A Decade of Prevalence Surveys in a Tertiary-Care Center: Trends in Nosocomial Infection Rates, Device Utilization, and Patient Acuity

1999 ◽  
Vol 20 (8) ◽  
pp. 543-548 ◽  
Author(s):  
Jeffrey W. Weinstein ◽  
Dorothy Mazon ◽  
Elizabeth Pantelick ◽  
Patricia Reagan-Cirincione ◽  
Louise M. Dembry ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Bloodstream Infection ◽  
Acute Care ◽  
Nosocomial Infections ◽  
Tertiary Care ◽  
Infection Rates ◽  
Nosocomial Bloodstream Infection ◽  
Abnormal Laboratory ◽  
Infection Surveillance ◽  
The Mean

AbstractObjective:To evaluate the usefulness of repeated prevalence surveys to determine trends in the rates of nosocomial infections and to detect changes in risk factors (eg, use of invasive devices) associated with nosocomial infections.Patients And Methods:Ten annual prevalence surveys were conducted by trained infection control practitioners between 1985 and 1995 for acute-care patients on the medical, surgical, pediatric, and obstetric-gynecologic services at a 900-bed, tertiary-care, teaching hospital with 750 acute-care beds. The same methods of chart review and concurrent reporting from nursing, the microbiology and clinical laboratory, and the pharmacy were used each year to collect data on the prevalence of nosocomial infections, invasive-device utilization, and abnormal laboratory indicators. Although data were collected on a single day, a period-prevalence study approach was used, because charts were reviewed for any infection data occurring within the 7 days prior to the survey.Results:The hospital census for acute-care patients, as measured by the prevalence surveys, declined sharply over the 10 years, from 673 to 575 patients (P=.02). However, the medical service census increased from 150 to 188 patients (P=.01). During the same period, there was a significant decrease in the mean length of stay, from 7.3 to 6.0 days (P=.01), and a concomitant increase in the mean diagnosis-related-group case-mix index, from 1.03 to 1.24 (P=.001). Overall, nosocomial infection rates remained unchanged over the study period (mean of 9.85 infections per 100 patients), but rates of nosocomial bloodstream infection increased from 0.0% in 1985 to 2.3% in 1995 (P=.05). Nosocomial infection rates were significantly higher on the medical and surgical services than on other services (P<.001). Utilization rates increased significantly for Foley catheters (9.0% to 16.0%, P=.002) and ventilators (5.0% to 8.0%, P=.05).Conclusions:Despite apparent increases in the severity of illness of our patients, overall rates of nosocomial infection remained stable during a decade of study. Rates of nosocomial bloodstream infection increased, in parallel with National Nosocomial Infection Surveillance System data. We found repeated prevalence surveys to be useful in following trends and rates of infection, device utilization, and abnormal laboratory values among patients at our institution. Such methodologies can be valuable and low-cost components of a comprehensive infection surveillance, prevention, and control program and other potential quality-improvement initiatives, because they enable better annual planning of departmental strategies to meet hospital needs

Device-Associated Nosocomial Infection Rates in Turkish Medical-Surgical Intensive Care Units

2006 ◽  
Vol 27 (4) ◽  
pp. 343-348 ◽  
Author(s):  
Dilara Inan ◽  
Rabin Saba ◽  
Ata Nevzat Yalcin ◽  
Murat Yilmaz ◽  
Gozde Ongut ◽  
...  
Keyword(s):  
Intensive Care ◽  
Urinary Tract ◽  
Nosocomial Infection ◽  
Infection Rate ◽  
Nosocomial Infections ◽  
University Hospital ◽  
Infection Rates ◽  
Surgical Intensive Care ◽  
The Mean ◽  
Device Associated Infection

Objective.To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates.Design.Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions.Setting.Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey.Patients.All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission.Results.Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter–days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line–days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases).Conclusion.We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.

Analysis of Hospital Infection Surveillance Data

1984 ◽  
Vol 5 (7) ◽  
pp. 332-338 ◽  
Author(s):  
David Birnbaum
Keyword(s):  
Nosocomial Infection ◽  
Infection Control ◽  
Data Processing ◽  
Acute Care ◽  
Cost Effective ◽  
Cross Infection ◽  
Infection Site ◽  
Infection Rates ◽  
Infection Surveillance ◽  
Surveillance Programs

AbstractHow often infection rates should be calculated and how large a change is required for “significance” are pertinent questions in nosocomial infection surveillance programs. A method is presented which establishes outbreak threshold infection frequencies. Comparison is direct and immediate: computation of rates or use of electronic data processing is not required. We have validated this method, using computer systems, by comparing the distributions of mean weekly incidence and prevalence statistics for each ward by nosocomial infection site in an acute care general hospital against both our theoretical outbreak threshold limits and the distribution of proven infection outbreaks. Sensitive and specific distinction between random variation or sporadic cross-infection and true persisting outbreaks requiring intervention is obtained. This approach provides a simple and timely alternative to intuitive after-the-fact interpretation of infection patterns which is applicable to infection surveillance and cost-effective infection control in hospitals of all sizes.

Surveillance Objectives: Descriptive Epidemiology

1987 ◽  
Vol 8 (11) ◽  
pp. 454-458 ◽  
Author(s):  
Frank S. Rhame
Keyword(s):  
Nosocomial Infection ◽  
Infectious Diseases ◽  
Gold Standard ◽  
Medical Records ◽  
Infection Rates ◽  
High Quality Research ◽  
Clinical Events ◽  
Infection Surveillance ◽  
Weak Evidence ◽  
Feedback Data

This paper addresses the problems associated with defining and classifying events as nosocomial infections, discusses the methods by which rates of nosocomial infection are calculated and their rationales, and presents some specific rates useful in nosocomial epidemiology. Previously unpublished data demonstrate important differences between antibiotic susceptibility tallies produced by clinical laboratories and similar tallies derived from nosocomial infection surveillance data.Conversion of real world events into categorical data presents formidable difficulties. Surveillance personnel must classify a given series of clinical events as 0,1, or more infections and make a determination as to whether each infection is nosocomial or community acquired. High-quality research studies to validate these efforts should compare the sensitivity and specificity of methods used to some “gold standard.” The gold standard is usually a review of medical records or patients by an infectious diseases physician. But even the standard is flawed. In clinical practice this flaw presents less of a problem because therapy for infectious diseases is generally quite safe and may be instituted when the probability of infection is 10%, 5%, or even lower. For surveillance purposes a higher standard is required, which is particularly important when surveillance information is used to provide feedback data to physicians who understandably bridle at overestimates of infection rates in their patients. The overestimation of infections based on weak evidence under-cuts feedback efforts.

Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Jona Gjevori ◽  
Kahina Abdesselam
Keyword(s):  
Public Health ◽  
Staphylococcus Aureus ◽  
Nosocomial Infection ◽  
Bloodstream Infection ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Incidence Rates ◽  
Surveillance Program ◽  
Methicillin Resistant ◽  
Infection Surveillance ◽  
Healthcare Associated

Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.

Impact of International Nosocomial Infection Control Consortium’s multidimensional approach on central line–associated bloodstream infection rates in Bahrain

2019 ◽  
Vol 21 (4) ◽  
pp. 481-489
Author(s):  
Safaa Alkhawaja ◽  
Nermeen Kamal Saeed ◽  
Victor Daniel Rosenthal ◽  
Sana Abdul-Aziz ◽  
Ameena Alsayegh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Infection Control ◽  
Bloodstream Infection ◽  
Infection Rate ◽  
Bloodstream Infections ◽  
Central Line ◽  
Multidimensional Approach ◽  
Infection Rates

Background: Central line–associated bloodstream infections are serious life-threatening infections in the intensive care unit setting. Methods: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line–associated bloodstream infection rates in Bahrain from January 2013 to December 2016, we conducted a prospective, before-after surveillance, cohort, observational study in one intensive care unit in Bahrain. During baseline, we performed outcome and process surveillance of central line–associated bloodstream infection on 2320 intensive care unit patients, applying Centers for Disease Control and Prevention’s National Healthcare Safety Network definitions. During intervention, we implemented IMA through ISOS, including (1) a bundle of infection prevention interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on central line–associated bloodstream infection rates and consequences, and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using a logistic regression model to estimate the effect of the intervention on the central line–associated bloodstream infection rate. Results: During baseline, 672 central line days and 7 central line–associated bloodstream infections were recorded, accounting for 10.4 central line–associated bloodstream infections per 1000 central line days. During intervention, 13,020 central line days and 48 central line–associated bloodstream infections were recorded. After the second year, there was a sustained 89% cumulative central line–associated bloodstream infection rate reduction to 1.2 central line–associated bloodstream infections per 1000 central line days (incidence density rate, 0.11; 95% confidence interval 0.1–0.3; p, 0.001). The average extra length of stay of patients with central line–associated bloodstream infection was 23.3 days, and due to the reduction of central line–associated bloodstream infections, 367 days of hospitalization were saved, amounting to a reduction in hospitalization costs of US$1,100,553. Conclusion: Implementing IMA was associated with a significant reduction in the central line–associated bloodstream infection rate in Bahrain.

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