WASHINGTON – Nine Maryland hospitals consistently failed to follow a nationally established guideline designed to prevent surgical infections, according to recent data from the Hospital Quality Alliance.
Three hospitals are using antibiotics longer than recommended at least 80 percent of the time after surgery, conflicting with guidelines established by the Joint Commission on Accreditation of Healthcare Organizations.
The commission recommends that hospitals stop giving antibiotics within 24 hours after surgery to avoid side effects and antibiotic resistance.
While experts agree that continuing to treat a surgical patient with antibiotics after 24 hours is not initially harmful, it contributes to a worldwide problem of antibiotic-resistant bacteria.
These bacteria, which cannot be treated effectively with conventional antibiotics, are a major problem in hospitals and are becoming more common outside health facilities as well.
“They are very difficult if not impossible to treat,” said Dr. Diane Griffin, chairwoman of molecular microbiology and immunology at the Johns Hopkins School of Public Health.
When antibiotics are used unnecessarily, “you increase the problems for everybody,” said Griffin, who is also president of the American Society for Microbiology.
The data, compiled in a joint project by the Centers for Medicare and Medicaid Services and the Hospital Quality Alliance, represents medical records volunteered by 45 accredited, acute care hospitals across Maryland between October 2004 and September 2005.
The project found that Garrett County Memorial Hospital in Oakland followed the guidelines for post-surgical antibiotics only 11 percent of the time, and Sacred Heart Hospital in Cumberland followed them only 12 percent of the time. Chester River Hospital Center in Chestertown was in compliance with the guidelines 17 percent of the time.
“We recognize that was an area that needed to be worked on,” said Trena Williamson, a spokeswoman for Chester River Hospital Center. The hospital looks at the results as a tool for improvement, and it has already implemented a policy to reduce ambiguities about timing the dosage of drugs after surgery, she said.
Nationwide, an average of 67 percent of patients in reporting hospitals received antibiotics for the recommended time period after surgery. Maryland’s reporting hospitals performed slightly below the national average at 62 percent.
Six other Maryland hospitals followed post-surgical guidelines for antibiotics less than half of the time including Westminster’s Carroll Hospital Center; Civista Medical Center in La Plata; Memorial Hospital and Medical Center in Cumberland; Montgomery General Hospital in Olney; Baltimore’s Northwest Hospital Center; and Saint Agnes Hospital in Baltimore.
Two Maryland hospitals showed very high compliance rates, better than 90 percent, Memorial Hospital at Easton and Saint Mary’s Hospital in Leonardtown.
An estimated 2 million people annually contract infections while in the hospital, according to the Centers for Disease Control and Prevention. The infections account for 90,000 deaths and $4.5 billion in excess health care costs each year.
But administering antibiotics longer than recommended after surgery also costs hospitals in the long run.
“Its wasteful, it’s expensive and it causes side effects, said Dr. William Minogue, director of the Maryland Patient Safety Center. Still, “It’s not the central part of preventing the wound infections.”
Another quality measure aimed at preventing surgical infections is administering antibiotics to patients one hour before surgery.
“The science is very clear that use of prophylactic antibiotics in that magic hour dramatically reduces wound infections,” Minogue said.
Maryland hospitals administered preventative antibiotics within the recommended time period 80 percent of the time, above the national average of 74 percent.
On this measure, Chester River Hospital Center, Fort Washington Hospital and Saint Mary’s Hospital all performed well, among the top 10 percent of hospitals nationwide.
Maryland General Hospital in Baltimore ranked lowest among the state’s reporting hospitals in this measure, with only 38 percent of patients receiving antibiotics an hour before surgery.
Implementing quality measures depends on a number of factors that vary with each hospital.
“It sounds to the public like it’s an easy thing to attain but it’s not,” said Annette Mucha, executive director of the Society for Healthcare Epidemiology of America. While there may be established guidelines, there aren’t any standards about how to put them into practice.
“It may not be hospital practices,” said Griffin. “It may be the physicians.”
Garrett County Memorial Hospital’s low performance in the quality measure for antibiotics after surgery is driven by physicians, said Lance Rhodes, patient safety officer and director of pharmacy at the hospital.
The facility performs many orthopedic surgeries using prosthetics and doctors aren’t always comfortable with the abbreviated period of antibiotics, said Rhodes.
Infections aren’t as much of a problem since the hospital is located in a rural area, and has lower resistance rates than a hospital in an urban center, said Rhodes.
But, resistance is becoming more of an issue, and the hospital is reviewing its procedures. Garrett County’s surgeons, he said, have been steadily decreasing the length of time their patients are on antibiotics for the last six months.