DHMC infection rates drop relative to nation

by Emily Fletcher | 8/8/11 10:00pm

A new report by the New Hampshire Department of Health and Human Services shows that health-care-associated infections at Dartmouth-Hitchcock Medical Center are lower than the national average and have decreased significantly in the last year.

DHMC's improved from 36 percent below the national average in 2009 to 64 percent below the average in 2010. In 2010, the hospital reported 22 HAIs, according to the report. HAIs are defined as infections patients contract while being treated for another condition in a health care environment.

"These results that position [DHMC] as having some of the best outcomes in the state are no accident, but are due to targeted work by many and represent a real team effort," anesthesiologist and DHMC Patient Safety Training Center Medical Director George Blike said in an email to The Dartmouth.

A total of 114 HAIs were reported in New Hampshire in 2010, while health care providers reported 134 in 2009, according to the report.

The numbers were analyzed by predicting the number of infections expected in the state and at each hospital based on the national average, the number of patients admitted and the health of the patients admitted, according to Jodie Dionne-Odom, DHMC infectious diseases doctor and New Hampshire deputy state epidemiologist.

"The real beauty of this type of analysis is to look year to year at what the trends are and what hospitals are doing to decrease their infection rates," Dionne-Odom said.

The report focused on central line-associated bloodstream infections in adult intensive care units, central line insertion practices, surgery site infections after colon and knee arthroplasty surgeries, surgical antimicrobial prophylaxis and coronary artery bypass grafts a specific type of heart surgery.

Central line-associated bloodstream infections are associated with the use of catheters placed in a large vein in the neck, which are often used to administer medications or fluids, monitor the cardiovascular system and take blood tests. Prophylaxis refers to giving patients antibiotics during or after a procedure to prevent infection.

The report covers infections and procedure types that provide the most useful information for examining "meaningful outcomes," according to Dionne-Odom.

The overall HAI rate in New Hampshire was 39 percent lower than the national average, with 55 percent fewer central-line-associated bloodstream infections and 35 percent fewer surgical site infections, according to the report. Of the 114 total reported infections in 2010, 94 were surgical site infections and 20 were central-line-associated infections.

The report also analyzed influenza vaccination rates among hospital staff members, which have been shown to be "important for patient safety," Dionne-Odom said. In 2010, 75.3 percent of DHMC staff received the flu vaccine, which was comparable to but slightly lower than the state average of 77.4 percent.

In 2006, the New Hampshire legislature passed a law requiring all hospitals to identify, track and report HAIs to DHHS, which published a report based on data from the state's 26 acute care hospitals for the first time in 2009. The most recent report is the second published by DHHS.

Infection rates vary considerably from state to state, Dionne-Odom said. New Hampshire likely has relatively low rates due to the number of active organizations of doctors and nurses working to minimize infections, according to Dionne-Odom.

Dionne-Odom said that hospitals have been focusing on details such as washing hands and using the right protective equipment to lower the rates even further.

"It's difficult to improve when you're already at 96 or 97 percent," she said. "Because New Hampshire overall looks so good compared to national numbers, there's nothing major we point to as things we really need to work on to improve."

There is variability between hospitals, however, and Dionne-Odon said that DHHS is constantly working with hospitals to further decrease their infection rates.

Nationwide, HAIs cause an estimated 1.7 million infections, 99,000 deaths and over $30 billion in excess health care costs every year, according to the report.

The annual report is not only informative for health care providers and the state, but also for patients, Dionne-Odon said.

"The purpose of this is also for consumers we want the average patient to be aware of what hospitals across the country are doing to reduce infection rates," she said.

New Hampshire has been working to prevent HAIs through the creation of a patient safety checklist, a "High Five for Healthy New Hampshire" campaign designed to encourage 100 percent compliance with hand hygiene practices, and a 10-hospital project that is working with a Johns Hopkins University research group to develop better HAI-prevention practices, according to the report.

In the spring of 2009, DHHS also created the 18-member HAI Technical Advisory Workgroup to advise the state's HAI program, according to the report. Two DHMC doctors sit on the committee, which meets quarterly.

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