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Case-Mix Adjustment Approach to Benchmarking Prevalence Rates of Nosocomial Infection in Hospitals in Cyprus and Greece

Published online by Cambridge University Press:  02 January 2015

Evangelos I. Kritsotakis
Affiliation:
Laboratory of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University of Crete, Crete, Greece
Ioannis Dimitriadis
Affiliation:
Department of Pneumonology, General Hospital of Larnaca, Cyprus
Maria Roumbelaki
Affiliation:
Infection Control Unit, University Hospital of Heraklion, Crete, Greece
Emelia Vounou
Affiliation:
Department of Internal Medicine, Limassol General Hospital, Cyprus
Maria Kontou
Affiliation:
Department of Internal Medicine, Nicosia General Hospital, Cyprus
Panikos Papakyriakou
Affiliation:
Department of Internal Medicine, General Hospital of Pafos, Cyprus
Maria Koliou-Mazeri
Affiliation:
Infectious Diseases and Immunology Unit, Archbishop Makarios Hospital of Nicosia, Cyprus
Ioannis Varthalitis
Affiliation:
Department of Oncology, General Hospital of Chania, Crete, Greece
George Vrouchos
Affiliation:
Intensive Care Unit, “Venizelion” General Hospital, Crete, Greece
George Troulakis
Affiliation:
Intensive Care Unit, General Hospital of Agios Nikolaos, Crete, Greece
Achilleas Gikas
Affiliation:
Laboratory of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University of Crete, Crete, Greece
Corresponding
E-mail address:

Abstract

Objective.

To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection.

Design.

Cross-sectional survey.

Setting.

Eleven hospitals located in Cyprus and in the region of Crete in Greece.

Methods.

The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe- Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.

Results.

The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%–8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%–9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1–6.1]).

Conclusion.

The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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