Hospital-acquired infections

[Villages PL]

In yesterdays Daily sun (Jan. 1, 2015, page A4) there was a Q&A with the president and CEO of the Central Florida Health Alliance.

Q: What's the top accomplishment for 2014?

A: "We have been working for several years behind the scenes to decrease our hospital-acquired infections and improve our patient-safety ratings. And all of those began to be recognized by the outside national companies that look at these things and rank hospitals."

My comment: Having just read the book, "Missing Microbes", by Martin J. Blaser, MD, I learned that hospitals give people antibiotics before open heart surgery to prevent infection.

Is this how hospitals are dealing with the problem? What about other operations, do they get routine antibiotics too? Is this the reason why some hospitals are doing better? Is this the right way to go about preventing infections? I thought they had new special equipment to automatically disinfect rooms etc..

Lack of information leads to speculation: The newspaper is often full of statistics but there were none concerning the rate of infections. What percentage of patients had hospital-acquired infections in previous years compared to those in 2014? If there was truly significant improvement, why not let us in on the details and tell us how it was accomplished.

[blueash]

If you use google scholar as your search engine you can search for medical studies using whatever parameters you choose You may then look at the hits. Some will only be links to a brief summary as the whole article will be hidden behind a paywall. Other times you can read the whole study. You will find the answer to the risk vs benefit of prophylactic antibiotics in those studies much more likely than on this forum.

For articles on use in heart surgery since 2011 you will get results such as this
prophylactic antibiotics heart surgery - Google Scholar (http://scholar.google.com/scholar?as_ylo=2011&q=prophylactic+antibiotics+heart+surgery&hl=en&as_sdt=0,10)

[dbussone]

As blue ash points out almost all operations, and many other procedures,involve the use of prophylactic antibiotics. They are usually administered within 60 minutes prior to the start of a procedure. The purpose is to reduce the opportunity for an infection to develop.

[Villages PL]

If you use google scholar as your search engine you can search for medical studies using whatever parameters you choose You may then look at the hits. Some will only be links to a brief summary as the whole article will be hidden behind a paywall. Other times you can read the whole study. You will find the answer to the risk vs benefit of prophylactic antibiotics in those studies much more likely than on this forum.

For articles on use in heart surgery since 2011 you will get results such as this
prophylactic antibiotics heart surgery - Google Scholar (http://scholar.google.com/scholar?as_ylo=2011&q=prophylactic+antibiotics+heart+surgery&hl=en&as_sdt=0,10)

Thanks for the information.

JAMA Network | JAMA Surgery | Timing of Surgical Antibiotic Prophylaxis and the Risk of Surgical Site Infection (http://archsurg.jamanetwork.com/article.aspx?articleid=1669977)

The following statement, from the above link, got my attention:

"Numerous studies have failed to demonstrate that adherence to the Surgical Care Improvement Project prophylactic antibiotic timely administration measure is associated with decreased surgical site infection (SSI)."

Therefore it seems if The Villages hospital is making progress with this problem it's not because of prophylactic antibiotics. We still don't know the extent of the problem, like what is their infection rate and how does it compare with previous years. Or: How many people die each year from infections? There's no substitute for them being straight-forward with the public.

[rubicon]

Too many assumptions being rendered here

[Bogie Shooter]

And accusations....................

[dbussone]

Per usual

[sunnyatlast]

If you want to go back to the days before penicillin, head for the hills, build an off-grid hut, and don't go to a doctor or dentist.

Here is an excerpt from a memoir of those "wonderful" pre-penicillin days:

The discovery of penicillin has often been described as a miracle drug, and that is exactly what it was. Prior to the discovery of penicillin, death could occur in what would seem, today, to be very trivial injuries and diseases. It could occur from minor wounds that became infected or from diseases such as Strep Throat, and venereal diseases such as syphilis and gonorrhea were a much more serious issue.

Early in 2005, an email came asking for information about penicillin. The email was from Dr. Morton Paterson, a retired philosophy professor, now living in Canada. He was writing his autobiography for his grandchildren as a legacy for them. Part of that autobiography had to do with the impact penicillin played in his life. When he emailed me the story, I knew that it was one that I wanted to share. As a boy, just prior to the discovery of mass producing penicillin, Dr. Paterson had badly scraped his knee, an injury that he almost died from. The following is his account of this injury and how it was treated at that time:

"It was the late spring of 1942, and I was seven years old. My sister Lorna had just been born. One day I was outside playing with my friends - running while playing tag or something. There weren't any parks or grassy fields, so the kids played on the rocks or on the streets. I fell on the street, which was covered with chunks of slag (waste from the Smelter), and scraped my right knee. I guess it was bleeding pretty bad, so I ran home. Later I was told that it was on a Wednesday, and that my temperature shot up and up. By Saturday Mum and Dad had a sick boy on their hands, so on the advice of Dr. Chappell, our family doctor, I was rushed to St. Joseph's Hospital in Sudbury.

The cut on my knee had become infected, and I had blood poison. For a few days I guess I was "out of it", in a coma, and hung in the balance between life and death. I was diagnosed as having osteomyelitis, which means "bone infection". Apparently what happens with osteomyelitis is that the infected blood seeks out a part of the body which is already weak for some reason. In my case that happened to be the socket in my left hip.
Don't ask me why I had a weak hip - cause I don't know the answer. I just did.

Anyway, they knew they had to operate fast to stop the infection before it traveled to a vital organ. That led to three months in hospital. The surgeon was Dr. Mowat, and I remember him as a very kind and soft-spoken man. He had to scrape out the infected bone, but then leave the large incision open so the nurses could pack it every day with fresh gauze……."


Penicillin, The Wonder Drug (http://www.botany.hawaii.edu/faculty/wong/BOT135/Lect21b.htm)


….

[Villages PL]

Thanks for the information.

JAMA Network | JAMA Surgery | Timing of Surgical Antibiotic Prophylaxis and the Risk of Surgical Site Infection (http://archsurg.jamanetwork.com/article.aspx?articleid=1669977)

The following statement, from the above link, got my attention:

"Numerous studies have failed to demonstrate that adherence to the Surgical Care Improvement Project prophylactic antibiotic timely administration measure is associated with decreased surgical site infection (SSI)."

Therefore it seems if The Villages hospital is making progress with this problem it's not because of prophylactic antibiotics. We still don't know the extent of the problem, like what is their infection rate and how does it compare with previous years. Or: How many people die each year from infections? There's no substitute for them being straight-forward with the public.

If numerous studies have failed to demonstrate any positive outcome for the use of prophylactic antibiotics in a hospital setting, then I doubt The Villages Hospital has anything other than that same result. If they do have a positive result, then they should shout it from the rooftops and let other hospitals learn from their experience. At the same time we Villagers would be proud of their accomplishment. Let's here about it!

As far as how many people die each year from hospital infections, I'm not assuming anything. It might be zero. Wikipedia: Zero is a number. So again I ask, "How many people die each year from infections?"

If prophylactic antibiotics have no positive outcome, should patients be needlessly exposed to them?

[Barefoot]

If you want to go back to the days before penicillin, head for the hills, build an off-grid hut, and don't go to a doctor or dentist.

You nailed it Sunny.
As a preventative measure, because of a knee replacement, for two years I'm required to take an anti-biotic before I have my teeth cleaned.
I don't worry about it.
I think that needless worrying about statistics is just another way to shorten a healthy lifespan.

[Villages PL]

You nailed it Sunny.
As a preventative measure, because of a knee replacement, for two years I'm required to take an anti-biotic before I have my teeth cleaned.
I don't worry about it.
I think that needless worrying about statistics is just another way to shorten a healthy lifespan.

Nothing was nailed unless you mean the subject was shifted to something else. My questions are still valid questions that haven't been answered.

[dbussone]

If I recall correctly, I gave the OP a link several months ago that provided access to the most recent CDC report on hospital related deaths and hospital acquired infections. It was about 97 pages long.

[champion6]

Lack of information leads to speculation: The newspaper is often full of statistics but there were none concerning the rate of infections. What percentage of patients had hospital-acquired infections in previous years compared to those in 2014? If there was truly significant improvement, why not let us in on the details and tell us how it was accomplished.No one on TOTV is able to supply the detailed information you desire. Therefore, your speculation will continue. Why don't you call The Villages Regional Hospital and ask for their Director of Infection Control? This person is responsible for these issues which intrigue you.

[dbussone]

Excellent suggestion!

[graciegirl]

Why is the use of prophylactic antibiotics before surgery of interest to you?

Do you think from reading your book that you have sufficient information to call for the abandonment of prophylactic antibiotics before surgery?

What is the point of your inquiry?

Has it been suggested that you have surgery?

Do you dislike the use of antibiotics because you feel the use of any medicine is in conflict with your views on healthy diet?

What is the point of your interest and concern and how is it tied to your healthy diet and your abhorrence of obesity?

[Barefoot]

No one on TOTV is able to supply the detailed information you desire. Therefore, your speculation will continue. Why don't you call The Villages Regional Hospital and ask for their Director of Infection Control? This person is responsible for these issues which intrigue you.

Excellent response.

[blueash]

Thanks for the information.

JAMA Network | JAMA Surgery | Timing of Surgical Antibiotic Prophylaxis and the Risk of Surgical Site Infection (http://archsurg.jamanetwork.com/article.aspx?articleid=1669977)

The following statement, from the above link, got my attention:

"Numerous studies have failed to demonstrate that adherence to the Surgical Care Improvement Project prophylactic antibiotic timely administration measure is associated with decreased surgical site infection (SSI)."

Therefore it seems if The Villages hospital is making progress with this problem it's not because of prophylactic antibiotics. We still don't know the extent of the problem, like what is their infection rate and how does it compare with previous years. Or: How many people die each year from infections? There's no substitute for them being straight-forward with the public.

If you do make the effort to read the literature, and I am impressed that you are doing so, it would be best if you don't cherry pick a sentence that does not support your conclusions. The JAMA article is looking at a specific medicare quality measure as to the timing of prophylactic antibiotics. Medicare/Medicaid uses a 60 minute cutoff time to judge if the antibiotic was given at an appropriate time. This study suggests that the arbitrary 60 minute cutoff is not supported in their review of the literature. That is the reason for the word "timely" in the sentence you selected.

Here is the pertinent sentence regarding these authors' view of the value of prophylactic antibiotics:

The efficacy of prophylactic antibiotics in reducing SSI (surgical site infections) for major surgical procedures has been proven in clinical trials

[manaboutown]

About a month and a half ago I had a Mohs procedure to remove a melanoma from my scalp. The plastic surgeon gave me a prophylactic antibiotic and no infection resulted for which I am grateful.

I, too, remember pre-penicillin days. I had a carbuncle on my stomach and a sulfa drug was utilized. It took a long, long time to get rid of the infection. Thank God for antibiotics! Unfortunately they have been carelessly overused all over the world but they have saved many lives.

[Villages PL]

I keep seeing ads by The Villages Hospital saying that they got a good rating for safety by "healthgrades", but I had doubts that it told the whole story so I went to Healthgrades > Find a Doctor | Doctor Reviews | Hospital Ratings (http://www.healthgrades.com).

Here's what I found concerning infection: There's a chart and it has "sepsis - mortality-based rating" for which TVRH gets one star. One star means: "worse than expected"

Search: Sepsis Definition - Diseases and Conditions - Mayo Clinic
"Sepsis is a potentially life-threatening complication of an infection."

Number of cases 901 (Number of cases may not represent total volume.)

Actual Mortality In Hospital: 14.98%

Mortality Within 30 Days: 19.87%

They also have predicted mortality but I'm not sure what that's about. Check it for yourself to make sure the above information is correct.

[dbussone]

I keep seeing ads by The Villages Hospital saying that they got a good rating for safety by "healthgrades", but I had doubts that it told the whole story so I went to Healthgrades > Find a Doctor | Doctor Reviews | Hospital Ratings (http://www.healthgrades.com).

Here's what I found concerning infection: There's a chart and it has "sepsis - mortality-based rating" for which TVRH gets one star. One star means: "worse than expected"

Search: Sepsis Definition - Diseases and Conditions - Mayo Clinic
"Sepsis is a potentially life-threatening complication of an infection."

Number of cases 901 (Number of cases may not represent total volume.)

Actual Mortality In Hospital: 14.98%

Mortality Within 30 Days: 19.87%

They also have predicted mortality but I'm not sure what that's about.

Please read blueash's post above.

Have you called TVRH infection control department as suggested by another responder?

[Villages PL]

I keep seeing ads by The Villages Hospital saying that they got a good rating for safety by "healthgrades", but I had doubts that it told the whole story so I went to Healthgrades > Find a Doctor | Doctor Reviews | Hospital Ratings (http://www.healthgrades.com).

Here's what I found concerning infection: There's a chart and it has "sepsis - mortality-based rating" for which TVRH gets one star. One star means: "worse than expected"

Search: Sepsis Definition - Diseases and Conditions - Mayo Clinic
"Sepsis is a potentially life-threatening complication of an infection."

Number of cases 901 (Number of cases may not represent total volume.)

Actual Mortality In Hospital: 14.98%

Mortality Within 30 Days: 19.87%

They also have predicted mortality but I'm not sure what that's about. Check it for yourself to make sure the above information is correct.

Why was the last sentence deleted in the previous post? (I'm referring to the sentence above in bold print)

If anyone doubts the above information they are free to check other sources. I do not wish to call The Villages Hospital as I have more confidence in seeing the information in print.

[blueash]

https://data.medicare.gov/Hospital-Compare/Healthcare-Associated-Infections-Hospital/77hc-ibv8
enter 100290 in the search box and it will give you the infection rates for 2013 for the Villages Hospital
You have to scroll to the right on the screen to see the data. I do not know how to find the earlier years, and suspect the 2014 data is not yet available. However the newspaper report you mention says that the hospital is pleased that is has lowered hospital acquired infections. When you look at the 2013 data you will see that except for urinary catheter associated infections, even in 2013 TVRH was average to above average in avoiding acquired infections already.

The Healthgrade website in its methodology reports it used data from 2011 to 2013 in aggregate. Thus three years of data is being lumped into one score. If the data from 2011 was bad and the data from 2013 was improved, the cumulative score would still be poor.

Predicted mortality is the number of patients that would be expected to die who present with a particular illness. There is an attempt to adjust for the other factors in your patient mix. For instance if your hospital admits more elderly patients than the average hospital, you would expect a higher death rate. So, in this sepsis category, TVRH had a higher death rate than would be expected based on the predicted death rate for a similar patient mix. But of course the adjustments can be very off depending on how well the coding clerks add diagnostic codes on the billing forms.

Additionally, the methodology of Healthgrades was to take the first diagnostic code used in billing. So this was likely patients who came to the hospital already septic. It is not a representation of patients who developed infections in the hospital nor does it relate to your original concern with hospital acquired infections and the impact of prophylactic antibiotics.

[graciegirl]

https://data.medicare.gov/Hospital-Compare/Healthcare-Associated-Infections-Hospital/77hc-ibv8
enter 100290 in the search box and it will give you the infection rates for 2013 for the Villages Hospital
You have to scroll to the right on the screen to see the data. I do not know how to find the earlier years, and suspect the 2014 data is not yet available. However the newspaper report you mention says that the hospital is pleased that is has lowered hospital acquired infections. When you look at the 2013 data you will see that except for urinary catheter associated infections, even in 2013 TVRH was average to above average in avoiding acquired infections already.

The Healthgrade website in its methodology reports it used data from 2011 to 2013 in aggregate. Thus three years of data is being lumped into one score. If the data from 2011 was bad and the data from 2013 was improved, the cumulative score would still be poor.

Predicted mortality is the number of patients that would be expected to die who present with a particular illness. There is an attempt to adjust for the other factors in your patient mix. For instance if your hospital admits more elderly patients than the average hospital, you would expect a higher death rate. So, in this sepsis category, TVRH had a higher death rate than would be expected based on the predicted death rate for a similar patient mix. But of course the adjustments can be very off depending on how well the coding clerks add diagnostic codes on the billing forms.

Additionally, the methodology of Healthgrades was to take the first diagnostic code used in billing. So this was likely patients who came to the hospital already septic. It is not a representation of patients who developed infections in the hospital nor does it relate to your original concern with hospital acquired infections and the impact of prophylactic antibiotics.


I LOVE it when you talk scientifically. Wow. You are one smart fella.

VPL, read over Blueash's post several times. You have your answer. Do not pick some statement out of context and fixate on it.

Then have a nice donut. You will feel better.

[dbussone]

https://data.medicare.gov/Hospital-Compare/Healthcare-Associated-Infections-Hospital/77hc-ibv8
enter 100290 in the search box and it will give you the infection rates for 2013 for the Villages Hospital
You have to scroll to the right on the screen to see the data. I do not know how to find the earlier years, and suspect the 2014 data is not yet available. However the newspaper report you mention says that the hospital is pleased that is has lowered hospital acquired infections. When you look at the 2013 data you will see that except for urinary catheter associated infections, even in 2013 TVRH was average to above average in avoiding acquired infections already.

The Healthgrade website in its methodology reports it used data from 2011 to 2013 in aggregate. Thus three years of data is being lumped into one score. If the data from 2011 was bad and the data from 2013 was improved, the cumulative score would still be poor.

Predicted mortality is the number of patients that would be expected to die who present with a particular illness. There is an attempt to adjust for the other factors in your patient mix. For instance if your hospital admits more elderly patients than the average hospital, you would expect a higher death rate. So, in this sepsis category, TVRH had a higher death rate than would be expected based on the predicted death rate for a similar patient mix. But of course the adjustments can be very off depending on how well the coding clerks add diagnostic codes on the billing forms.

Additionally, the methodology of Healthgrades was to take the first diagnostic code used in billing. So this was likely patients who came to the hospital already septic. It is not a representation of patients who developed infections in the hospital nor does it relate to your original concern with hospital acquired infections and the impact of prophylactic antibiotics.

Well done, although I doubt it will make any difference to the OP. He seems to like creating pseudo scientific posts on a variety of subjects, while ignoring rational and referenced responses that provide the correct response.

[Villages PL]

https://data.medicare.gov/Hospital-Compare/Healthcare-Associated-Infections-Hospital/77hc-ibv8
enter 100290 in the search box and it will give you the infection rates for 2013 for the Villages Hospital
You have to scroll to the right on the screen to see the data. I do not know how to find the earlier years, and suspect the 2014 data is not yet available. However the newspaper report you mention says that the hospital is pleased that is has lowered hospital acquired infections. When you look at the 2013 data you will see that except for urinary catheter associated infections, even in 2013 TVRH was average to above average in avoiding acquired infections already.

If I can't totally rely on healthgrades and can't make any sense of the link you gave me, it doesn't appear to be user friendly for the average healthcare consumer.

The Healthgrade website in its methodology reports it used data from 2011 to 2013 in aggregate. Thus three years of data is being lumped into one score. If the data from 2011 was bad and the data from 2013 was improved, the cumulative score would still be poor.

So what's the purpose of the website, to give misleading information to healthcare consumers?

Predicted mortality is the number of patients that would be expected to die who present with a particular illness. There is an attempt to adjust for the other factors in your patient mix. For instance if your hospital admits more elderly patients than the average hospital, you would expect a higher death rate. So, in this sepsis category, TVRH had a higher death rate than would be expected based on the predicted death rate for a similar patient mix. But of course the adjustments can be very off depending on how well the coding clerks add diagnostic codes on the billing forms.

Is "predicted mortality" predicted for 2015? On Healthgrades I didn't see where it said that it was for a particular illness. I assumed it was for all sepsis infections in general. That's what I'm interested in, all sepsis infections across-the-board, acquired in the hospital.

Additionally, the methodology of Healthgrades was to take the first diagnostic code used in billing. So this was likely patients who came to the hospital already septic. It is not a representation of patients who developed infections in the hospital nor does it relate to your original concern with hospital acquired infections and the impact of prophylactic antibiotics.

Again, if a consumer has to read incomplete or misleading information on healthgrades, the rating system is not user friendly. This service is supposed to grade the hospital rather than blame patients for coming in with septic infections. Consumers want to know the bottom line and be able to compare it to other hospitals so they will know their risk of acquiring a potentially lethal infection.

The article didn't say that they made considerable improvement or even good improvement in decreasing hospital-acquired infections. It just said that it began to be recognized by outside rating companies. What does that mean, are they up to one and a half stars yet? And if they made progress, how did they do it? Did they do it by cleaning up their hospital procedures or by greater reliance on antibiotics?

Thanks for trying to be helpful. If what you said is true, I give both the rating system and the hospital a failing grade.

[Chi-Town]

Antibiotics is an easy fix. The Pharmacy is autonomous in a hospital. Changing somewhat due to formulary dictates, but there is much less bureaucracy in acquiring product to treat a condition. When it comes to nosocomial infections and procedures to avoid them then you are in the land of Materials Management/Purchasing. Measuring long term savings v. product cost is a concept generally lost there. Case in point: powdered latex OR gloves or synthetic powder free OR gloves. Even after scrubbing there is residual powder which in a wound sight is bad news. Also, latex allergies are common for patients and end users. A no brainer then? Less infections and less time off? Hardly. Powder free synthetics were more expensive. It took years to move to nitrile or other synthetics.

Progressive teaching hospitals are the best.

[Villages PL]

Antibiotics is an easy fix. The Pharmacy is autonomous in a hospital. Changing somewhat due to formulary dictates, but there is much less bureaucracy in acquiring product to treat a condition. When it comes to nosocomial infections and procedures to avoid them then you are in the land of Materials Management/Purchasing. Measuring long term savings v. product cost is a concept generally lost there. Case in point: powdered latex OR gloves or synthetic powder free OR gloves. Even after scrubbing there is residual powder which in a wound sight is bad news. Also, latex allergies are common for patients and end users. A no brainer then? Less infections and less time off? Hardly. Powder free synthetics were more expensive. It took years to move to nitrile or other synthetics.

Progressive teaching hospitals are the best.

Thanks for the idea about progressive teaching hospitals, I'll keep it in mind for future reference.