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Practical risk-adjusted quality control charts for infection control

AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 406-414页

作者： Gustafson, TL Infect Control & Prevent Analysts Inc Austin TX 78735 USA

Background: Control chart methodology has been widely touted for monitoring and improving quality in the health care setting. P charts and U charts are frequently recommended for rate and ratio statistics, but their practical value in infection control may be limited because they (1) are not risk-adjusted, and (2) perform poorly with small denominators. The Standardized Infection Ratio is a statistic that overcomes both these obstacles. It is risk-adjusted, and it effectively increases denominators by combining data from multiple risk strata into a single value. Setting: The AICE National Database Initiative is a voluntary consortium of US hospitals ranging in size from 50 to 900 beds. The infection control professional submits monthly risk-stratified data for surgical site infections, ventilator-associated pneumonia, and central line-associated bacteremia. Methods: Run charts were constructed for 51 hospitals submitting data between 1996 and 1998. Traditional hypothesis tests (P values < .05) flagged 128 suspicious points, and participating infection control professionals investigated and categorized each flag as a "real problem" or "background variation." This gold standard was used to compare the performance of 5 unadjusted and 11 risk-adjusted control charts. Results: Unadjusted control charts (C, P, and U charts) performed poorly. Flags based on traditional 3-sigma limits suffered From sensitivity < 50%, whereas 2-sigma limits suffered from specificity < 50%. Risk-adjusted charts based on the Standardized Infection Ratio performed much better The most consistent and useful control chart was the mXmR chart. Under optimal conditions, this chart achieved a sensitivity and specificity > 80%, and a receiver operating characteristic area of 0.84 (P < .00001). Conclusions: These findings suggest a specific statistic (the Standardized Infection Ratio) and specific techniques that could make control charts valuable and practical tools for infection control.

关键词：菌血症/流行病学菌血症/病因学偏倚(流行病学) 交叉感染/流行病学交叉感染/病因学数据说明统计数据库事实型表格和记录管理/标准指导方针(主题) 医院病床数感染控制/组织和管理信息管理/标准病案/标准肺炎/流行病学肺炎/病因学质量控制问卷调查风险调节/组织和管理敏感性与特异性外科伤口感染/流行病学外科伤口感染/病因学美国/流行病学人类

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Implementing and evaluating a rotating surveillance system and infection control guidelines in 4 intensive care units

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 89-93页

作者： Lemmen, SW Zolldann, D Gastmeier, P Lütticken, R Univ Hosp Rhein Westfal TH Aachen Dept Infect Control D-52057 Aachen Germany Free Univ Berlin Inst Hyg D-1000 Berlin Germany Univ Hosp Rhein Westfal TH Aachen Inst Med Microbiol Aachen Germany

Background: In clinical practice, scientific evidence about infection control is often ignored and hygiene rituals are followed. Methods: Within an evidence-based infection control program, a quarterly rotating surveillance program for nosocomial infections was implement ed in 4 intensive care units (ICUs) at the Aachen University Hospital, Germany. Results: For the first time, the unit-specific nosocomial infection situation was made clear to the clinical staff by interpretive feedback of the surveillance data. This led to an increased awareness of infection control and a critical review of hygiene practices. After the first surveillance period, the hygiene practices of each ICU were revised and modified. The Centers for Disease Control and Prevention/Hospital Infection Control Practices Advisory Committee guidelines for the prevention of nosocomial infections were adopted and established in tight collaboration with the ward staff. Conclusions: Within the surveillance process, communication and team spirit between infection control and patient care personnel showed a remarkable improvement. Awareness and compliance with hospital hygiene and infection control practices could be raised without directive interaction.

关键词：医务工作者的态度交叉感染/流行病学交叉感染/病因学交叉感染/预防和控制教育考核循证医学德国坚持准则健康知识态度实践医院大学感染控制/组织和管理感染控制/标准在职培训/组织和管理重症监护病房/组织和管理重症监护病房/标准医务人员医院/教育医务人员医院/心理学模型组织管理护理人员医院/教育护理人员医院/心理学诊疗准则(主题) 规划制订/方法方案评价/方法前瞻性研究问卷调查人类

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Research Priorities Project, year 2000: Establishing a direction for infection control and hospital epidemiology

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第2期29卷 73-78页

作者： Lynch, P Jackson, M Saint, S Epidemiol Associates Seattle WA USA Univ Calif San Diego Med Ctr Dept Educ Dev & Res San Diego CA 92103 USA Univ Michigan Sch Med Ann Arbor MI USA

Background: The field called "infection control" has expanded beyond hospitals to include many health care locations, some aspects of personnel health, elements of noninfectious complications, and occasionally the epidemiology of other problems that occur in care facilities. A research agenda that addresses these newer segments and provides a framework for answering fundamental questions is essential for the field and for the work of The Research Foundation for Prevention of Complications Associated with Health Care (formerly APIC Research Foundation). Methods: We used a multiple-round iterative consensus process (Delphi technique) with 50 experts and a validation round among participants at the 4th Decennial Conference. Results: The expert panel reduced 102 separate items to 21 high-ranked research priorities. The highest-ranked subject areas involved research to improve compliance 4 with excellent practices, to study antibiotic usage and resistance, to measure the financial impact of complications and value of interventions, to perform surveillance of infectious and noninfectious complications across the spectrum of care delivery, and to study effectiveness of interventions to prevent complications at specific sites. There were differences in education and discipline between the expert panel and the 4th Decennial participants and with respect to ranking some of the individual priorities Among respondents from outside the United States and Canada, occupational health issues were ranked more highly. Conclusions: The research priorities provide a blueprint for future progress and will require a collaborative, multicenter, multinational approach.

关键词：医务工作者的态度费用效益分析德尔菲技术流行病学/组织和管理预测基金会/组织和管理卫生工作重点卫生服务研究/组织和管理感染控制/组织和管理需求估价/组织和管理组织目标研究设计全面质量管理/组织和管理成年人老年人人类中年人

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Watching the bottom line: Enhancing the role and impact of infection control in a managed care environment

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第1期28卷 25-29页

作者： Rhinehart, E AIG Consultants Inc Healthcare Management Div Qual Management Serv Atlanta GA 30328 USA

Health care expenditures exceeded $1 trillion in 1997, with projections for $2.2 trillion in expenditures by 2008. Decreasing organizational revenues and efforts to reduce operating costs have had a direct impact on infection control programs. Senior managers in hospitals and other provider organizations are focusing on achieving and maintaining revenues while controlling costs. Infection control professionals must align themselves and their programs with these organizational goals by (1) identifying areas in which the infection control program can support and enhances revenues, (2) facilitating the avoidance of excess costs for care, especially those related to nosocomial infection, (3) identifying opportunities for cost reduction through value analysis, and (4) participating in efforts to measure and prevent other adverse outcomes of care.

关键词：费用控制筹资组织/组织和管理卫生经费支出/统计学和数值数据卫生经费支出/发展趋势感染控制/组织和管理管理医疗规划/组织和管理模型经济计量学结果评价(卫生保健)/组织和管理风险分担财政/组织和管理美国利用情况审核/组织和管理人类

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Staffing requirements for infection control programs in US health care facilities: Delphi project

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第6期30卷 321-333页

作者： O'Boyle, C Jackson, M Henly, SJ Univ Minnesota Sch Nursing Minneapolis MN 55455 USA Univ Calif San Diego Dept Educ Dev & Res Med Ctr La Jolla CA 92093 USA

Background: The guideline for staffing infection control programs of I infection control professional (ICP) for every 250 occupied acute care beds has been used in many health care facilities in the United States since 1985. Since that time, the health care system, patient populations, and expectations about the work of infection prevention and control programs have changed substantially. Methods: The Delphi method was used;data were obtained from a group of ICPs through a series of 10 surveys. Through this iterative process, participant responses were progressively synthesized and areas of agreement and disagreement identified. These surveys were conducted by electronic and paper mail to identify the personal ICP characteristics and structural variables associated with performance of activities required for contemporary infection prevention and control programs in a variety of health care settings. Results: Delphi panel members (n = 32) from 20 states and who represented acute care, long-term care, and community care settings reported tasks in addition to those identified in earlier task analyses as well as expanded responsibilities. Competing responsibilities and lack of adequate resources were the most frequently cited reasons for nonperformance of essential infection control tasks. A ratio of 0.8 to 1.0 ICP for every 100 occupied acute care beds was suggested as adequate staffing by the Delphi panel. Conclusions: Infection control responsibilities have expanded beyond the traditional acute care setting. Recommendations for staffing must not only consider the number of occupied beds (average daily census) but also include the scope of the program, the complexity of the health care facility or system, the characteristics of the patient population, and the unique or urgent needs of the facility and community.

关键词：病床利用率数据收集德尔菲技术卫生设施/组织和管理卫生服务需求医院病床数感染控制/方法感染控制/组织和管理感染控制人员/组织和管理人员配备和时间安排/组织和管理可重复性结果时间因素时间安排美国人类中年人

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Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department

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AMERICAN JOURNAL OF INFECTION CONTROL 2003年第5期31卷 261-265页

作者： Zolldann, D Haefner, H Poetter, C Buzello, S Sohr, D Luetticken, R Lemmen, SW Univ Hosp Aachen Dept Infect Control D-52057 Aachen Germany Univ Hosp Aachen Inst Med Microbiol D-52057 Aachen Germany Free Univ Berlin Inst Hyg D-1000 Berlin Germany Univ Hosp Dept Infect Control Cologne Germany

Background: The implementation of a time- and cost-effective system for the surveillance of the nosocomial infection (NI) is a challenge for infection control practitioners. Objectives: The aim of this study was to assess the sensitivity and the time reduction using a selective surveillance method (SSM) for the detection of NIs in comparison with a reference surveillance method (RSM). Methods: During a 12-month period, surveillance was performed prospectively in 4 intensive care departments on a rotating basis. Using the RSM, NIs were identified by prospective chart reviews performed twice a week combined with weekly infectious disease ward rounds. In the SSM, surveillance was reduced to microbiologic data and participation in the weekly infectious disease ward rounds followed by selective chart review. Results: In all, 578 patients amounting to 3597 patient-days were included in the study. In total, 78 NIs among 56 patients were identified. The overall sensitivity of the SSM compared with the RSM was 93.6% (73 of 78 NIs). The sensitivity of the SSM for the most important device-associated NIs (pneumonia, bloodstream infections, and urinary tract infections) was 96.3% (52 of 54 NIs) and 87.5% (21 of 24 NIs) for other NIs. Time required using the SSM was 1.3 hours compared with 4.1 hours per 10 beds per week (P = .0001) with the RSM. Conclusions: Within our setting, a SSM with restriction to microbiology reports and participation in the infectious disease ward rounds detected NIs with a high sensitivity and a remarkable time reduction.

关键词：交叉感染/诊断交叉感染/流行病学交叉感染/预防和控制德国/流行病学感染控制/组织和管理重症监护病房前瞻性研究敏感性与特异性哨点监测人类中年人

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Expanding the infection control team: Development of the infection control liaison position for the neonatal intensive care unit

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第3期30卷 174-178页

作者： Wright, J Stover, BH Wilkerson, S Bratcher, D Univ Louisville Sch Med Dept Pediat Div Neonatal Med Louisville KY 40292 USA Kosair Childrens Hosp Neonatal Intens Care Unit Louisville KY USA Univ Missouri Kansas City MO 64110 USA Childrens Mem Hosp Dept Pediat Div Infect Dis Kansas City MO USA

Neonatal survival has risen progressively during the past 30 years. As the limits of viability continue to decline, the challenges of providing care to infants at the lowest extremes of gestational age and birth weight continually increase. Nosocomial infections in this very fragile population can be devastating. The complexity of care of these premature infants requires specialized knowledge of the neonate, infectious disease processes, and methods to reduce infection risks in the neonatal intensive care unit. The role of infection control liaison has been established in our institution as an adjunct to meeting this challenge by providing a line of communication between staff, neonatologists, and the infection control team. This article describes the role of the infection control liaison and its overall impact on the infection control program in an 87-bed level II, III, and IV neonatal intensive care unit from 1995 to 1999.

关键词：交叉感染/流行病学交叉感染/病因学医院感染控制/方法感染控制/组织和管理重症监护病房新生儿/人力重症监护病房新生儿/组织和管理肯塔基护理/组织和管理病人医疗小组/组织和管理危险因素人类婴儿新生

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Pediatric Prevention Network: A multicenter collaboration to improve health care outcomes

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第3期29卷 158-161页

作者： Girouard, S Levine, G Goodrich, K Jones, S Keyserling, H Rathore, M Rubens, C Williams, E Jarvis, W Natl Assoc Childrens Hosp & Related Inst Alexandria VA 22314 USA Childrens Hosp & Med Ctr Seattle WA 98105 USA Childrens Healthcare Atlanta Atlanta GA USA Wolfson Childrens Hosp Jacksonville FL USA Ctr Dis Control & Prevent Hosp Infect Program Atlanta GA USA

Nosocomial infections and antimicrobial resistance are major causes of mortality and morbidity and have become a major public health focus. To date, most national and international nosocomial infection surveillance and prevention activities have been focused on adults, despite the fact that pediatric patients are at high risk for nosocomial infections because of their immature immune systems and prevalent device usage. In 1997 the Hospital Infections Program at the Centers for Disease Control and Prevention and the National Association of Children's Hospitals and Related Institutions partnered to establish a Pediatric Prevention Network. Infection control professionals and their hospital administrators at all children's hospitals were invited to participate. The objectives of the network are to establish baseline infection rates;design, implement, and evaluate prevention interventions establish benchmark rates and best practices;and serve as a site for multicenter studies to improve outcomes for hospitalized children. This network serves as a model for quality improvement systems in health care.

关键词：合作行为医院儿科/组织和管理感染控制/组织和管理机构间关系组织目标质量保证卫生保健/组织和管理美国儿童人类

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Reduction in colonization and nosocomial infection by multiresistant bacteria in a neonatal unit after institution of educational measures and restriction in the use of cephalosporins

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AMERICAN JOURNAL OF INFECTION CONTROL 2001年第3期29卷 133-138页

作者： Calil, R Marba, STM von Nowakonski, A Tresoldi, AT State Univ Campinas Neonatal Unit Dept Pediat Fac Med Sci Campinas SP Brazil

Introduction: Previous administration of third-generation cephalosporins predisposes to colonization and infections by multiresistant Enterobacter sp. The emergence of multiresistant bacteria infections in a neonatal unit during 1995, especially Enterobacter cloacae, stimulated this study. Objective: To evaluate the efficacy of measures to control colonization and nosocomial infection by multiresistant bacteria in a neonatal unit. Setting: A tertiary care university hospital. Patients and Methods: This study was conducted from October 1995 through December 1999 in 4 phases: a cross-sectional study, a longitudinal study with intervention measures, monthly cross-sectional studies, and determination of nosocomial infections caused by multiresistant bacteria (oxacillin-resistant Sraphylcoccus aureus and gram-negative bacteria resistant to either aminoglycosides or third-generation cephalosporins). Specimens for surveillance culture were obtained through umbilical and rectal swabs, and tracheal aspirates from intubated babies. The intervention measures were as follows: (1) appropriated training of the whole health care team, emphasizing measures to reduce cross-colonization, and the importance of rational usage of antibiotics and (2) suppression of usage of third-generation cephalosporins. Risk factors were analyzed through univariate and multivariate logistic regression. Results: In the first phase, 32% (10/31) of the patients were colonized by multiresistant bacteria (29% by multiresistant E cloacae). In the second phase, 342 patients were evaluated;33% of them were colonized by E cloacae, and a multiresistant strain was isolated in 10.8% (37/342) of the babies. A logistic regression model indicated parenteral nutrition and antibiotic usage as risk factors for colonization by multiresistant E cloacae. In the third phase, for 6 months, only 2 patients were colonized by multiresistant E cloacae. In the fourth phase, the analysis of bacterial resistance profile indicated

关键词：方差分析细菌感染/流行病学细菌感染/微生物学细菌感染/预防和控制巴西/流行病学头孢菌素类/治疗应用交叉感染/流行病学交叉感染/微生物学交叉感染/预防和控制横断面研究抗药性多药肠杆菌阴沟肠杆菌科感染/流行病学肠杆菌科感染/预防和控制感染控制/组织和管理在职培训重症监护病房新生儿前瞻性研究危险人类婴儿新生

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Infection control in Saudi Arabia: Meeting the challenge

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AMERICAN JOURNAL OF INFECTION CONTROL 2002年第1期30卷 57-65页

作者： Memish, ZA King Fahad Natl Guard Hosp Natl Guard Hlth Affairs Dept Med Riyadh 11426 Saudi Arabia King Fahad Natl Guard Hosp Dept Infect Prevent & Control Riyadh 11426 Saudi Arabia

Hospital-acquired infection poses significant clinical and economic burden worldwide. In the Kingdom of Saudi Arabia, infection control is a young, rapidly growing specialty, An infrastructure to expedite the growth of this important discipline is fast being established. The kingdom faces unique challenges when addressing infection control, which are the subject of this review, Much of the policy-making in domestic infection control is driven by the preventive medicine concerns of the annual pilgrimage (Hajj) to Mecca, which are unparalleled. The Saudi Ministry of Health acts to contain and control public health risks at this gathering of 2 million. Infectious hazards at the Hajj include meningococcal meningitis, respiratory tract infections, bloodborne diseases, and zoonotic diseases, all of which have international ramifications as pilgrimaging Muslims return home, In the wake of the extraordinary pace of modernization in Saudi Arabia, deficiencies in infection control remain, which are slowly being redressed. This review examines the anatomy of infection control and its evolution in the kingdom, Future goals and infection control policy-making are given particular emphasis. Saudi Arabia seeks increasing international partnership in the area of infection control and preventive medicine. The Saudi health care system was formed on the basis of Western models to resounding success. Saudi Arabia is now in a position to provide experience and knowledge in return. International dialogue in the infection control arena is of mutual value. Important public health progress is afoot in this young kingdom, and these advances translate both regionally and on the international platform.

关键词：周年纪念日和特殊事件交叉感染/预防和控制卫生政策/发展趋势感染控制/经济学感染控制/立法和法学感染控制/组织和管理国际合作伊斯兰教公共卫生沙特阿拉伯人类

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