State Health Officials Cite Beth Israel Deaconess Medical Center with Serious Deficiencies in its Infection Control Program

Problems identified in connection with ongoing review of MRSA infections in labor and delivery patients

BOSTON — The Massachusetts Department of Public Health (DPH) has cited Beth Israel Deaconess Medical Center (BIDMC) for serious deficiencies in infection control practices at its Boston campus.

A team from the DPH Health Care Safety and Quality Bureau completed an on-site survey of infection control practices at the hospital in March, in response to the hospital’s report of a cluster of methicillin-resistant Staphylococcus aureus (MRSA) infections in some of the hospital’s labor and delivery patients.

As a result of that survey, the hospital has been cited with a number of deficiencies including problems with organizational policies, training, and infection control practices.

None of the deficiencies cited were identified as the source of the MRSA infection cluster at the hospital, however they were serious enough to warrant an immediate plan of correction from BIDMC. That plan is due from the hospital by close of business today, April 9, 2009.

Because of the deficiencies cited, BIDMC will also be required to undergo a full hospital survey as part of its status as a health care facility participating in the Medicare program. The survey, performed under the auspices of the federal Centers for Medicare & Medicaid Services, will be scheduled in the coming weeks and will involve examining a number of quality care practices at the hospital.

MRSA is a kind of bacteria, often referred to as “staph,” which is resistant to some kinds of antibiotics. People who are infected with MRSA are often said to have a “staph infection.” MRSA infections in health care settings are a national problem, as is the growing problem of community-associated MRSA infections. According to the Centers for Disease Control and Prevention (CDC), more than 1.7 million people nationwide get infections while they are in the hospital each year. About 8 percent of those are staph infections, of which smaller percentages are MRSA infections.

Since December 2008, the Boston Public Health Commission and DPH have been working with BIDMC officials to identify the source of what subsequently totaled 37 cases of MRSA infection in 18 mothers and 19 infants. The first case was identified in November 2008, and the most recent case was identified earlier this week.

Ten of the cases (eight mothers and two infants) have required hospitalization for treatment of their infection, including two for serious complications. All of the cases have recovered following treatment, and none of the cases remain hospitalized.

Each of the cases developed an infection with the same strain of MRSA bacteria after discharge from the hospital, which suggests a common source of infection — however a source of those infections has not yet been identified. The infections were caused by a strain of MRSA that is usually associated with infections acquired in the general community, rather than one of the strains more commonly associated with exposure to health care settings. At the request of public health and hospital officials, infectious disease specialists from the CDC are assisting state, city and BIDMC staff to identify a cause of the previous infections and work to prevent future cases.

BIDMC officials have cooperated fully with public health investigators during their review of the cases. Health officials stress that while the clusters of MRSA infections can be serious, the cases of infection in this cluster represent a small percentage of the nearly 5,000 births that take place at BIDMC every year.

Preventing health care-acquired infections has been an increasing focus of health care and government officials in Massachusetts. Over the last year and a half, DPH has initiated a number of activities in partnership with hospitals throughout the state highlighting the problem of health care acquired infections and sharing ideas about how to prevent them.

The Department worked with the Massachusetts Coalition for the Prevention of Medical Errors to develop a tool kit of best practices in reducing medical errors and infections. That effort was spurred in part by a 2007 report by the Betsy Lehman Center for Patient Safety and Medical Error Reduction, which documented the human and financial cost of such infections. Massachusetts will soon begin public reporting of certain health care-associated infections, including infections that develop after hip and knee replacement and when lines are placed in large blood vessels to deliver fluids, medications and nutrition to patients.

Last year, DPH added two full-time infection control practitioners to evaluate infection control practices in hospitals throughout the Commonwealth, and to provide hospital officials guidance on effective infection control procedures. Also, Governor Patrick recently announced that DPH’s health care quality efforts are slated to receive federal stimulus funding this summer. The new funding will allow the Department to continue its focus on improving quality of care for all Massachusetts residents.

For a fact sheet on how individual patients can reduce their risk of developing infections during a hospital stay, please see http://tinyurl.com/PreventInfection.

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