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Your chances of getting a MRSA infection in a Tennessee hospital are 12 percent greater than they should be, according to a state report.

But you're much more likely to get a urinary tract infection if you end up in an intensive-care unit — where the odds are 40 percent higher than the national hospital standard. The statistics are revealed in the most recent Tennessee's Report on Healthcare-Associated Infections, which also provides raw numbers for the first six months of 2013.

There is positive news in the report: Tennessee hospitals are doing a good job at preventing deadly bloodstream infections. The odds of getting one in a Tennessee hospital are significantly lower than the national standard.

"We have made substantial progress on central line bloodstream infections," said Dr. Marion Kainer with the Tennessee Department of Health. "We have a lot of work to do on catheter-associated urinary tract infections and a lot of work to do with MRSA. We are so-so in regard to surgical site infections."

Tennessee in 2008 started requiring hospitals to report bloodstream infections and surgical site infections from heart bypasses, then began releasing hospital-specific data. Two years ago, the state began doing the same thing with MRSA and Clostridium difficile, a type of diarrhea caused by the overuse of antibiotics, as well as infections stemming from colon surgeries and hysterectomies.

The Tennessee Hospital Association has led a statewide effort among hospitals to share best practices at preventing these infections. Hospitals are in a race against organisms that are increasingly becoming resistant to antibiotics — a scenario that medical experts say is caused by the overuse of antibiotics. Doctors in Tennessee prescribe antibiotics at the third-highest rate in the nation.

"What's really disturbing is Alaska, Hawaii and California consumed less than half compared to Tennessee," Kainer said. "We use double what California, Alaska and Hawaii use per capita."

She also pointed out that among the 10 states involved in a federally sponsored project to track emerging infections, Tennessee hospitals administered more antibiotics than their counterparts. One factor is Tennessee's problem with catheter-assisted urinary tract infections among patients in intensive-care units.

Catheter risks

Chris Clarke with the Tennessee Hospital Association said curbing urinary infections has been a more challenging task than preventing bloodstream infections for many hospitals.

"We need to view a urinary catheter as a risk device rather than a convenience device," Clarke said. "That's a change of mindset."

Health-care providers think of catheters as a way to carefully monitor kidney function or a means to prevent bedsores, she said, but in many cases they don't focus enough on the infection risks. Hospitals also may be needlessly using catheters on patients who can walk around and be keeping them in patients longer than necessary, said Kainer and Clarke.

Ten hospitals in this state, including Saint Thomas West and Saint Thomas Midtown, reported these urinary infections at rates significantly higher than the national standard.

"In our ongoing effort at driving hospital-acquired infections to zero, we have created a specific high-reliability work group focused on catheter-assisted urinary tract infections," said Rebecca Climer, a spokeswoman for Saint Thomas Health. Over the past four to six months, Saint Thomas has seen a significant decrease in the infection rate, she said.

Clostridium difficile diarrhea, which can be life threatening, is a common problem in hospitals and nursing homes. Skyline Medical Center had cases significantly higher than the national standard in the latest state report.

Stephanie Bowen, a spokeswoman for Skyline, said more recent data show an improvement in infection rates. She said the hospital has taken steps such as dedicating a pharmacist to review antibiotic use and using a more sensitive test for earlier diagnosis.

"As with all quality improvement efforts, this is a continual process, and we will remain vigilant," she said.

Tennessee infection fight

The state has made great progress in some areas but still faces challenges in other hospital safety measures.

THE Good

• Tennessee hospitals have a bloodstream infection rate 49 percent better than the national standard in adult hospitals and 66 percent better than the national standard in children's hospitals.

• Surgical site infections with heart bypass surgery are 50 percent better than the national standard.

• Tennessee hospitals also surpass the national standard for a type of antibiotic-related diarrhea by 77 percent.

THE Bad

• Tennessee hospitals report catheter-assisted urinary tract infections at a rate 40 percent higher than the national standard.

• Tennessee hospitals have a MRSA infection rate 12 percent higher than the national standard.

— Tennessee Department of Health

The good news

Bloodstream infections

Tennessee hospitals have made great strides in preventing bloodstream infections. None had an infection ratio significantly worse than the national standard, and six scored significantly better:

• Vanderbilt University Medical Center

• Monroe Carell Jr. Children's Hospital at Vanderbilt

• Le Bonheur Children's Hospital

• Methodist University Hospital

• Jackson-Madison County General Hospital

• University of Tennessee Medical Center

— Tennessee Department of Health

The bad news

Catheter-related urinary infections

Tennessee hospitals are not doing a good job at preventing catheter-related urinary tract infections. Ten hospitals were redlined for infection ratios significantly higher than the national standard:

• Erlanger Medical Center

• Fort Sanders Regional Medical Center

• Holston Valley Medical Center

• Methodist Healthcare South

• Methodist University Hospital

• Physicians' Regional Medical Center

• Regional One Health

• Saint Thomas Midtown

• Saint Thomas West

• University of Tennessee Medical Center

Colon surgery infections

While the overall infection ratio for colon surgery is in line with the national standard, two hospitals had significantly higher cases:

• Jackson-Madison County General Hospital

• University of Tennessee Medical Center

Methicillin-resistant staphylococcus aureus (MRSA)

MRSA infections at Tennessee hospitals are 12 percent higher than the national standard. Two hospitals had infection ratios significantly higher:

• Baptist Memorial Hospital Memphis

• Regional One Health Memphis

Clostridium difficile infections

Clostridium difficile is a serious type of diarrhea that occurs when overuse of antibiotics has killed good bacteria within the digestive system. While the incidence of this diarrhea in Tennessee is 23 percent lower than the national standard, some hospitals have reported cases significantly higher than the baseline:

• Skyline Medical Center

• St. Jude Children's Research Hospital

— Tennessee Department of Health

Getting sickin the hospital

In the first six months of 2013, thousands of Tennessee hospital patients caught health-care-acquired infections.

1,066 - Clostridium difficile

488 - Catheter-related urinary infections

202 - Bloodstream infections

170 - MRSA

121 - Colon surgery infections

29 - Hysterectomy infections

21 - Heart bypass infections

— Tennessee Department of Health

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