Excellent response.

I understand that reading this can be challenging BUT
 

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

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.

www.healthgrades.com
 

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.

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.

Hospital-acquired infections
 

Please read blueash's post above.

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

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.

https://data.medicare.gov/Hospital-C...ital/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.

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.

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.

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

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.

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.

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.