Seven Florida hospitals fell below national standards for combating a deadly infection known as MRSA — and patients at Miami-Dade's Jackson Health System were more likely to develop a MRSA infection than patients at any other hospital in Florida, according to data collected by the federal government as part of a national effort to reduce the infections.
Jackson Health, the county's taxpayer-owned hospital system, reported 61 cases of MRSA across its three hospitals — Jackson Memorial in Miami, Jackson North Medical Center in North Miami Beach and Jackson South Community Hospital in South Miami-Dade — for the year ending June 2017, according to information from the Centers for Medicare and Medicaid Services.
Federal health regulators track how hospitals around the nation perform on preventing six types of frequently occurring infections, including MRSA bloodstream infections, urinary tract infections that result from catheters and surgical site infections that develop after colon and hysterectomy operations.
Jackson Health did worse than the national standard for MRSA bloodstream infections, but the hospital system scored at or better than the benchmark in five others. MRSA is a type of bacterial infection that is resistant to some antibiotics that are often used to treat infections.
Six other Florida hospitals fell below the national benchmark in MRSA bloodstream infections — including UF Health Jacksonville, Bay Medical Center in Panama City, Parrish Medical Center in Titusville, Health Central in Ocoee, Steward Hospital in Rockledge and Bayfront Health in Brooksville.
CMS collected the data on infections from nearly 4,800 hospitals around the county, including 186 in Florida, between July 2016 and June 2017.
The majority of Florida hospitals — 116 — were at the national standard for MRSA bloodstream infections. Only four were better than the benchmark: Lee Memorial in Fort Myers, Flagler Hospital in St. Augustine, Palm Beach Gardens Medical Center and Tallahassee Memorial.
Dr. Peter Paige, chief medical officer for Jackson Health, said the hospital system recognized infection control as a priority about two years ago and appointed a leadership team to address the problem.
"We’ve just had a phenomenal performance over the past two years," he said. "It’s a continuing process."
Dr. Lilian Abbo, chief of infection prevention for Jackson Health, said the numbers were higher than expected. But she said they don't take into account the high prevalence of MRSA in Miami-Dade or the caseload at Jackson Health — one of the largest public hospital systems in the nation with 2,100 beds — which treats many patients considered at higher risk of carrying MRSA, including nursing home residents, trauma and dialysis patients, and those undergoing organ transplantation and cancer care, who tend to have weaker immune systems because of treatment.
In addition, Abbo said, patients who are homeless or inject drugs also are more likely to carry MRSA bacteria and to develop an associated bloodstream infection.
"We’re being compared by our hospital size and case mix that doesn’t take into account what is the prevalence of MRSA in your community," she said.
Jackson Health is working to reduce the occurrence of MRSA using new protocols that include a root cause analysis for every case, improved hygiene and cleaning practices, and active surveillance measures, such as identifying patients considered high risk for active MRSA infections.
Patients found to be colonizing or harboring MRSA in their noses and other areas where the bacteria commonly thrive undergo disinfection with alcohol-based sanitizers, Abbo said.
"We know there has been a problem with MRSA," Abbo said. "There's a high prevalence in the community. We are taking measures to improve and we have demonstrated that we can do it as we have done with other [hospital acquired infections] in the past."
Abbo said Jackson Health has reduced the incidence of catheter-associated bloodstream and urinary tract infections at its hospitals over the past two years.
Jackson Health reported about 50 catheter-associated bloodstream and 90 urinary tract infections in 2017 — down from an estimated 175 bloodstream and 130 urinary tract infections in 2015.
Abbo said catheter-associated infections were the first priority for Jackson Health infection control specialists in 2015, and now that those are under control, they have turned their efforts to reducing and preventing MRSA bloodstream infections.
"Within the next 12 months, our numbers are going to be significantly better," she said. "MRSA is trending down."
However, through the first three months of 2018, Jackson Health has reported about 15 MRSA bloodstream infections, according to a presentation that Abbo delivered to Jackson Health trustees on May 30. That puts Jackson Health on pace for about 60 cases for 2018 — roughly the same as the prior year.
Abbo said Jackson Health is rolling out the new protocol to all three hospitals, and she expects improvement.
"We’re doing our part in the hospital by educating our providers, educating our patients, making sure they have good personal hygiene, hand hygiene, good oral care," she said.
Paige, the chief medical officer, said Jackson Health made infection control everybody's responsibility.
"This is truly a team effort," he said. "Multiple disciplines have to be on it every day, every shift, every hour, including nursing residents, physicians, infection-control practitioners. It's so across-the-board that it takes a significant momentum surge to get things moving the way they have."