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High hospital-acquired infection rates at Stanford Health Care have caused Medicare to reduce payments to the hospital for the second year in a row.
Now, members of Service Employees International Union — United Healthcare Workers West (SEIC-UHW), the health workers union serving the hospital, claim the high rates are because of inadequate staffing and training, union members said during a press conference at Stanford Medical Center on Tuesday.
But hospital officials are disputing that assertion. They say the data is old and the union is using a strong-arm tactic to gain leverage during contract negotiations. The current contract expires in August, according to union spokesman Tom Parker.
The dispute alleging high infection rates is focused on Stanford’s Palo Alto campus and does not include the Pleasanton location, Stanford Health Care – Valley Care, Parker said.
Union officials said on Tuesday that the issue isn’t just another ugly fight over a contract. They have been struggling with the hospital for more stringent changes and better staffing for a year. They said they have chosen to make the information public because the hospital has turned a deaf ear to their concerns.
“That is not a bargaining tactic,” Linda Cornell, a union member and 37-year patient-unit secretary, said of the yearlong negotiations. “Please don’t be that cynical. We are not here today as a first course of action.”
A Nov. 21 memo from union representatives to Suzanne Harris of Stanford Employee and Labor Relations shows that union officials had been asking the hospital to address high-infection-rate and worker and patient safety concerns for at least several months. Two weeks ago, union representatives were to meet with hospital CEO David Entwistle to discuss the concerns related to the infection data but the hospital canceled the meeting, they said. The canceled meeting prompted the union members to make their case public, SEIU-UHW President Dave Regan said.
Stanford Health Care received a penalty reduction in reimbursements from the Centers for Medicare & Medicaid Services in fiscal years 2016 and 2017 after the hospital had high rates of hospital-acquired infections, including surgical site infection after colon surgery and abdominal hysterectomy; diarrhea-causing Clostridium difficile (C. diff), and catheter-associated urinary tract infections, among others, according to data from the Centers for Medicare.
The latest federal figures stem from hospital-reported data for the fiscal year 2017 reporting period, with data from 2016.
The Centers for Medicare Services’ Hospital-Acquired Condition Reduction Program ranked 3,203 hospitals nationwide during fiscal year 2017 for their hospital-acquired infection rates. Nationwide Medicare penalized 769 hospitals. Children’s hospitals, VA hospitals, and critical access hospitals, among others, are exempt from the hospital-acquired condition reduction program.
On a scale from 1 to 10, with 10 being the most severe, Stanford had an overall hospital-acquired conditions score of 7.85 in fiscal year 2017. Specific ratings that contributed to that score included:
– Central line-associated blood stream infections: 7
– Catheter-associated urinary tract infections: 8
– Surgical site infection: 10
– Methicillin-resistant staphylococcus aureus infection: 6
– Clostridium difficile infection: 9
In addition, the score includes the Agency for Healthcare Research and Quality Patient Safety Index (or PSI 90 Composite), which considers eight safety concerns, including pressure ulcer rate, postoperative hip fractures, postoperative sepsis, accidental punctures or lacerations, pulmonary embolism and deep-vein thrombosis (around time of surgery), among others. Stanford scored a 7.
Placing in the bottom-performing 25 percent of hospitals nationwide for hospital-acquired conditions, Stanford received a 1 percent reduction in Medicare reimbursements for each of the two fiscal years. The penalty for fiscal year 2017 runs from October 2017 through September 2018. Hospital spokeswoman Lisa Kim did not immediately know how much that percentage translated to in number of dollars.
Stanford maintains the figures represented by the union are outdated. Specifically, the data includes a comparison between seven Bay Area teaching hospitals of patient infection rates of one of the most pernicious gastrointestinal infections, Clostridium difficile.
The union presented state data for its comparison from the California Office of Statewide Health Planning and Development, which is publicly available through 2014. That data shows an infection rate nearly double the rates for University of California, San Francisco Medical Center, which was the second worst of the other teaching hospitals. Other hospitals included University of California, Davis, California Pacific Medical Center, San Francisco General, Santa Clara Valley Medical Center and St. Mary’s Hospital.
But Stanford instead pointed to U.S. Centers for Disease Control and Prevention’s National Healthcare Safety Network metrics to show the hospital has greatly improved in recent years. The Standardized Infection Ratio scores for C. diff, for example, showed an improvement of 1.09 cases per 1,000 patient days in 2015 and 1.12 in 2016. The rate of infection for the first quarter of 2017 is 0.871, which is better than the 1.0 benchmark, Stanford interim Chief Quality Officer Dr. Ann Weinacker said. She did not provide scores for the other infectious disease rates that are also measured by the CDC’s Healthcare Safety Network.
The data is submitted to the Safety Network monthly, spokeswoman Lisa Kim said.
“National Healthcare Safety Network (NHSN) is the only reliable source of these data because they provide training in standard surveillance methods. It’s also the nation’s most widely used healthcare-associated infection tracking system,” Kim said in an email.
Weinacker said that one reason Stanford’s C. diff rate jumped in recent years by more than 100 percent is because the hospital began using new and much more sensitive testing procedures that are picking up more cases. The hospital began using the sensitive tests in 2012.
State data shows that Stanford first had a huge jump in C. diff cases in 2011. The rate between 2011 and 2012 was the same at 1.05 cases per 1,000 patient days compared to 0.30 in 2010.
Weinacker said the hospital has been tracking their data monthly so that officials can make adjustments to procedures. The hospital has signage for every room and pictograms of all precautionary procedures for a particular disease that staff and visitors must take before entering a room, such as hand-washing and wearing a mask or a gown.
But the union, which represents 95,000 hospital service workers statewide, including 1,800 at Stanford, claims protocol enforcement has been inconsistent, communication is poor and staffing is inadequate.
Nate Anderson, who has worked at the hospital for three years as a transporter bringing patients from the emergency room, said he has been tested three times in the same year for tuberculosis. Anderson said the tests came back negative, but he is still concerned about the potential for exposure.
“People come through the ER and we aren’t told if they are suspected of having an infection,” he said.
In the five minutes it takes for him to wheel a patient to their room, other staff, such as doctors and nurses, are already prepared in gowns, gloves or masks when he arrives, he said.
Anderson fears that as he moves from room to room or has passed patients and visitors in the hallways, he might be contaminating people. When patients potentially have a disease passed by droplets through sneezing or coughing, they should be wearing masks. Often they are not when they are handed off to him, he said.
“Everyone is confused about the proper protocol. Ask two different people and you get two different answers; ask three people and you get three different answers,” he said.
Salyna Nevarez, a phlebotomist, said she worries on a daily basis about diseases she could bring home.
“About one month ago there was a patient with active TB (tuberculosis),” she said. The patient was placed in a unit where phlebotomists were exposed to the infected patient but did not have any notice to take precautions. It wasn’t until after going into other patients’ rooms that management informed Nevarez that she had been exposed, she said.
Other employees said that housekeeping workers are put on a strict schedule of cleaning rooms that don’t give them adequate time. Cornell said that housekeepers are given 28 minutes to clean a room of a noninfectious patient and 43 minutes to clean an isolation room. There are 25 patients on her unit. Two housekeepers empty trash and two handle linens. In addition, the cleaning staff must handle conference rooms, nursing stations and hallways.
“There is not enough staffing in all areas. They are under constant pressure. They are rushing to beat the clock,” she said.
Anish Singh, a member of the Patient Companion Pool, which brings staff to sit with patients for up to eight hours a day, said he has also seen things left uncleaned because of staffing shortages.
Cornell and Nevarez also said because of hospital overcrowding, some infectious patients are placed in the hallways and are surrounded by screens, but they are concerned that the hallways might be contaminated. There are many workers, including housekeepers and kitchen staff, who may have exposure to those patients and who have contact with other patients throughout the hospital, they added.
Stanford officials said the number of housekeepers per bed is 98 to 100 percent of the industry benchmarks established by United HealthCare and Vizient, two ranking organizations.
Weinacker did not refute that some patients might be placed in halls when necessary, but she said that every precaution is taken to protect them and others from being contaminated. The hospital also has an active control group that works to refine protocols.
“There are hours and hours of training for workers and managers to ensure how to protect themselves from potential infection. They receive in-person and online training. We take this very seriously,” she said.
In a statement, Stanford officials said through its “escalation policy,” all employees are encouraged to share concerns through established channels.
And although the hospital maintains the union’s data is outdated, officials have shared the information with its quality department, which will conduct a thorough review into the information, Stanford officials said.