Parents whose children are ill enough to spend time in an intensive care unit may have something else to worry about on top of that serious medical condition, according to new research published in Consumer Reports. The risk of a serious bloodstream infection contracted in hospitals, the report says, is 20 percent higher in pediatric intensive care units (ICUs) than in adult intensive care units.
The Consumer Reports Health Ratings Center also rated pediatric ICUs across the country based on how well they prevented a certain type of dangerous infection that affects central lines, long tubes inserted into veins that go directly to blood vessels feeding the heart used to administer medication and fluids.
Based on data from 92 ICUs gathered in 2010, researchers discovered that only five earned the highest possible rating of 5, meaning they reported no central line infections. Twenty-four ICUs received a 2, the second-lowest rating. Their infection rates were higher than the national average of 1.5 blood infections per 1,000 days children had central lines. Two hospitals scored a 1, the lowest rating, with rates more than twice the national average.
The report cites data from the U.S. Centers for Disease Control and Prevention (CDC) that estimated 27,000 to 65,000 central line bloodstream infections in U.S. hospitals in 2009. Between 12,000 and 28,000 of them occurred in ICUs, and about 25 percent of them were fatal.
"These are serious infections that can lead to the death of a patient and are preventable, but hospitals are not doing enough to prevent them," said Dr. John Santa, director of the Consumer Reports Health Ratings Center.
The infections, he explained, often occur because health care personnel don't take enough precautions to ensure the lines are inserted under absolutely sterile conditions or make sure they are kept very clean so bacteria can't enter the bloodstream.
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Santa also said that despite the fact that there are more than 400 hospitals with pediatric ICUs nationwide, only 92 made it into the analysis, because more than half of them did not make their infection data public and the others did not utilize enough central lines to make a fair comparison. Hospitals are not required in every state to report their data on infections.
"We are very concerned that hospitals are not sharing their data and are concealing it, and we also know this is a very important issue for parents," he said.
Children with Central Lines Pose Unique Challenges
Santa and experts not involved with the Consumer Reports research say it can be more difficult to prevent infections in children with central lines.
"We know from previous research that children have higher rates of these infections, and you can imagine why," Santa said. "Children are not as cooperative as adults as far as keeping the lines out of their mouths, out of their diapers or trying to keep them clean."
Health care personnel also access central lines sometimes hundreds of times a day to give medication, provide nutrition or replace fluids, and there are additional reasons to utilize a central line in a child, such as to draw blood.
"In a broad generalization, if you are an adult, you're likely to be stuck with a needle to draw blood," said Dr. Marlene Miller, vice president for quality transformation for the Children's Hospital Association and vice chair of quality and safety at Johns Hopkins Children's Center. "But with a three-year-old child, they will have bloods drawn using the central line instead of a needle stick for compassionate reasons, adding to the number of times people use the line." She also said because it's more difficult to insert a central line into a small child, the line needs to be kept in the body longer, which can also increase vulnerability to infection.
ABC News reached out to a number of hospitals that rated low in the report, but none of them commented at the time of this writing. But several of the lower-rated hospitals told Consumer Reports they have implemented strategies for decreasing central line infections, including standardized central line insertion and maintenance procedures.
"The ways to reduce infection rates are pretty simple," said Dr. Steven Lipshultz, chair of pediatrics at the University of Miami's Miller School of Medicine. "There can be better training for doctors, nurses and other staff as well as relatively simple things such as an emphasis on washing hands before touching the central line, barrier protection and disinfection of the skin around the line."
Lipshultz credited the report for drawing attention to an important issue and forcing hospitals to make changes.
"The goal of every hospital is to be as close to zero as possible," he said.
But Miller said rating hospitals based on central line infection rates is unfair. Central line infections, she explained, can't always be prevented, despite a medical center's very best efforts.
"Often times, patients who are critically ill have bacteria in their gut that can cross the bloodstream and they can get very sick. They can be so sick bacteria can get into the blood even if clinicians do everything perfectly, and this rating system doesn't exclude these infections," she said.
Another issue Miller raised is that some hospitals have a much higher volume of patients, or have patients that are very sick and require specialized treatment that make them more vulnerable to infections.
"Some hospitals are going to appear to have higher rates, and it makes a difference if it's there are transplant patients or cancer patients, who always have central lines."
Santa acknowledged that not all hospitals are the same, but said that the five top-ranked hospitals all see a lot of very complicated patients.
"We think regardless of how sick a child may be, hospitals should be doing these measures rigorously for evey child in every way possible," he said.
While he voiced concern about the number of infections, he said the situation is improving.
"The numbers are getting better," he added. "The CDC reported in 2011 that progress is occurring around central line infections. The instances are decreasing significantly, which is even more of a reason to make sure hospitals who are still lagging catch up."
Miller added that there's still room for improvement, but said over the past five years or so, things have gotten a lot better.
"ICUs across the country, including specifically PICUs, have made dramatic improvement in central line bloodstream infections in the last five years," she said. "This has resulted in over $100 million in savings to the healthcare system due to infection prevention."