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Comparison of Hospitalwide Surveillance and Targeted Intensive Care Unit Surveillance of Healthcare-Associated Infections

Published online by Cambridge University Press:  02 January 2015

David J. Weber ,
Emily E. Sickbert-Bennett ,
Vickie Brown  and
William A. Rutala
David J. Weber*
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
Emily E. Sickbert-Bennett
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
Vickie Brown
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina
William A. Rutala
Affiliation:
Department of Hospital Epidemiology, University of North Carolina Health Care System, Chapel Hill, North Carolina Division of Infectious Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
*
CB #7030, 130 Mason Farm Road, UNC at Chapel Hill, Chapel Hill, NC 27599-7030 (dweber@unch.unc.edu)
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Abstract

Objectives.

To assess the surveillance coverage obtained with Centers for Disease Control and Prevention (CDC)-recommended surveillance of healthcare-associated infections (HAIs), which is focused on intensive care units (ICUs) and emphasizes device-related infections (ie, those associated with central venous catheters, ventilators, and/or urinary catheters), compared with the surveillance coverage achieved by comprehensive hospitalwide surveillance. In addition, we assessed whether the infection rates in step-down units more resemble those in wards or ICUs.

Methods.

Review of prospectively obtained, comprehensive hospitalwide surveillance data from 2004 through 2005 for an acute care tertiary care hospital with approximately 700 beds. Surveillance data was obtained by trained infection control professionals using standard CDC criteria for HAIs.

Results.

CDC-recommended ICU surveillance for catheter-related bloodstream infection (BSI) and ventilator-associated pneumonia would have detected only 87 (21.4%) of 407 catheter-related BSIs and only 66 (37.9%) of 174 respiratory tract infections that occurred in the medical and surgical services. Only 31 (34.8%) of 89 infections caused by methicillin-resistant Staphylococcus aureus and 7 (31.8%) of 22 infections caused by vancomycin-resistant Enterococcus occurred in our adult ICUs.

Conclusions.

Rates of HAIs were highest in the ICUs, intermediate in step-down units, and lowest in the wards. The rates of infections in the step-down units were more similar to those in the wards than to those in the ICUs. To prevent HAIs, more comprehensive surveillance may be indicated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 28 , Issue 12 , December 2007 , pp. 1361 - 1366
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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References

1.Centers for Disease Control and Prevention. Estimates of healthcare-associated infections. Available at: http://www.cdc.gov/ncidod/dhqp/hai.html. Accessed October 15, 2007.Google Scholar
2.Wenzel, RP, Edmond, MB. The impact of hospital-acquired bloodstream infections. Emerg Infect Dis 2001;7:174–177.Google Scholar
3.Gaynes, R, Richards, C, Edwards, J, et al. Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295–298.CrossRefGoogle ScholarPubMed
4.Boyce, JM, Pittet, D; Healthcare Infection Control Practices Advisory Committee; HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Guidelines for hand hygiene in health-care settings. MMWR Recomm Rep 2002;51(RR-16):1–45.Google ScholarPubMed
5.Garner, JS. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.CrossRefGoogle ScholarPubMed
6.Centers for Disease Control and Prevention. Monitoring hospital-acquired infections to promote patient safety—United States, 1990-1999. MMWR Morb Mortal Wkly Rep 2000;49:149–153.Google Scholar
7.Richards, C, Emori, TG, Edwards, J, Fridkin, S, Tolson, J, Gaynes, R. Characteristics of hospitals and infection control professionals participating in the National Nosocomial Infections Surveillance System 1999. Am J Infect Control 2001;29:400–403.CrossRefGoogle ScholarPubMed
8.Burke, JP. Infection control—a problem for patient safety. New Engl J Med 2003;348:651–656.CrossRefGoogle ScholarPubMed
9.Weinstein, RA. Nosocomial infection update. Emerg Infect Dis 1998;4 416–420Google Scholar
10.Jarvis, WR. Infection control and changing health-care delivery systems. Emerg Infect Dis 2001;7:170–173.Google Scholar
11.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infection, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
12.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606–608.CrossRefGoogle ScholarPubMed
13.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Baltimore: Lipincott, Williams & Wilkins 1659–1702.Google Scholar
14.Emori, TG, Culver, DH, Horan, TC, et al. National nosocomial infections surveillance systems (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
15.Thompson, RL. Surveillance and reporting of nosocomial infections. In: RP, Wenzel, ed. Prevention and Control of Nosoocomial Infections. Baltimore: Lipincott, Williams & Wilkins; 1987:70–82.Google Scholar
16.Centers for Disease Control and Prevention. National Nosocomial Infection Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004;32:470–485.CrossRefGoogle Scholar
17.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
18.Kohn, LT, Corrigan, JM, Donaldson, MS (Institute of Medicine). To Err is Human: Building a Safer Health System. Washington, DC: National Academy Press; 2000.Google Scholar
19.Smolinski, MS, Hamburg, MA, Lederberg, J (Institute of Medicine). Microbial Threats to Health. Washington, DC: National Academy Press; 2003.Google Scholar
20.McCannon, CJ, Schall, MW, Calkins, DR, Nazem, AG. Saving 100,000 lives in US hospitals. BMJ 2006;332:1328–1330.CrossRefGoogle Scholar
21.Berwick, DM, Calkins, DR, McCannon, CJ, Hackbarth, AD. The 100,000 Lives campaign. JAMA 2006;295:324–327.Google Scholar
22.Climo, M, Diekema, D, Warren, DK, et al. Prevalence of the use of central venous access devices within and outside of the intensive care unit: results of a survey among hospitals in the prevention epicenter program of the Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 2003;24:942–945.Google Scholar