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Participation in nnis facilitates quality improvement
AJIC
April 1992
94 Abstracts POSTER PRESENTATIONS
USING THE NATIONAL NOSOCOMIAL INFECTION SURVEILLANCE SYSTEM TO REDUCE VENTILATORASSOCIATED PNEUMONIAS IN ADULT INTENSIVE CARE UNITS. K. Mullaney, RN, BSN,* A. Adams, RN, BSN, P. McLanglilin, RN, MPH, M. Miller, MD, M. Catalano, MD. Montefiore Medical Center, Bronx, NY. Nosocomial infections are one of the most frequent medical complications affecting patients in intensive care units. In June 1989, our Infection Control Unit (ICU) became a participant in the Adult Intensive Care Unit (ICU) component of the National Nooocomial Infections Surveillance System (NNIS). The overall objective of the surveillance program was to reduce nosocomial infections through feedback of the data to relevant staff. We opted to do surveillance for alternating six-month periods in the Surgical ICU (SICU) and the Medical ICU (MICU). The first two periods of surveillance data in the SICU revealed a ventilator-associated pneumonia rate (VAPR) of 42.66 (per 1,000 ventilator days) and 53.97, respectively; as compared to the NNIS rate of 26.2 (75th percentile). No other site-specific infection rates were different from NNIS' rates. The initial analysis of the MICU yielded a VAPR of 33.42 as compared to NNIS' rate of 17.2 (75th percentile). All other site-specific infection rates were equal to or less than NNIS' 75th percentile rates. Following feedback of the data, each departmental Quality Improvement Committee was requested to develop strategies aimed at decreasing the risk for nosecomial pneumonia. The interventions implemented included: (1) QI monitoring of ventilator tubing and cascade changes, (2) daily changes of ambu bags, (3) QI monitoring of the care of ventilated patients, and (4) the use of contrast media in tube feedings to assess for aspirations. Subsequent surveillance in the SICU and MICU showed VAPRs of 25.77 and 13.9 respectively. These rates were within NNIS' 75th percentile for VAPR, and represented a greater than 50% reduction for VAPRs in the MICU. For both units, the average severity of illness and average length of stay scores remained virtually unchanged, suggesting that the control measures led to the improvement. Participation in the NNIS program, data feedback and control measures helped to achieve lower ventilator-associated pneumonia rates.
PARTICIPATION IN NNIS FACILITATES QUALITY IMPROVEMENT. M. DeCastro, RN, CIC,* J. MacDonald, MD, M. Poole, MD, S. Ragans, RN, E. Votra, RN. Tallahassee Memorial Regional Medical Center, Tallahassee, FL. The Centers for Disease Control's (CDC), National Nosocomial Infection Surveillance System (NNIS) was adopted in our institution in October: 1990. Upon reviewing the March 1991 distribution of the CDC Analysis of 1986-1990 National Data, we identified the need to further investigate our high risk nursery central line associated laboratory confirmed bloodstream infection (LCBI) rate. A breach in the intralipid administration procedure was discovered. The literature associates intralipids with an increased risk of CNS bloodstream infection (BSI). We, therefore, hypothesized the intralipid administration hang time of greater than 12 hours to be the significant risk factor. Reinforcement of the intralipid administration policy and procedure resulted in a dramatic decrease in the LCBI rate from 31.6 per 1000 patient days during the outbreak period, to 4.0 per 1000 patient days over the consecutive eight months. Clearly, the risk of nosocomial BS1 has been reduced for neonates in Our high risk nursery. Overall, participation in the NNIS System has greatly benefited the ability to document quality improvement in this medical center.
HOW TO COMPARE YOUR HOSPITAL'S SURGICAL WOUND INFECTION RATES BY RISK CATEGORY TO NATIONAL BENCHMARK RATES. T. Horan, MPH, CIC,* D. Culver, PhD, R. Gaynes, MD. Hospital Infections Program, Centers for Disease Control, Atlanta, GA. Improvement in the quality of patient care requires proper interpretation of rates of adverse events associated with hospitalization. In the past- year, surgical wound infection (SWI) rates by type of operative procedure and risk index category that are potentially useful as benchmark rates for comparison were published by the National Nosoeomial Infections Surveillance (NNIS) System (Am J Meal 1991; 19 (Suppl 3B):152S-157S). Risk factors included in the index are duration of operation, wound class, and American Society of Anesthesiology (ASA) score (an assessment of preoperative severity of a patient's underlying illness). In order to help evaluate the efficacy of infection control and .prevention efforts aimed at surgical patients, infection control personnel may want to compare their hospital's SWl rates to NNIS SWI rates. Using published NNIS SWI rates and sample hospital data, detailed examples will be given of how to compare SWI rates. Examples will include: (1) overall risk category-specific rates (e.g., SWI rate for all operations on patients having only one risk factor), (2) procedure- and risk category-specific rates (e.g, SWI rate for coronary artery bypass graft (CABG) on patients having only one risk factor), and (3) procedure-specific, risk category-adjusted rates (e.g., an individual surgeon's CABG rate when the distribution of the surgeon's operations in the risk categories is very different from that of the NNIS data). Guidance on interpreting the results of these statistical tests will be given to help infection control personnel influence the quality of patient care in their institutions.
AN INTEGRATED COMPUTER-BASED INFECTION SURVEILLANCE PROGRAM FOR INFECTION CONTROL. K.H. St. John, MS, MT (ASCP). Sacred Heart Medical Center, Chester, PA. The ongoing surveillance of nosocomial infections necessarily involves the extraction of pertinent information found in the patient's medical record. The manual extraction of this information is tedious and time consuming. The infection control surveillance program for the CHARTCOMP system (Electronic Cottage Associates, West Chester, PA) is an on-line relational database incorporating the record-keeping function (abstracts) of the Medical Records department along with shared information from the Utilization/Quality Management department, including credentialing of medical staff and surgical case review. Direct links with the Pharmacy and the Microbiology laboratory computer systems are possible utilizing CH.ARTCOMP's open systems architecture, which is compatible with moot hardware/operating platforms (including UNIX, R/SC, VAX/VMS, UNISYS BIOS/CTOS, and IBM AS/400). The infection control surveillance program can capture abstracted information from the patient's medical record which includes demographics, diagnoses, surgical procedures performed, antibiotics given, laboratory culture information, etc. without tedious data entry by the operator. The application accesses a relational database with the ability to generate reports pre-determined by the operator, calculate incidence ratios based on denominators determined by the system, and analyze trends and interpret threshold values by charts and graphs. Examples of the database screens, patient abstract information, and final reports will be presented. Details of possible interlaces with existing hospital computer systems will be made available along with customization options.
April 1992
94 Abstracts POSTER PRESENTATIONS
USING THE NATIONAL NOSOCOMIAL INFECTION SURVEILLANCE SYSTEM TO REDUCE VENTILATORASSOCIATED PNEUMONIAS IN ADULT INTENSIVE CARE UNITS. K. Mullaney, RN, BSN,* A. Adams, RN, BSN, P. McLanglilin, RN, MPH, M. Miller, MD, M. Catalano, MD. Montefiore Medical Center, Bronx, NY. Nosocomial infections are one of the most frequent medical complications affecting patients in intensive care units. In June 1989, our Infection Control Unit (ICU) became a participant in the Adult Intensive Care Unit (ICU) component of the National Nooocomial Infections Surveillance System (NNIS). The overall objective of the surveillance program was to reduce nosocomial infections through feedback of the data to relevant staff. We opted to do surveillance for alternating six-month periods in the Surgical ICU (SICU) and the Medical ICU (MICU). The first two periods of surveillance data in the SICU revealed a ventilator-associated pneumonia rate (VAPR) of 42.66 (per 1,000 ventilator days) and 53.97, respectively; as compared to the NNIS rate of 26.2 (75th percentile). No other site-specific infection rates were different from NNIS' rates. The initial analysis of the MICU yielded a VAPR of 33.42 as compared to NNIS' rate of 17.2 (75th percentile). All other site-specific infection rates were equal to or less than NNIS' 75th percentile rates. Following feedback of the data, each departmental Quality Improvement Committee was requested to develop strategies aimed at decreasing the risk for nosecomial pneumonia. The interventions implemented included: (1) QI monitoring of ventilator tubing and cascade changes, (2) daily changes of ambu bags, (3) QI monitoring of the care of ventilated patients, and (4) the use of contrast media in tube feedings to assess for aspirations. Subsequent surveillance in the SICU and MICU showed VAPRs of 25.77 and 13.9 respectively. These rates were within NNIS' 75th percentile for VAPR, and represented a greater than 50% reduction for VAPRs in the MICU. For both units, the average severity of illness and average length of stay scores remained virtually unchanged, suggesting that the control measures led to the improvement. Participation in the NNIS program, data feedback and control measures helped to achieve lower ventilator-associated pneumonia rates.
PARTICIPATION IN NNIS FACILITATES QUALITY IMPROVEMENT. M. DeCastro, RN, CIC,* J. MacDonald, MD, M. Poole, MD, S. Ragans, RN, E. Votra, RN. Tallahassee Memorial Regional Medical Center, Tallahassee, FL. The Centers for Disease Control's (CDC), National Nosocomial Infection Surveillance System (NNIS) was adopted in our institution in October: 1990. Upon reviewing the March 1991 distribution of the CDC Analysis of 1986-1990 National Data, we identified the need to further investigate our high risk nursery central line associated laboratory confirmed bloodstream infection (LCBI) rate. A breach in the intralipid administration procedure was discovered. The literature associates intralipids with an increased risk of CNS bloodstream infection (BSI). We, therefore, hypothesized the intralipid administration hang time of greater than 12 hours to be the significant risk factor. Reinforcement of the intralipid administration policy and procedure resulted in a dramatic decrease in the LCBI rate from 31.6 per 1000 patient days during the outbreak period, to 4.0 per 1000 patient days over the consecutive eight months. Clearly, the risk of nosocomial BS1 has been reduced for neonates in Our high risk nursery. Overall, participation in the NNIS System has greatly benefited the ability to document quality improvement in this medical center.
HOW TO COMPARE YOUR HOSPITAL'S SURGICAL WOUND INFECTION RATES BY RISK CATEGORY TO NATIONAL BENCHMARK RATES. T. Horan, MPH, CIC,* D. Culver, PhD, R. Gaynes, MD. Hospital Infections Program, Centers for Disease Control, Atlanta, GA. Improvement in the quality of patient care requires proper interpretation of rates of adverse events associated with hospitalization. In the past- year, surgical wound infection (SWI) rates by type of operative procedure and risk index category that are potentially useful as benchmark rates for comparison were published by the National Nosoeomial Infections Surveillance (NNIS) System (Am J Meal 1991; 19 (Suppl 3B):152S-157S). Risk factors included in the index are duration of operation, wound class, and American Society of Anesthesiology (ASA) score (an assessment of preoperative severity of a patient's underlying illness). In order to help evaluate the efficacy of infection control and .prevention efforts aimed at surgical patients, infection control personnel may want to compare their hospital's SWl rates to NNIS SWI rates. Using published NNIS SWI rates and sample hospital data, detailed examples will be given of how to compare SWI rates. Examples will include: (1) overall risk category-specific rates (e.g., SWI rate for all operations on patients having only one risk factor), (2) procedure- and risk category-specific rates (e.g, SWI rate for coronary artery bypass graft (CABG) on patients having only one risk factor), and (3) procedure-specific, risk category-adjusted rates (e.g., an individual surgeon's CABG rate when the distribution of the surgeon's operations in the risk categories is very different from that of the NNIS data). Guidance on interpreting the results of these statistical tests will be given to help infection control personnel influence the quality of patient care in their institutions.
AN INTEGRATED COMPUTER-BASED INFECTION SURVEILLANCE PROGRAM FOR INFECTION CONTROL. K.H. St. John, MS, MT (ASCP). Sacred Heart Medical Center, Chester, PA. The ongoing surveillance of nosocomial infections necessarily involves the extraction of pertinent information found in the patient's medical record. The manual extraction of this information is tedious and time consuming. The infection control surveillance program for the CHARTCOMP system (Electronic Cottage Associates, West Chester, PA) is an on-line relational database incorporating the record-keeping function (abstracts) of the Medical Records department along with shared information from the Utilization/Quality Management department, including credentialing of medical staff and surgical case review. Direct links with the Pharmacy and the Microbiology laboratory computer systems are possible utilizing CH.ARTCOMP's open systems architecture, which is compatible with moot hardware/operating platforms (including UNIX, R/SC, VAX/VMS, UNISYS BIOS/CTOS, and IBM AS/400). The infection control surveillance program can capture abstracted information from the patient's medical record which includes demographics, diagnoses, surgical procedures performed, antibiotics given, laboratory culture information, etc. without tedious data entry by the operator. The application accesses a relational database with the ability to generate reports pre-determined by the operator, calculate incidence ratios based on denominators determined by the system, and analyze trends and interpret threshold values by charts and graphs. Examples of the database screens, patient abstract information, and final reports will be presented. Details of possible interlaces with existing hospital computer systems will be made available along with customization options.