scholarly journals Improving Risk Adjustment Above Current Centers for Disease Control and Prevention Methodology Using Electronically Available Comorbid Conditions

2016 ◽  
Vol 37 (10) ◽  
pp. 1173-1178 ◽  
Author(s):  
Sarah S. Jackson ◽  
Surbhi Leekha ◽  
Lisa Pineles ◽  
Laurence S. Magder ◽  
Kerri A. Thom ◽  
...  
Keyword(s):  
Renal Transplantation ◽  
Disease Control ◽  
Risk Adjustment ◽  
Surgical Site Infections ◽  
Bivariate Analysis ◽  
Data Repository ◽  
Comorbid Conditions ◽  
C Statistic ◽  
Control And Prevention ◽  
Centers For Disease Control

OBJECTIVETo identify comorbid conditions associated with surgical site infection (SSI) among patients undergoing renal transplantation and improve existing risk adjustment methodology used by the Centers for Disease Control and Prevention National Healthcare Safety Network (NHSN).PATIENTSPatients (≥18 years) who underwent renal transplantation at University of Maryland Medical Center January 1, 2010-December 31, 2011.METHODSTrained infection preventionists reviewed medical records to identify surgical site infections that developed within 30 days after transplantation, using NHSN criteria. Patient demographic characteristics and risk factors for surgical site infections were identified through a central data repository. International Statistical Classification of Disease, Ninth Revision, Clinical Modification codes were used to analyze individual component comorbid conditions and calculate the Charlson and Elixhauser comorbidity indices. These indices were compared with the current NHSN risk adjustment methodology.RESULTSA total of 441 patients were included in the final cohort. In bivariate analysis, the Charlson components of cerebrovascular disease, peripheral vascular disease, and rheumatologic disorders and Elixhauser components of obesity, rheumatoid arthritis, and weight loss were significantly associated with the outcome. A model utilizing the variables from the NHSN methodology had a c-statistic of 0.56 (95% CI, 0.48–0.63), whereas a model that also included comorbidities from the Charlson and Elixhauser indices had a c-statistic of 0.65 (95% CI, 0.58–0.73). The model with all 3 risk adjustment scores performed best and was statistically different from the NHSN model alone, demonstrated by improvement in the c statistic (0.65 vs 0.56).CONCLUSIONRisk adjustment models should incorporate electronically available comorbid conditions.Infect Control Hosp Epidemiol 2016;1–6

scholarly journals The Effect of Adding Comorbidities to Current Centers for Disease Control and Prevention Central-Line–Associated Bloodstream Infection Risk-Adjustment Methodology

2017 ◽  
Vol 38 (9) ◽  
pp. 1019-1024 ◽  
Author(s):  
Sarah S. Jackson ◽  
Surbhi Leekha ◽  
Laurence S. Magder ◽  
Lisa Pineles ◽  
Deverick J. Anderson ◽  
...  
Keyword(s):  
Disease Control ◽  
Bloodstream Infection ◽  
Risk Adjustment ◽  
Central Line ◽  
Case Mix ◽  
Type Model ◽  
Patient Case ◽  
Icu Patients ◽  
Control And Prevention ◽  
Centers For Disease Control

BACKGROUNDRisk adjustment is needed to fairly compare central-line–associated bloodstream infection (CLABSI) rates between hospitals. Until 2017, the Centers for Disease Control and Prevention (CDC) methodology adjusted CLABSI rates only by type of intensive care unit (ICU). The 2017 CDC models also adjust for hospital size and medical school affiliation. We hypothesized that risk adjustment would be improved by including patient demographics and comorbidities from electronically available hospital discharge codes.METHODSUsing a cohort design across 22 hospitals, we analyzed data from ICU patients admitted between January 2012 and December 2013. Demographics and International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) discharge codes were obtained for each patient, and CLABSIs were identified by trained infection preventionists. Models adjusting only for ICU type and for ICU type plus patient case mix were built and compared using discrimination and standardized infection ratio (SIR). Hospitals were ranked by SIR for each model to examine and compare the changes in rank.RESULTSOverall, 85,849 ICU patients were analyzed and 162 (0.2%) developed CLABSI. The significant variables added to the ICU model were coagulopathy, paralysis, renal failure, malnutrition, and age. The C statistics were 0.55 (95% CI, 0.51–0.59) for the ICU-type model and 0.64 (95% CI, 0.60–0.69) for the ICU-type plus patient case-mix model. When the hospitals were ranked by adjusted SIRs, 10 hospitals (45%) changed rank when comorbidity was added to the ICU-type model.CONCLUSIONSOur risk-adjustment model for CLABSI using electronically available comorbidities demonstrated better discrimination than did the CDC model. The CDC should strongly consider comorbidity-based risk adjustment to more accurately compare CLABSI rates across hospitals.Infect Control Hosp Epidemiol 2017;38:1019–1024

scholarly journals Surveying the Surveillance: Surgical Site Infections Excluded by the January 2013 Updated Surveillance Definitions

2014 ◽  
Vol 35 (5) ◽  
pp. 570-573 ◽  
Author(s):  
Kristen V. Dicks ◽  
Sarah S. Lewis ◽  
Michael J. Durkin ◽  
Arthur W. Baker ◽  
Rebekah W. Moehring ◽  
...  
Keyword(s):  
Disease Control ◽  
Surgical Site Infections ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Control And Prevention ◽  
Centers For Disease Control

The updated 2013 Centers for Disease Control and Prevention/National Healthcare Safety Network definitions for surgical site infections (SSIs) reduced the duration of prolonged surveillance from 1 year to 90 days and defined which procedure types require prolonged surveillance. Applying the updated 2013 SSI definitions to cases analyzed using the pre-2013 surveillance definitions excluded 10% of previously identified SSIs.

Using Surveillance Data to Direct Infection Control Efforts to Reduce Surgical-Site Infections Following Clean Abdominal Operations in Japan

2002 ◽  
Vol 23 (7) ◽  
pp. 404-406 ◽  
Author(s):  
Keita Morikane ◽  
Midori Nishioka ◽  
Hisami Tanimura ◽  
Hiroe Noguchi ◽  
Toshiro Konishi ◽  
...  
Keyword(s):  
Infection Control ◽  
Disease Control ◽  
Nosocomial Infections ◽  
Surgical Site Infections ◽  
Surveillance Data ◽  
Control And Prevention ◽  
Abdominal Operations ◽  
Centers For Disease Control ◽  
Clean Contaminated

AbstractWe initiated surveillance for surgical-site infections (SSIs) in a Japanese hospital using Centers for Disease Control and Prevention definitions and the approach of the National Nosocomial Infections Surveillance (NNIS) System. Patients were observed following clean and clean-contaminated abdominal operations. SSI rates were higher than those of the NNIS System, but there was a trend toward decreased SSI rates in the latter half of the study period.

Guideline for Prevention of Surgical Site Infection, 1999

1999 ◽  
Vol 20 (4) ◽  
pp. 247-280 ◽  
Author(s):  
Alicia J. Mangram ◽  
Teresa C. Horan ◽  
Michele L. Pearson ◽  
Leah Christine Silver ◽  
William R. Jarvis ◽  
...  
Keyword(s):  
Surgical Site Infection ◽  
Disease Control ◽  
Surgical Site Infections ◽  
Wound Infections ◽  
Site Infection ◽  
Surgical Wound ◽  
Control And Prevention ◽  
Centers For Disease Control

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

The Speech-Language Pathologists' Role in Mild Traumatic Brain Injury for Middle and High School–Age Children: Viewpoints on Guidelines From the Centers for Disease Control and Prevention

2019 ◽  
Vol 28 (3) ◽  
pp. 1363-1370 ◽  
Author(s):  
Jessica Brown ◽  
Katy O'Brien ◽  
Kelly Knollman-Porter ◽  
Tracey Wallace
Keyword(s):  
High School ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Disease Control ◽  
Mild Traumatic Brain Injury ◽  
School Age Children ◽  
School Age ◽  
Speech Language Pathologists ◽  
Control And Prevention ◽  
Centers For Disease Control

Purpose The Centers for Disease Control and Prevention (CDC) recently released guidelines for rehabilitation professionals regarding the care of children with mild traumatic brain injury (mTBI). Given that mTBI impacts millions of children each year and can be particularly detrimental to children in middle and high school age groups, access to universal recommendations for management of postinjury symptoms is ideal. Method This viewpoint article examines the CDC guidelines and applies these recommendations directly to speech-language pathology practices. In particular, education, assessment, treatment, team management, and ongoing monitoring are discussed. In addition, suggested timelines regarding implementation of services by speech-language pathologists (SLPs) are provided. Specific focus is placed on adolescents (i.e., middle and high school–age children). Results SLPs are critical members of the rehabilitation team working with children with mTBI and should be involved in education, symptom monitoring, and assessment early in the recovery process. SLPs can also provide unique insight into the cognitive and linguistic challenges of these students and can serve to bridge the gap among rehabilitation and school-based professionals, the adolescent with brain injury, and their parents. Conclusion The guidelines provided by the CDC, along with evidence from the field of speech pathology, can guide SLPs to advocate for involvement in the care of adolescents with mTBI. More research is needed to enhance the evidence base for direct assessment and treatment with this population; however, SLPs can use their extensive knowledge and experience working with individuals with traumatic brain injury as a starting point for post-mTBI care.

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