Hostname: page-component-76fb5796d-vvkck Total loading time: 0 Render date: 2024-04-26T16:08:48.708Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Correlates of Surveillance Events Detected by National Healthcare Safety Network Pneumonia and Lower Respiratory Infection Definitions—Pennsylvania, 2011–2012

Published online by Cambridge University Press:  13 April 2016

Isaac See ,
Julia Chang ,
Nicole Gualandi ,
Genevieve L. Buser ,
Pamela Rohrbach ,
Debra A. Smeltz ,
Mary Jo Bellush ,
Susan E. Coffin ,
Jane M. Gould  and
Debra Hess
...Show all authors
Isaac See*
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA
Julia Chang
Affiliation:
UCLA Geffen School of Medicine, Los Angeles, California
Nicole Gualandi
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
Genevieve L. Buser
Affiliation:
Epidemic Intelligence Service, Center for Surveillance, Epidemiology and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA Oregon Health Authority, Portland, Oregon
Pamela Rohrbach
Affiliation:
Pennsylvania Department of Health, Harrisburg, Pennsylvania
Debra A. Smeltz
Affiliation:
Pennsylvania Department of Health, Harrisburg, Pennsylvania
Mary Jo Bellush
Affiliation:
Excela Health Westmoreland Hospital, Greensburg, Pennsylvania
Susan E. Coffin
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Jane M. Gould
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Debra Hess
Affiliation:
Lancaster General Hospital, Lancaster, PA
Patricia Hennessey
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Sydney Hubbard
Affiliation:
The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
Andrea Kiernan
Affiliation:
St. Christopher’s Hospital for Children, Philadelphia, Pennsylvania
Judith O’Donnell
Affiliation:
Pennsylvania Presbyterian Medical Center, Philadelphia, Pennsylvania
David A. Pegues
Affiliation:
University of Pennsylvania Health System, Philadelphia, Pennsylvania
Jeffrey R. Miller
Affiliation:
Office of Public Health Preparedness and Response, CDC, assigned to the Pennsylvania Department of Health, Harrisburg, Pennsylvania
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Address correspondence to Isaac See, MD, 1600 Clifton Road, MS A-16, Atlanta, GA 30329-4027 (isee@cdc.gov).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To determine the clinical diagnoses associated with the National Healthcare Safety Network (NHSN) pneumonia (PNEU) or lower respiratory infection (LRI) surveillance events

DESIGN

Retrospective chart review

SETTING

A convenience sample of 8 acute-care hospitals in Pennsylvania

PATIENTS

All patients hospitalized during 2011–2012

METHODS

Medical records were reviewed from a random sample of patients reported to the NHSN to have PNEU or LRI, excluding adults with ventilator-associated PNEU. Documented clinical diagnoses corresponding temporally to the PNEU and LRI events were recorded.

RESULTS

We reviewed 250 (30%) of 838 eligible PNEU and LRI events reported to the NHSN; 29 reported events (12%) fulfilled neither PNEU nor LRI case criteria. Differences interpreting radiology reports accounted for most misclassifications. Of 81 PNEU events in adults not on mechanical ventilation, 84% had clinician-diagnosed pneumonia; of these, 25% were attributed to aspiration. Of 43 adult LRI, 88% were in mechanically ventilated patients and 35% had no corresponding clinical diagnosis (infectious or noninfectious) documented at the time of LRI. Of 36 pediatric PNEU events, 72% were ventilator associated, and 70% corresponded to a clinical pneumonia diagnosis. Of 61 pediatric LRI patients, 84% were mechanically ventilated and 21% had no corresponding clinical diagnosis documented.

CONCLUSIONS

In adults not on mechanical ventilation and in children, most NHSN-defined PNEU events corresponded with compatible clinical conditions documented in the medical record. In contrast, NHSN LRI events often did not. As a result, substantial modifications to the LRI definitions were implemented in 2015.

Infect Control Hosp Epidemiol 2016;37:818–824

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 7 , July 2016 , pp. 818 - 824
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

PREVIOUS PRESENTATION: This study was presented in part in abstract 894 at the 2014 IDWeek conference, Philadelphia, Pennsylvania, on October 10, 2014.

References

REFERENCES

1. Magill, SS, Edwards, JR, Bamberg, W, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med 2014;370:1198–1208.CrossRefGoogle ScholarPubMed
2. Davis, J, Finley, E. The breadth of hospital-acquired pneumonia: nonventilated versus ventilated patients in Pennsylvania. Pennsylvania Patient Safety Authority 2012;9:99–105.Google Scholar
3. Weber, DJ, Sickbert-Bennett, EE, Brown, V, Rutala, WA. Completeness of surveillance data reported by the National Healthcare Safety Network: an analysis of healthcare-associated infections ascertained in a tertiary care hospital, 2010. Infect Control Hosp Epidemiol 2012;33:94–96.Google Scholar
4. Klompas, M, Platt, R. Ventilator-associated pneumonia—the wrong quality measure for benchmarking. Ann Intern Med 2007;147:803–805.CrossRefGoogle ScholarPubMed
5. Klompas, M, Kulldroff, M, Platt, R. Risk of misleading ventilator-associated pneumonia rates with use of standard clinical and microbiological criteria. Clin Infect Dis 2008;46:1443–1446.Google Scholar
6. Meduri, GU, Wunderink, RG, Leeper, KV Jr, et al. Causes of fever and pulmonary densities in patients with clinical manifestations of ventilator-associated pneumonia. Chest 1994;106:221–235.CrossRefGoogle ScholarPubMed
7. Klompas, M. The paradox of ventilator-associated pneumonia prevention measures. Crit Care 2009;13:315.CrossRefGoogle ScholarPubMed
8. Magill, SS, Klompas, M, Balk, R, et al. Developing a new, national approach to surveillance for ventilator-associated events: executive summary. Clin Infect Dis 2013;57:1742–1746.CrossRefGoogle ScholarPubMed
9. Klompas, M. Complications of mechanical ventilation—the CDC’s new surveillance paradigm. N Engl J Med 2013;368:1472–1475.Google Scholar
10. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309–332.CrossRefGoogle ScholarPubMed
11. Act 52. Pennsylvania Patient Safety Authority website. http://patientsafetyauthority.org/PatientSafetyAuthority/Governance/Pages/Act52.aspx. Accessed February 5, 2015.Google Scholar
12. Centers for Disease Control and Prevention. Chapter 10. Ventilator-Associated Event (VAE). 2013 National Healthcare Safety Network Patient Safety Manual.Google Scholar
13. De Latorre, FJ, Pont, T, Ferrer, A, Rossello, J, Palomar, M, Planas, M. Pattern of tracheal colonization during mechanical ventilation. Am J Respir Crit Care Med 1995;152(3):1028–1033.Google Scholar
14. Canadian Critical Care Trials Group. A randomized trial of diagnostic techniques for ventilator-associated pneumonia. N Engl J Med 2006;355:2619–2630.Google Scholar
15. Durairaj, L, Mohamad, Z, Launspach, JL, et al. Patterns and density of early tracheal colonization in intensive care unit patients. J Crit Care 2009;24:114–121.Google Scholar
16. CDC/NHSN surveillance definitions for specific types of infections. http://www.cdc.gov/nhsn/PDFs/pscManual/17pscNosInfDef_current.pdf. Accessed June 30, 2015.Google Scholar
17. Guidelines for preventing health-care—associated pneumonia, 2003. Recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee. http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5303a1.htm. Published 2003. Accessed June 30, 2015.Google Scholar