A state report shows bacterial blood infections among the sickest patients in Tennessee hospitals was 20 percent higher than the national average in 2008.

The Tennessean in Nashville reports that the report is the first since the state's hospitals started actively collecting and sharing data with the state on the count of bloodstream infections in intensive care patients with central lines. Those are most commonly tubes near the groin and collarbone.

Vanderbilt University Medical Center's chief quality and patient safety officer, Julie Morath, told the newspaper the report based on information provided to the Tennessee Department of Health shows there is work to be done.

"It was a sobering report when we looked at how Tennessee compared with the rest of the nation," Morath said. "We have an obligation and some heavy lifting to do, but you can't improve on that which you are not aware."

The numbers were the highest among patients in pediatric intensive care units and teaching hospitals' trauma units, with more than three infections per 1,000 central line days.

Bacterial infections can happen when central lines are incorrectly inserted or are not maintained properly. One of the most common bacteria introduced is staph, or MRSA.

"Anytime you have a foreign object inserted into a patient, you run the risk of introducing bacteria to a patient's body," said Elizabeth Lemons, vice president for clinical effectiveness for Saint Thomas Health Systems. "The lines are put in the sickest patients, and their immune systems are more susceptible to germs and bacteria."

Tennessee lawmakers in 2006 directed hospitals to provide data on the infections. The result was a collaborative effort, even among competing hospitals that shared information on best practices such as continuous hand-washing, using head-to-toe protective gear, using a drape over the patient during the insertion and sterilizing the patient's skin.

Health-care-associated infections, including those from central lines, are one of the top 10 leading causes of deaths in the United States. There are more than 1.7 million infections each year, with 99,000 people dying from them, according to the Centers for Disease Control and Prevention.

The financial price tag associated with the infections is between $35 billion and $45 billion a year, the federal agency reports.

Baptist Hospital in Nashville, part of the Saint Thomas system, was among the few hospitals in the state to report zero infections in its ICU.

The health-care industry started addressing hospital-associated infections in the late 1990s.

Three years ago, the Tennessee Hospital Association started bringing hospitals together under its Patient Safety Center program.

"There is no competitor or hospital holding back if they found a better way to do it," said Craig Becker, association president. "We want to get to zero infection rates for central lines."

The 64 hospitals that were members of the Tennessee Hospital Association program fared better than those that were not. Hospitals that are not part of the education campaign had infection rates 40 percent higher than the national average.

Saint Thomas Health System and TriStar HCA are all members and incorporated similar measures. They follow a check-list format that standardizes care and procedures to make sure central lines are put in the same way in every patient, every time.

"We have learned more as a health-care industry that consistently using evidence-based practices works," said Ruth Westcott, vice president for quality and clinical services for HCA and TriStar. For those very critically ill patients, we have to ensure they too are safe from harm."