Hospitals reduced surgical site infections by 17% between 2008 and 2011 — greater than the 7% decline reported in 2010, according to a new report on the state of healthcare-associated infections issued by the CDC. The report analyzed data submitted to the National Healthcare Safety Network, CDC's premiere infection tracking system, which receives data from more than 11,500 healthcare facilities in the U.S. and Puerto Rico.

Other findings in the 2011 CDC report: Catheter-associated urinary tract infections dropped 7% since 2009, the same amount of reduction reported in 2010; and central line-associated bloodstream infections dropped 41% since 2008, up from the 32% reduction reported in 2010.

As part of the 2008 National Action Plan to Prevent Healthcare-Associated Infections, HHS set goals for reducing surgical site infections, catheter-associated urinary tract infections and central line-associated bloodstream infections by December 2013. The report data indicate steady progress toward the goal of a 50% reduction in central line-associated bloodstream infections and a 25% percent reduction for SSIs. The goal of a 25% reduction in catheter-associated urinary tract infections, while seeing slower progress, is still attainable, says the CDC.

Stephanie Wasek

Readmission rates for Medicare patients undergoing surgery in hospitals remain stagnant, according to a report issued by the Robert Wood Johnson Foundation. The report notes 1 in 8 patients were readmitted to hospitals within 30 days of surgery in 2010, a rate unchanged from 2 years earlier.

Readmission rates varied wildly in various parts of the country. Hospitals in Bend, Ore.; Boise, Idaho; Santa Barbara, Calif.; Spokane, Wash.; and Seattle, Wash., had the lowest rates (all under the national average of 16%). Facilities in New York — the Bronx, White Plains, East Long Island and Manhattan — had the highest, ranging from 16% to 18%. (Check out the Foundation's interactive map to see readmission rates in your area.)

Most hospital readmissions are avoidable, notes the report, and have come under increased scrutiny since CMS began reducing reimbursements to hospitals with high readmission rates. However, adds the report, many factors — some beyond hospitals' control — factor into the likelihood of patients returning following surgery.

The Foundation, for example, advises patients to ask for clarity about their post-op care, repeat discharge instructions to caregivers before leaving the hospital, have and follow a discharge plan, manage medications properly, keep follow-up care appointments and know who to contact if complications arise.

"Although hospitals are a key venue of care, the one thing that's clear is that this is not just a hospital problem," says Risa Lavizzo-Mourey, MD, president and CEO of the Foundation. "Patients, families, friends, and the entire community have a role to play in reducing avoidable readmissions, and to succeed we need to face this problem together."

Daniel Cook

A few years ago, orthopedic surgeon Robert Marx, MD, of New York City's Hospital for Special Surgery noticed something unusual among his ACL repair patients. More than a handful who'd suffered MRI-documented tears had healed up by 6 to 8 weeks later.

Since each of those patients had torn the ligament during recreational skiing — an activity known to result in less traumatic ACL injuries than football or soccer — he reviewed his case files of skiers who'd presented with first-time tears between 2003 and 2008.

What he found, and is reporting in an upcoming issue of the journal Knee Surgery Sports Traumatology Arthroscopy, was that about 25% of patients whose ACLs tore during skiing were able to accomplish a successful recovery without surgery.

In addition, conducting 2 non-invasive tests involving the physical manipulation of the knee at 6 to 12 weeks after the injury can help physicians to determine which patients' injuries are low-grade enough not to warrant surgery.

Unless surgery is required to fix concurrently suffered knee injuries, patients may be able to recover sooner without it, says Dr. Marx, especially since a full recovery from ACL surgery itself among older patients might take a year. "It is a huge deal to avoid surgery," he says.

David Bernard

Tell us in this week's InstaPoll if you use OR turnover kits between cases. These pre-packaged kits for fast operating room turnovers usually contain linens, trash bags, wipes and mop heads.

Readmissions are not a major concern for most of the 148 respondents to last week's poll. We asked, "What is your facility's 90-day readmission rate?" The results:

• Less than 10%: 86%
• Between 10-20%: 7%
• Between 20-30%: 3%
• More than 30%: 1%
• Don't know: 3%

Dan O'Connor

• Spinal best for TKA Operative times and post-op complication rates are reduced when total knee arthroscopy patients receive spinal instead of general anesthesia, according to a study in the Journal Bone & Joint Surgery. A review of more than 14,000 cases by researchers at the University of Iowa Hospitals and Clinics revealed that patients under spinal anesthesia had fewer superficial wound infections, needed fewer blood transfusions and had lower overall complication rates. In addition, cases involving spinal anesthesia were 4 minutes shorter, on average.
• Meningitis lawsuits consolidated The dozens of lawsuits that have emerged from the fungal meningitis outbreak as a result of steroid contamination at the New England Compounding Company will be consolidated before a federal judge in Boston, according to published reports. While the outbreak's illnesses and deaths occurred across the country, NECC and the continuing investigation of the company's practices are centered outside Boston.
• Comment on drug shortage plan Could improved communication from the federal government help healthcare providers manage drug and biological product shortages? If so, how? The FDA is seeking comment on these and other issues as it develops a strategic plan for the prevention and mitigation of such shortages. See its request for comment before March 14 for details.