Skip to main content Accessibility help
×
Home
Hostname: page-component-cf9d5c678-ttsf8 Total loading time: 0.167 Render date: 2021-07-29T16:47:08.125Z Has data issue: true Feature Flags: { "shouldUseShareProductTool": true, "shouldUseHypothesis": true, "isUnsiloEnabled": true, "metricsAbstractViews": false, "figures": true, "newCiteModal": false, "newCitedByModal": true, "newEcommerce": true, "newUsageEvents": true }

Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems

Published online by Cambridge University Press:  02 January 2015

Petra Gastmeier
Affiliation:
Institute of Medical Microbiologyand Hospital Epidemiology, Hannover Medical School, Hannover
Karin Menzel
Affiliation:
Department of Anesthesiology and Intensive Care, Wismar Community Hospital, Wismar
Dorit Sohr
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
Henning Rüden
Affiliation:
Institute of Hygiene and Environmental Medicine, Charité—University Medicine Berlin, Berlin, Germany
Corresponding

Abstract

Background.

Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).

Objective.

To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.

Methods.

This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI.

Results.

During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction.

Conclusion.

The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2007

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.)

References

1.O'Grady, NP, Alexander, M, Dellinger, EP, et al.Guidelines for the prevention of intravascular catheter–related infections. Infect Control Hosp Epidemiol 2002;23:759769.CrossRefGoogle Scholar
2.Tablan, OC, Anderson, LJ, Besser, R, et al.Guidelines for preventing healthcare-associated pneumonia, 2003: recommendations of CDC and the Healthcare Infection Control Practices Advisory Cmmittee. MMWR Recomm Rep 2004;53(RR-3):136.Google Scholar
3.Zuschneid, I, Schwab, F, Geffers, C, Rüden, H, Gastmeier, P. Reduction of central venous catheter associated bloodstream infection through surveillance. Infect Control Hosp Epidemiol 2003;24:501505.CrossRefGoogle ScholarPubMed
4.Emori, TG, Culver, DH, Horan, TC, et al.National Nosocomial Infection Surveillance System (NNIS): description of surveillance methodology. Am J Infect Control 1991;19:1935.CrossRefGoogle Scholar
5.National Nosocomial Infections Surveillance (NNIS). National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992–June 2004, issued October 2004. Am J Infect Control 2004;32:470485.CrossRefGoogle Scholar
6.Gastmeier, P, Geffers, C, Sohr, D, Dettenkofer, M, Daschner, F, Rüden, H. Five years working with the German Nosocomial Infection Surveillance System KISS. Am J Infect Control 2003;31:316321.CrossRefGoogle Scholar
7.Keita-Perse, O, Gaynes, RP. Severity of illness scoring systems to adjust nosocomial infection rates: a review and commentary. Am J Infect Control 1996;24:429434.CrossRefGoogle ScholarPubMed
8.Soufir, L, Timsit, J-F, Mahe, C, Carlet, J, Regnier, B, Chevret, S. Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study. Infect Control Hosp Epidemiol 1999;20:396401.CrossRefGoogle ScholarPubMed
9.Knaus, WA, Draper, EA, Wagner, DP, Zimmermann, JE. APACHE II: A severity of disease classification system. Crit Care Med 1985;13:818829.CrossRefGoogle Scholar
10.Miranda, DR, de Rijk, A. Simplified Therapeutic Intervention Scoring System: the TISS-28 items—results from a multicenter study. Crit Care Med 1996;24:6473.CrossRefGoogle ScholarPubMed
11.Garner, JS, Emori, WR, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128140.CrossRefGoogle ScholarPubMed
12.Fernándes-Crehuet, R, Diaz-Molina, C, de Irala, J, Martinez-Concha, D, Salcedo-Leal, I, Masa-Calles, J. Nosocomial infection in an intensive care unit: identification of risk factors. Infect Control Hosp Epidemiol 1997;18:825830.Google Scholar
13.Bueno-Cavanillas, A, Rodriguez-Contreras, R, Lopez-Luque, A. Usefulness of severity indices in intensive care medicine as a predictor of nosocomial infection risk. Intensive Care Med 1991;17:336339.CrossRefGoogle Scholar
14.Vincent, J-L, Bihari, D, Suter, PM, et al.The prevalence of nosocomial infections in intensive care units in Europe. JAMA 1995;274:639644.CrossRefGoogle Scholar
15.Hurr, H, Bradford Hawley, H, Czachor, J, Markert, R, McCarthy, M. APACHE II and ISS scores as predictors of nosocomial infections in trauma patients. Am J Infect Control 1999;27:7983.CrossRefGoogle ScholarPubMed
16.McCusker, M, Périssé, A, Roghmann, M-C. Severity of illness markers as predictors of nosocomial infection in adult intensive care patients. Am J Infect Control 2002;30:139144.CrossRefGoogle Scholar
17.Girou, E, Pinsard, M, Auriant, I, Canonne, M. Influence of the severity of illness measured by the simplified acute physiology score (SAPS) on occurrence of nosocomial infections in ICU patients. J Hosp Infect 1996;34:131137.CrossRefGoogle ScholarPubMed
18.Joshi, N, Russell Localio, A, Hamory, BH. A predictive risk index for nosocomial pneumonia in the intensive care unit. Am J Med 1992;93:135142.CrossRefGoogle ScholarPubMed
19.de Irala-Estévez, J, Martínez-Concha, D, Días-Molina, C, Masa-Calles, J, Serrano del Castillo, A, Fernández-Crehuet Navajas, R. Comparison of different methodological approaches to identify risk factors of nosocomial infection in intensive care units. Intensive Care Med 2001;27:12541262.CrossRefGoogle ScholarPubMed
20.Torres, A, Aznar, R, Gatell, J, et al.Incidence, risk, and prognosis factors of nosocomial pneumonia in mechanically ventilated patients. Am Rev Respir Dis 1990;142:523528.CrossRefGoogle ScholarPubMed
21.Tejada Artigas, A, Bello Dronda, S, Chacon Valles, E, et al.Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med 2001;29:304309.CrossRefGoogle ScholarPubMed
22.Barsic, B, Beus, I, Marton, E, Himberle, J, Klinar, I. Nosocomal infections in critically ill infectious disease patients: results of a 7-year focal surveillance. Infection 1999;27:1622.CrossRefGoogle Scholar
23. National Reference Center for Surveillance of Nosocomial Infections (Nationales Referenzzentrum für Surveillance von nosokomialen Infektionen [NRZ]). Available at: http://www.nrz-hygiene.de. Accessed August 21, 2005.Google Scholar
24.Mustard, RA, Bohnen, JM, Rosati, C. Pneumonia complicating abdominal sepsis: an independent risk factor for mortality. Arch Surg 1991;126:170175.CrossRefGoogle ScholarPubMed
25.Cunnion, KJ, Weber, DJ, Broadhead, WE, Hanson, LC, Pieper, CF, Rutala, WA. Risk factors for nosocomial pneumonia: comparing adult critical-care populations. Am J Respir Crit Care Med 1996;153:158162.CrossRefGoogle ScholarPubMed
6
Cited by

Send article to Kindle

To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems
Available formats
×

Send article to Dropbox

To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems
Available formats
×

Send article to Google Drive

To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems
Available formats
×
×

Reply to: Submit a response

Please enter your response.

Your details

Please enter a valid email address.

Conflicting interests

Do you have any conflicting interests? *