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Tuesday, August 5, 2014

Nashua hospitals do well in measure of health-related infections

Scores for most state hospitals remained high in the latest government survey of patient infections caused by medical practices, and the rankings for Nashua’s two hospitals were virtually unchanged.

But the mere fact the issue was measured, and the results published, may be as important as the actual scores themselves. ...

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Scores for most state hospitals remained high in the latest government survey of patient infections caused by medical practices, and the rankings for Nashua’s two hospitals were virtually unchanged.

But the mere fact the issue was measured, and the results published, may be as important as the actual scores themselves.

“When you get down to the hospital level, the numbers are so small it’s hard to see statistical significance,” said Beth Daly, infectious disease surveillance section chief for the state Department of Health and Human Services. “Just requiring them to do the surveillance and report it to us has created a dialogue. … It helps them figure out: Do they have something going on, is this an isolated incident or an outbreak due to contamination or something else.”

St. Joseph Hospital and Southern New Hampshire Medical Center had the expected number of what are called health care-associated infections, which can happen when, for example, a catheter is improperly inserted or left in a patient too long, or not all the proper anti-infection practices take place before and after surgery. Such infections are considered one of the most important measures of practices in a hospital.

Statewide, the incidence of such infections declined slightly in 2013 compared to 2012, according to a complex of measures. These involve processes with mind-numbing acronyms, including CLABSI (central line-associated bloodstream infection) and “SSIs following CABG, COLO, HYST, and KPRO,” which concerns surgical site infections following a variety of procedures.

Figures from 2011 and earlier are not comparable because more processes are now included in the scorecard.

In 2013, Southern New Hampshire Medical Center reported eight such infections, slightly more than half its “expected number” of 13.9, based on the number and type of medical procedures that it performed during the year.

St. Joseph Hospital had nine such infections, exactly its expected number.

The two facilities reported the same number of health care-associated infections in the 2012 report.

The report, released Tuesday by the New Hampshire Department of Health and Human Services, examined a variety of measurements related to this issue among New Hampshire’s 26 acute-care hospitals. Similar reports have been issued for four years as part of federal efforts to measure the quality and cost effectiveness of health care in the U.S.

Other aspects of medical care also are being measured by the government as part of health care reform in the past five years. Most notably, hospitals are now scored on how quickly patients treated under Medicaid, the federal health insurance program for the poor, return to the emergency room.

The figures can’t be compared directly to the results from 2011 or earlier because a new procedure, catheter-associated urinary tract infections, is now included in the results. Daly said that’s example of how measuring and reporting problems can help.

“That is an area that is very preventable,” she said, pointing to the insertion of catheters to collect urine from patients. “Catheters are overused.”

Further, she said, infections related to urinary catheters are often misdiagnosed and thus treated unnecessarily by antibiotics. Adding the matter to the annual scorecard can raise awareness.

“It helped us do education about what is truly a urinary infection,” she said.

And all hospitals are examining their own numbers carefully, Daly said.

“They can still use this data in a meaningful way,” she said. “If (a hospital) had six (infections) and the year earlier they had four, it’s not statistically different, but they should be looking closely … to see if it’s an indication of anything.”

David Brooks can be reached at 594-6531 or dbrooks@nashua
telegraph.com. Also, follow Brooks on Twitter (@GraniteGeek).