Kentucky's two biggest hospital systems had some of the country's highest instances of an often deadly bacterial bloodstream infection known as MRSA in fiscal year 2017.
The University of Kentucky Chandler Hospital and Norton Healthcare in Louisville each had 40 MRSA bloodstream infections between July 1, 2016 and June 30, 2017, according to federal data from the U.S. Centers for Medicare and Medicaid Services.
UK's MRSA number was deemed "no different from the national benchmark," which considers a hospital's size and mission, according to a report by the CDC that compares hospitals.
Still, UK's number was higher than many comparable teaching hospitals, such as the University of Cincinnati hospital, which had 27, or the University of North Carolina, with 33.
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Of the 3,800 hospitals reporting, the highest number of cases belonged to Jackson Memorial Hospital in Miami, Fla., which had 61. Norton and UK ranked sixth and 7th in the nation, respectively.
Norton and the bottom six hospitals were deemed "worse than the national benchmark."
MRSA (methicillin-resistant staphylococcus aureus) is resistant to many antibiotics. It usually attacks soft tissue, but is considered most dangerous as a bloodstream infection.
"This is very alarming to patients, and you want to make sure hospitals are following the latest protocols from the CDC (Centers for Disease Control)" said Kevin Kavanagh, who heads Health Watch USA, a patient advocacy group in London.
Officials from both hospitals said they follow those precautions, and that using the raw number of cases can be misleading because it doesn't take into account how many patients are admitted each year and how long they stay.
"At UK HealthCare, we take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe," said spokeswoman Kristi Willett. "Our large patient volumes and high level of patient complexity make us unique in the state of Kentucky as those things are known risk factors that can increase the risk of infection."
UK's most recent data shows that the "standardized Infection ratio" for the last quarter was down 55 percent compared to 2016, when UK added protocols for ICU patients, such as washing them with antibacterial soap, and using nose antiseptic swabs, said Derek Forster, UK's medical director for Infection Prevention and Control. MRSA can live in the nostrils, then transfer to the skin.
MRSA infections in UK's Intensive Care Units have fallen 51 percent in that same time period, Forster said.
UK takes in many of the most complex medical cases in the state, which means patients stay for longer, Forster said.
"I think the complexity of cases seen at UK does contribute to an increased number of (MRSA) cases," Forster said. "I think we're unique in that complexity."
Norton's cases come from its five hospitals, which average about 70,000 patients a year.
"Patient safety is of the utmost importance at Norton Healthcare, and our goal is zero infections," said Steven T. Hester, chief medical officer for Norton Healthcare.
Hester said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue.
"Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse," Hester said. "We had concerns that our increase in MRSA could be related to the increased incidence and risk with substance dependent patients, specifically intravenous drug users."
Since then, protocols include special skin baths and antimicrobial nasal swabs and standardized room cleaning to reduce risk.
Nationally, MRSA bloodstream infections dropped 60 percent between 2005 and 2013, said Cal Ham, a medical officer with the CDC. In 2015, there were 72,852 cases. About 12,000 of those started in hospitals.
"Bloodstream infections are very, very serious and associated with high mortality," Ham said.
The most important controls are "contact precautions," including patient isolation and the use of gowns and gloves with those patients.
"We think most hospitals do that, but we are aware that some have stopped using contact precautions," he said.
UK and Norton officials both said they follow all CDC recommendations.
Among other hospitals in Kentucky, the University of Louisville Hospital had 17 MRSA cases, Pikeville Medical Center had 12 and Hazard ARH had 10 cases. Hazard's number was deemed to be "worse than the national benchmark."
Most of Kentucky's small, regional hospitals had fewer than five cases.
The 10 U.S. Hospitals with the highest number of MRSA bloodstream cases in fiscal year 2017
Jackson Medical Center, Miami, Fla.: 61
Montefiore Medical Center, Bronx, NY: 58
Methodist Healthcare Memphis, Memphis, Tenn.: 52
Charleston Area Medical Center, Charleston, WV: 41
Mount Sinai Hospital, New York, NY: 41
Norton Healthcare, Louisville, KY: 40
University of Kentucky Hospital, Lexington, KY: 40
Long Island Jewish Medical Center, New Hyde Park, NY: 39
New York Presbyterian Hospital, New York, NY: 38
Florida Hospital, Orlando, Fla. : 36