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To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15–1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, −25%; IQR, −20% to −29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%–105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, −15%; IQR, −14% to −21%) and decreased the SIR at all hospitals (median, −8%; IQR, −4% to −11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.
Healthcare-associated infection reporting validation is essential because this information is increasingly used in public healthcare quality assurances and care reimbursement. Washington State’s validation of central line-associated bloodstream infection reporting applies credible quality sciences methods to ensure that hospital reporting accuracy is maintained. This paper details findings and costs from our experience.
The government publishes 3 different public report surgical site infection (SSI) metrics, all called standardized infection ratios (SIRs), that impact perceived hospital quality. We conducted a non-random cross-sectional observational pilot study of 20 California hospitals that voluntarily submitted colon surgery and SSI data. Discordant SIR values, leading to contradictory conclusions, occurred in 35% of these hospitals.
Little is known about postdischarge surveillance practices currently in place among American hospitals. This survey describes practices used by acute care hospitals covered by Washington State's legislated mandate for public reporting of surgical site infections. While the vast majority of facilities use multiple techniques, wide variation in practices was discovered.
The standardized infection ratio (SIR) is an indirectly standardized morbidity ratio that has been used to compare the infection rate in a hospital with an expected number of infections from a national standard and is being increasingly promoted as a metric for the public reporting of healthcare-associated infections (HAIs).
To identify potential discrepancies between SIR and other measures of risk.
Hypothetical and real data were compared using relative risk, a directly standardized morbidity ratio, and SIR values across a range of varying hospital population compositions.
In real and hypothetical data, other summary statistics were consistent with each other and with underlying HAI incidence density rates. However, use of the SIR frequently led to conclusions inconsistent with these other inherently unbiased estimators.
Because of a recognized type of distortion inherent in the calculation of indirectly standardized ratios, use of the SIR can lead to conclusions that differ from those reached when using other traditional measures of risk and to incorrect assessments of conclusions about the performance of hospitals or states. In addition, the tendency to inappropriately arrange SIR values in rank order for comparison makes SIR unsuitable as a statewide metric for monitoring HAIs.
L’arbre. Les arbres du genre Carapa (Meliaceae) sont
présents dans toutes les forêts d’Afrique tropicale au niveau de l’équateur, du rift
d’Albertine jusqu’au Sénégal et au Mali pour sa distribution la plus septentrionale. En
Afrique comme en Amérique tropicale, le carapa est une source importante de Produits
Forestiers ligneux (bois) et Non-Ligneux (PFNL). Le fruit et les graines. Le
fruit typique de carapa est une capsule à quatre ou cinq valves qui renferment chacune
deux à cinq graines, soit un total de huit à vingt graines par fruit. L’extraction
de l’huile. Les villageois ramassent les graines tombées au sol avant qu’elles ne
soient parasitées ou germées, ce qui est défavorable à la production d’une huile de
qualité. L’extraction de l’huile se fait par ébouillantage des graines. L’huile extraite,
polyvalente, est la substance issue de la plante qui est la plus utilisée devant les
extraits de feuilles, d’écorce et de racines. Le marché. En Afrique, le
commerce de l’huile de carapa est essentiellement local et reste une activité très
marginale. Une demande accrue émane toutefois de l’utilisation de cette huile comme
insecticide naturel dans la culture du coton biologique. Discussion. Compte
tenu du potentiel économique de l’huile de carapa, sa commercialisation devrait respecter
une rétribution équitable des paysannes afin de mieux rentabiliser la production. Des
mesures de protection des arbres de carapa et de leur habitat doivent également être
prises pour permettre une gestion de la production d’huile à long terme. La plantation
semble être une option durable en vue de la conservation des peuplements naturels de
Analysis of variance (ANOVA) is used to prevent inflated type I error when hypothesis testing involves comparing more than two groups. If an ANOVA result indicates a statistically significant difference exists somewhere within, the next task is to discover exactly which combination or combinations of those groups account for the significant difference. Among many methods available for that exploration, orthogonal contrasts and relatively simple graphs are noteworthy (Infect Control Hosp Epidemiol 2003;24:544-547).
The Canadian Institute for Health Information (CIHI) maintains databases to report independently on the health of Canadians and the performance of their healthcare system. CIHI recently received funding to improve indicator development for tracking quality, because in Canada we really have very few data that allow us to make comparable observations down to a regional or institution-specific interest level. We have a long way to go, and we recognize that collaboration and partnership is the only way that this development will move ahead.
SHEA and the American Society for Quality's Health Care Division have been collaborating in areas of common concern to improve healthcare quality. We each possess a heritage of different but complementary approaches and stand a better chance of success together than apart. This presentation describes rapid growth of our interdisciplinary, international, special interest group and progress made thus far, as well as challenges facing hospital epidemiologists and quality improvement professionals.
Change must begin with education. Theme 8 explored issues that need attention in Disaster Medicine education.
Details of the methods used are provided in the introductory paper. The chairs moderated all presentations and produced a summary that was presented to an assembly of all of the delegates. The chairs then presided over a workshop that resulted in the generation of a set of action plans that then were reported to the collective group of all delegates.
Main points developed during the presentations and discussion included: (1) formal education, (2) standardized definitions, (3) integration (4) evaluation of programs and interventions, (5) international cooperation, (6) identifying the psychosocial consequences of disaster, (7) meaningful research, and (8) hazard, impact, risk and vulnerability analysis.
Three main components of the action plans were identified as evaluation, research, and education. The action plans recommended that: (1) education on disasters should be formalized, (2) evaluation of education and interventions must be improved, and (3) meaningful research should be promulgated and published for use at multiple levels and that applied research techniques be the subject of future conferences.
The one unanimous conclusion was that we need more and better education on the disaster phenomenon, both in its impacts and in our response to them. Such education must be increasingly evidence-based.
This article focuses on the selection and interpretation of diagnostic tests, emphasizing the importance of understanding how their mathematical parameters affect the information they provide in various settings. The utility and limitations of sensitivity, specificity, predictive value, and receiver operating characteristic (ROC) curves are discussed using catheter-related bloodstream infections as an example. ROC curves have been used for selecting optimal cutoff values for a positive result and for selecting among several alternative diagnostic tests. For example, 16 different tests have been proposed for diagnosis of catheter-related bloodstream infection; ROC analysis provides an effective way to determine which test offers the best overall performance.