired conditions, were authorized under the Affordable Care Act," Liberman writes. "They could be in jeopardy if the law is repealed. Some hospitals probably would be happy if they disappeared."

Penalties are levied against hospitals that have a high number of patients with avoidable infections and complications, including blood clots, urinary-tract and surgical-site infections, bed sores and falls. And this year, infections related to antibiotic-resistant infections, like methicillin-resistant Staphylococcus aureus (MRSA) and C. difficile, have been added to the list.

"The federal Agency for Healthcare Research and Quality says there were 3.8 million hospital injuries last year. That translates to 115 injuries per 1,000 patient stays," and "antibiotic-resistant bacteria infect some two million people annually. One quarter of a million cases occur in hospitals," Liberman notes.

Medicare will impose a 1 percent cut in payment to 769 U.S. hospitals who fell short of these patient safety standards in the fiscal year that ended Sept. 30. Eleven Kentucky hospitals were on the list, two more than last year, but five Kentucky hospitals that were penalized last year are not on this year's list.

Since the inception of the penalty program, Lieberman reports, 241 hospitals have been punished in all three years, but 347 that were penalized last year are not on the "bad-guy list."

Critical-access hospitals (by definition, rural) and specialized hospitals that treat psychiatric patients, veterans and children are exempt from the penalties.

"Larger teaching hospitals could lose as much as $1 million or more," Lieberman writes. McGiffert told her that the penalties have gotten the attention of hospital CEOs.

McGiffert said that as recently as 12 years ago, hospitals said infections were not preventable, but, “Now, most people in health care believe most infections are.” She also noted that government agencies have only recently started reporting hospital mistakes and other data to help patients.

McGiffert said patients should use the data to decide where they go for care when they have a choice. She suggested that they look for improvements from one year to the next, which could indicate that that particular hospital' emphasis on patient safety. She also encouraged patients to ask questions if the numbers show a hospital isn't performing as well as it has in the past.

Click here and follow the prompts to learn about Kentucky hospitals. You can compare three at a time. Click on the tab for "complications" to learn more about surgical complications and healthcare-associated infections in each of the facilities.

Medicare cuts 11 Ky. hospitals for patient-safety issues; repeaters in Louisville, Danville, Hopkinsville, Lexington, Paducah, Florence

The federal government is penalizing 11 Kentucky hospitals for falling short on patient safety in the fiscal year that ended Sept. 30, two more than last year.

Medicare has imposed a 1 percent cut in payments to 769 U.S. hospitals that have high rates of potentially avoidable infections and complications such as blood clots, bedsores and falls. "The reductions apply not only to patient stays but also will reduce the amount of money hospitals get to teach medical residents and care for low-income people," Kaiser Health News reports.

This is the third year of the Hospital-Acquired Conditions Reduction Program, created by the 2010 health reform law, but the first year that "the spread of antibiotic-resistant germs" has figured in the assessment, Kaiser notes. The federal Agency for Healthcare Research and Quality "estimates there were 3.8 million hospital injuries last year, which translates to 115 injuries during every 1,000 patient hospital stays."

The many rural hospitals that are designated "critical access" are not subject to the penalties. Neither are "specialized hospitals, such as those that treat psychiatric patients, veterans and children," Rau notes.

"Of the remaining hospitals, the Affordable Care Act requires that Medicare penalize the 25 percent that perform the worst on these measures, even if they have reduced infection rates from previous years," Rau reports. The list of penalized hospitals is at http://khn.org/Njg1NzMw; it's also available as a PDF or in a sortable Excel file.

University Hospital and Jewish Hospital & St. Mary's Healthcare, both in Louisville and part of KentuckyOne Health, are on the penalty list for the third straight year.

Ephraim McDowell Regional Medical Center in Danville and Jennie Stuart Medical Center in Hopkinsville were penalized last year and are also on the list this year.

Harrison Memorial Hospital in Cynthiana, St. Elizabeth Fort Thomas and Baptist Health Paducah are being penalized for the first time. Nationally, "40 percent of the hospitals penalized this year escaped punishment in the first two years," Kaiser reports.

The University of Kentucky hospital, Lourdes Hospital in Paducah and St. Elizabeth Florence, which were penalized two years ago but not last year, are on this year's penalty list.

Hospitals that were penalized last year but are NOT being penalized this year are Georgetown Community Hospital, Muhlenberg Community Hospital in Greenville; Rockcastle Regional Hospital and Respiratory Care in Mount Vernon; Saint Joseph East in Lexington; and Taylor Regional Hospital in Campbellsville.

Kentucky Hospital Association will be part of a national effort to reduce infections, other acquired conditions, and readmissions

The Kentucky Hospital Association says it will again be part of a national effort to reduce preventable hospital-acquired conditions and readmissions.

“Kentucky hospitals work very hard to provide the highest quality and safest care possible. We are constantly adopting new evidence-based practices to improve our patient outcomes," KHA President Michael T. Rust said in a news release. "Quality improvement is never finished, and we proudly pledge to continue finding ways to sustain the patient safety gains we’ve made, while improving overall quality and safety across Kentucky.”

KHA will participate as part of the American Hospital Association's role in one of 16 "Hospital Improvement Innovation Networks," which will work through 2019 to achieve a 20 percent reduction in overall patient harm and a 12 percent reduction in hospital readmissions within 30 days of discharge. They will also work to assure health equity for Medicare patients, the release says. All efforts will be monitored by the Centers for Medicare and Medicaid Services.

Some areas of patient harm to be addressed include adverse drug events, infections related to central lines, surgical sites and catheters, antibiotic stewardship programs, sepsis, pressure ulcers and injuries from falls.

The release says KHA will build on its ongoing Hospital Engagement Network efforts, which has provided leadership and support for 77 Kentucky hospitals as they reduced preventable readmissions and hospital-acquired infections and other conditions over the past four years.

Drug-resistant infections are a grave threat but are loosely monitored; Ky. health facilities must now report them electronically

By Melissa Patrick
Kentucky Health News

Antibiotic-resistant infections are considered one of the gravest threats to humanity, but such infections and the deaths they cause are not routinely reported, hindering the battle against them, Ryan McNeill, Deborah J. Nelson and Yasmeen Abutaleb report for the Reuters news service.

Reporting on their detailed investigation, they write: "Even when recorded, tens of thousands of deaths from drug-resistant infections – as well as many more infections that sicken but don’t kill people – go uncounted because federal and state agencies are doing a poor job of tracking them."

“You need to know how many people are dying of a disease,” Ramanan Laxminarayan, director of the Center for Disease Dynamics, Economics & Policy, a Washington-based health policy research organization, told Reuters. “For better or worse, that’s an indicator of how serious it is.”

The report noted many reasons such infections are omitted from death certificates, from poor training in how to fill out the forms to a reluctance of health-care facilities to mention them because "counting deaths is tantamount to documenting your own failures. By acknowledging such infections, hospitals and medical professionals risk potentially costly legal liability, loss of insurance reimbursements and public-relations damage."

The federal Centers for Disease Control and Prevention estimates that about 23,000 people die each year from 17 types of antibiotic-resistant infections and another 15,000 die from Clostridium difficile, a pathogen linked to long-term antibiotic use, but these numbers are "mostly guesswork" based on "few reported deaths from drug-resistant infection," Reuters reports.

Michael Craig, the CDC’s senior adviser for antibiotic resistance coordination and strategy, told Reuters that the agency settled on “an impressionist painting rather than something that is much more technical . . . because of our profound concern about the seriousness of the threat.” They said they are working to improve the estimates.

The numbers of uncounted deaths from drug-resistant infections “speak to what can happen when we don’t allocate the necessary resources to bolster … our public health safety network,” U.S. Sen. Sherrod Brown, D-Ohio, told Reuters. “When we see discrepancies in reporting, are unable to finance a workforce to monitor infections, and can’t even soundly estimate the number of Americans that die from [antibiotic-resistant infections] each year, we know we have a problem.”

Brown recently introduced a bill that would require the CDC to collect more and better data on superbug infections and death rates.

Wide variation in tracking

Reuters did a survey of the nation's health departments and found a wide variation in how seven leading superbug infections are reported, if they are at all.

It found that 17 states report C. difficile infections; 26 states report methicillin-resistant staphlycoccus aureus (MRSA); fewer than half report carbapenem-resistant Enterobacteriaceae (CRE), a family of pathogens that the CDC has deemed an “urgent threat;" and 24 states do not regularly track deaths due to antibiotic-resistant infections. "States that said they do track deaths generally do so for only a few types of drug-resistant infections, and not consistently," Reuters reports.

As of Oct. 1, a new regulation requires Kentucky health-care facilities to report a long list of drug-resistant infections to the Kentucky Department of Public Health electronically. The regulation also requires simultaneous data reporting to the CDC, and allows the agencies to share the data.

"This regulation on encouraging health-care facilities to report is extremely important to track these infections, to learn how to stop these infections and to identify problem areas in the state that need to be addressed," Dr. Kevin Kavanagh, an infection-control activist who leads the Somerset-based watchdog group Health Watch USA, said in a telephone interview with Kentucky Health News.

Kavanagh said proper reporting will allow examination of the methods health-care facilities use to fight these infections and determine whether they are effective or not. He called the matter a "huge, huge issue in nursing homes."

In the Reuters survey, U.S. health departments reported about 3,300 deaths from drug-resistant infections in 2003-2014, but the news service's own analysis of death certificates found 180,000 such deaths during the same time period. More than 20,000 were in California and more than 5,000 were in Tennessee, both states that do not require reporting of deaths linked to such infections.

Reuters found that Kentucky health departments only reported nine deaths related to health care acquired infections between 2003-2014, but Reuter's investigation found 3,027.

Patient-safety advocates petitioned the CDC in 2011 to add a question about hospital-acquired infections to its standard death certificate, which is used by many states, and have been told that it will be considered the next time the CDC revises its certificate.

Little progress made

Over-prescription of antibiotics and their overuse in farm animals has worsened antibiotic-resistant infections. Also, more people are living with weak immune systems and spending more time in health-care facilities, where most most of these infections occur.

Kavanagh said better reporting could indicate whether the overuse of antibiotics in agriculture plays a large part or a small part in the problem.

Reuters reports that in 2001, a task force led by the CDC, the Food and Drug Administration and the National Institutes of Health declared antibiotic-resistant infections to be a grave public health threat and issued an action plan to tame the problem. The plan included creating a national surveillance program and speeding the development of new antibiotics. But little progress has been made toward these goals.

A new national plan to combat this problem was introduced in 2014. Congress followed in 2015 with "a $160 million increase in the CDC’s budget to bolster research, drug development and surveillance of superbugs by the states," Reuters reports. But the news service found that states often come up against strong institutional resistance and laws that shield the health-care industry when it comes to surveillance.

Bacteria that can't be treated by any antibiotic now in U.S.; Kentucky ranks first in one type of antibiotic-resistant infection

A colorized scanning  of E.Coli
Credit: CDC/Jancie Haney Carr

For the first time, researchers have found a person in the United States carrying bacteria that can't be treated by "last resort" antibiotics.

The antibiotic-resistant bacteria found in the 49-year-old Pennsylvania woman's urine was from a strain of E.coli bacteria that is resistant to an antibiotic called colistin, a last-resort drug with serious side effects that is used only when other antibiotics don't work.

For example, colistin is used to treat the superbug carbapenem-resistant Enterobacteriaceae, commonly called CRE, which health officials call a "nightmare bacteria."

Nearly half of patients who become infected with CRE die from it, Lena H. Sun and Brady Dennis report for The Washington Post.

The Pennsylvania woman was able to be treated with other antibiotics, but the discovery of the colistin-resistant strain has placed health officials on alert.

Health officials say it's not time to panic, but there is great concern that this colistin-resistance gene could spread to other bacteria that are also antibiotic-resistant creating many more bacteria strains that are untreatable, reports the Post.

The colistin-resistant strain was first found in pigs, raw pork and a few people in China in November. It has also been found in Europe.

“It basically shows us that the end of the road isn’t very far away for antibiotics — that we may be in a situation where we have patients in our intensive care units, or patients getting urinary-tract infections for which we do not have antibiotics,” CDC Director Tom Frieden told the Post.

Separate research found that the same colistin-resistant strain was found in a sample from one pig intestine in the United States. Colistin is widely used in Chinese livestock, but is not used in the United States, though plenty other antibiotics are, Tom Philpott reports for Mother Jones.

"Around 80 percent of the antibiotics sold in the United States go to livestock farms, and of that, 60 percent are considered crucial to human medicine," Philpott writes. Farmers mostly use antibiotics to help their livestock grow faster.

Yohei Doi, an infectious-disease doctor at the University of Pittsburgh, told the Post that he thought the widespread use of the antibiotic in Chinese livestock is likely what has led to the bacteria evolving and gaining resistance to the drug, and then leaping from livestock to humans through food.

Dr. Kevin Kavanagh, a retired physician and chairman of HealthWatch USA, said he isn't convinced that the U.S. pig was infected by livestock from China. He noted that colistin is commonly used to treat CRE, cystic fibrosis and that a form of colistin can be found in many over-the-counter topical antibiotics.

"It's probably more likely that the pig in the U.S. obtained this from the farmer's medicine cabinet than from another pig in China," Kavanagh said.

Experts in infectious diseases have called for action to curb the overuse of antibiotics in livestock worldwide. They have also warned that if these antibiotic-resistant bacteria continue to spread, treatment options could be severely limited.

Kavanagh  recognized the importance of research around the overuse of antibiotics in livestock but said that he thought more emphasis should be placed on the human side of healthcare related to antibiotic-resistance bacteria than the agriculture side of it.

 "The foremost emphasis should be placed on controlling antibiotic usage, controlling the spread of these organisms and surveillance of these organisms. ... We don't really know how many infections exist because we have a fragmented reporting system, but you know how many cows there are in each county," he said.

The federal Centers for Disease Control and Prevention estimates that at least 2 million people are infected with antibiotic-resistant bacteria each year, and 23,000 die.

Kentucky ranked first in MRSA cases, July 2014 - June 2015.

HealthWatchUSA

Kentucky has one of the highest prescribing rates of antibiotics in the nation and also leads the nation in another antibiotic resistant infection called MRSA (methicillin-resistant staphylococcus areus).

"Overuse of antibiotics has got to stop," says Kavanagh said. "The use of antibiotics needs to be curtailed to only when it is necessary. ... Every time you take an antibiotic you remove your good bacteria and run a real risk of activating a superbug in your body which can cause you extreme harm and even death. You should only take antibiotics when you have to take them."

Pharmaceutical companies have stepped away from developing new antibiotics because they aren't very profitable. But William Schaffner, medical director of the National Foundation for Infectious Diseases, told WebMD, "The Infectious Diseases Society of America has been working with Congress and with industry to create incentives for the pharmaceutical industry to reopen its antibiotic research laboratories."

In addition, "Late last year, as part of a broader budget deal, Congress agreed to give hundreds of millions of dollars to the federal agencies engaged in the battle against antibiotic-resistant bacteria," reports the Post.

There's a big difference in hospitals, as various ranking systems show; op-ed analyzes the leading hospitals in Kentucky

Being a responsible health consumer requires some homework, especially when it comes to choosing a hospital, but if you wait until the emergency occurs it is likely too late to do a "thoughtful search," Dr. Kevin Kavanagh of Somerset, chairman of Health Watch USA writes in an opinion piece for the Lexington Herald-Leader.

Kavanagh explained that there are three types of reports available to consumers. U.S. News & World Report ranks mostly on the institutions’ capabilities, while patient safety is the main factor for Consumer Reports, The Leapfrog Group and Medicare’s penalty system for hospital-acquired conditions. Finally, there are patient surveys "which are largely decried by the industry as not truly reflective of quality," although others say "this is the score facilities have to worry about most," Kavanagh writes.

Kavanagh summarizes an analysis that revealed patterns across these ranking systems for high- and low-performing hospitals in Kentucky, along with a chart.

  (4) Centers for Medicare and Medicaid Services readmission penalty, up to 3% penalty on Medicare payments.

  (5) Rates of MRSA bloodstream infections. The national benchmark of 1.00 is the starting point, not the goal, so a value of 1 shows no improvement. Percentage is the penalty or bonus on the facility's Medicare payments.

  (6) CMS patient survey results, on a scale of 1 to 5 stars. This data is from Medicare's Hospital Compare site.

(+) Listed as: St. Elizabeth Healthcare - Edgewood/Grant/Covington

(++) Listed as Norton Hospital, Norton Hospitals, or Norton Healthcare

(+++) Listed as Jewish Hospital, Jewish Hospital & St. Mary's Healthcare or Sts. Mary's & Elizabeth Hospital; Consumer Reports only lists Jewish Hospital. CMS combines the data from Jewish and St. Mary's Healthcare; The Leapfrog Group(sm) surveys the hospitals separately and reports a safety score for both Jewish and Sts. Mary's & Elizabeth Hospital.

Read more here: http://www.kentucky.com/opinion/op-ed/article54997560.html#storylink=cpy

Here are some highlights of Kavanagh's analysis:

• Baptist Health Louisville, Baptist Health Lexington, St. Elizabeth Medical Center and Frankfort Regional Hospital appear to be the top performers.
• St. Joseph Hospital East in Lexington has fallen from a C to an F on the Leapfrog score and is receiving a penalty for hospital-acquired conditions, along with a 2.42 percent penalty for readmission of patients for the same condition within 30 days, more than twice that of other regional institutions.
• University of Louisville Hospital scored a C on the Leapfrog survey, has a high rate of methicillin-resistant staphylococcus areus (MRSA) bloodstream infections and is doing poorly on patient surveys.

"Bloodstream infections are only the tip of the MRSA iceberg," Kavanagh writes. "Overall, Kentucky has the nation’s second-highest rate of MRSA bloodstream infections, with the University of Kentucky and the University of Louisville being worse than the national benchmark."

He notes that only one hospital, Baptist Health Louisville, was ranked as better than the national benchmark, but writes that the benchmark should not be the goal, going so far as to calling it a failing grade because it is set at an "unacceptably high pre-intervention rate."

Other findings included:

• Baptist Health Lexington, Baptist Health Louisville, St. Joseph Hospital, St. Joseph East and St. Joseph Hospital London were cited in a U.S. Department of Justice settlement for false billing of non-Medicare approved insertions of cardiac devices, although the U.S. attorney "stated the settlements were heavily based on evidence-based medicine."
• St. Joseph London was also involved in a $16.5 million settlement for unnecessary heart procedures in 2014 and one of its staff cardiologists is currently serving a 30-month federal prison sentence.
• Baptist Health Lexington, Baptist Health Louisville, Frankfort Regional and St. Elizabeth Medical Center have achieved the prestigious Magnet designation, given by the American Nurses Credentialing Center. The University of Kentucky lost this designation in 2011 and has applied to regain it.

And while the Joint Commission accredits hospitals, almost all receive its Gold Seal of Approval, he writes, noting that St. Joseph East scored low on several ranking systems but has a Gold Seal. "Not achieving this designation would be a sign of major problems," he writes.

"Substantial quality improvements are needed in our health-care system in Kentucky and nationwide," Kavanagh opines. "Until this takes place, one should preemptively study and evaluate treatment options. As the old saying goes, 'Let the buyer beware,' for in health care, there is little opportunity to return or redo the service."