Burbank hospital’s infection control faulted

Something was amiss last fall at Providence Saint Joseph Medical Center in Burbank.

On Nov. 27, one patient had a wound infection in her groin after an operation. Another patient, who was in the hospital because of a blocked bowel, had a drug-resistant form of staphylococcus bacteria detected in his urine.

Yet the hospital employee assigned to track and prevent the spread of infections and communicable diseases was unaware that the two patients were in the hospital, according to state inspectors working on behalf of the U.S. Centers for Medicare and Medicaid Services.

An inspection the next day revealed other problems. An anesthesiologist who should have been wearing sanitized scrubs was found wearing, in the operating room, a black fleece jacket that had visible stains and spots on the back. Visibly soiled cloth tape held up paper notices in a different operating room.

Citing such problems, the state inspectors said the hospital, the largest serving the San Fernando Valley, had “serious deficiencies,” and federal officials said it did not meet Medicare’s standards for infection control.

If it does not resolve those problems, the 431-bed nonprofit hospital could be stripped of federal funding.

It is common for complaints to be lodged against a hospital, which prompts an investigation by public health officials. Investigators determine whether the complaint is substantiated. If deficiencies are found, they usually do not rise to the level at which federal officials determine that the hospital fails to meet Medicare’s standard.

“It has to be really egregious,” said Chris Cahill, a retired hospital inspector for the California Department of Public Health.

Healthcare experts say that keeping a hospital clean is crucial for the prevention of hospital-acquired infections, and that reducing infections would save not only lives, but also money for the cash-strapped U.S. healthcare system.

In an interview last week, hospital officials said they did not believe the medical center had poor hygienic practices or an “infection problem.” They pointed to its ranking on CalHospitalCompare.org, a website that tracks statewide hospital performance. The site ranks Providence Saint Joseph “above average” in “surgical infection prevention.”

But the officials acknowledged opportunities for improvement and have launched new sanitation procedures and hired new staff.

“Everyone was mortified” at the inspectors’ report, said Barry Wolfman, chief executive of the hospital. “We’re not cavalier about it. We’re not cocky about it.”

“What we realized was our oversight wasn’t at the level it needs to be,” said Dr. Bernard Klein, the hospital’s chief medical officer.

Steven Chickering, an associate regional administrator for the Centers for Medicare and Medicaid Services, said the hospital has been asked to demonstrate how it intends to resolve the deficiencies listed in the report.

The hospital has submitted a plan. If the federal agency accepts the report, the hospital will be subject to another inspection.

“Whatever they do, we want that correction to be sustained,” Chickering said. “It’s not just a one-time fix or Band-Aid approach.”

The November inspection came a month after the hospital was cited by the Department of Public Health for failing to report a 2006 case in which a patient was diagnosed with so-called flesh-eating bacteria. The hospital was also cited for failing to implement its policy on monitoring, preventing and controlling hospital-acquired infections.

The 2006 incident involved actress Alicia Cole, who on Aug. 15 underwent routine surgery to remove noncancerous growths on her uterus. Ten days after the surgery, she was diagnosed with flesh-eating bacteria and had to undergo five surgeries to remove infected skin, according to a state citation. She is still recovering (see accompanying story). A friend’s call to the Department of Public Health triggered the November 2007 inspection.

Among the findings of that inspection:

On Nov. 27, 2007, the hospital’s infection control practitioner was unaware of the two patients who had infections. She told inspectors at 2:40 p.m. that she was 24 hours behind schedule and had not reviewed the daily patient list. She also said “she was the only infection control officer and that she had to cover two hospitals.”

Inspectors found paper sheathed in plastic protectors inside the operating rooms; one of the sheet protectors on the main operating room door “was full of dust and dirt.”

Inspectors said hospital officials failed to provide evidence that they acted on an internal report that showed doctors had violated infection control practices in the operating room June 6, 2007.

That internal report said an epidemiology nurse saw a surgeon walk into the operating room wearing a white lab coat, while an anesthesiologist brought in a bag from the outside. Neither wore a hat, shoe covers or a mask. Such practices can track in germs.

Cahill found the problems listed in the report troubling.

“You don’t allow anesthesiologists to wear their own fleece jackets in the operating room,” he said. “We don’t know where that jacket has been.”

Anything brought from outside the operating room can carry in germs, said Cahill, who is supporting legislation in Sacramento that would require hospitals to report infection rates on certain procedures.

Wolfman said the hospital has taken aggressive steps in the last few months to respond to the report. Providence Saint Joseph has hired a second infection control practitioner and is looking to hire a third. Infection control practitioners are typically registered nurses.

The hospital has also instituted a policy stating that anyone wearing inappropriate attire in the operating room will be asked to leave. Officials say they welcome anonymous calls and e-mails from staff if they think violations are occurring.

“Could we have gotten a little lax? Perhaps,” Wolfman said. “Do we need to remind people that this is a serious issue? Absolutely.”

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ron.lin@latimes.com

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