A hospital in California has received a preliminary denial of accreditation from The Joint Commission, which may lead to a loss of Medicare and Medicaid funding. This move is rare – less than 1% of hospitals are denied accreditation. The ruling was made during an onsite survey after reports that four patients had developed surgical-site infections after hip replacement surgery within a month. (The patients all recovered after administration of antibiotics.)
Says the hospital’s Associate Director of Emergency Services, “Surgical infections are extremely rare. When we saw the cluster we stood up and took notice. We stabbed every corner and every crevice.”
However, that may not be entirely true. First of all, surgical infections are probably not what’s considered “extremely rare”. In a recent study, the Centers for Disease Control and Prevention (CDC) found that 1 in 25 patients acquires an infection while in the hospital and infections are among the leading cause of death worldwide. (See our previous blog for more details.) Only slightly more than 20% of those infections were found to be surgical site infections from inpatient surgery, but that still results in about 157,500 surgical site infections a year.
There’s also a question about how quickly action was taken to address the issues identified by The Joint Commission, specifically high humidity. After the four patients were infected with enterobacter (a bacteria that is harmless in the gut but can cause illness in a wound), the hospital cultured equipment and instruments and found no contamination. However, three of the surgeries which resulted in the surgical site infections took place in an operating room that had been identified in February or March to have high humidity due to issues with the heating and ventilation system. Although a new system would not be installed for several months, surgeries continued to take place in that operating room until The Joint Commission identified problems with heat and humidity.
The germs that caused these infections can also be introduced to a surgical site by medical staff – usually due to improper hand washing or surgical prep procedures. It’s unclear if this may have been the case here – there has been no discussion of this possibility – but handwashing issues are a constant source of infections at healthcare facilities. According to studies, more than 50% of infections are largely preventable with good hygiene and technique.
The hospital has 23 days from the October 8th preliminary denial of accreditation to meet federal standards. The hospital is installing new heating and air conditioning equipment and is reviewing its procedures for “hospital documentation and staff communication”. Hopefully other processes will be reviewed as well. The hospital expects to reopen its operating rooms soon.
To view an overview of the investigation of this issue, please click “Download PDF” above. The downloadable PDF shows the goals impacted by this issue, a visual layout of the cause-and-effect relationships that led to the impacted goals, and the solutions being discussed by the hospital to improve patient safety regain their accreditation.