Hostname: page-component-848d4c4894-4rdrl Total loading time: 0 Render date: 2024-06-14T10:50:24.332Z Has data issue: false hasContentIssue false
  • English
  • Français

Case-Mix Adjustment Approach to Benchmarking Prevalence Rates of Nosocomial Infection in Hospitals in Cyprus and Greece

Part of: WILLIAM JARVIS AWARD RECIPIENTS

Published online by Cambridge University Press:  02 January 2015

Evangelos I. Kritsotakis ,
Ioannis Dimitriadis ,
Maria Roumbelaki ,
Emelia Vounou ,
Maria Kontou ,
Panikos Papakyriakou ,
Maria Koliou-Mazeri ,
Ioannis Varthalitis ,
George Vrouchos  and
George Troulakis
...Show all authors
Evangelos I. Kritsotakis
Affiliation:
Laboratory of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University of Crete, Crete, Greece
Ioannis Dimitriadis
Affiliation:
Department of Pneumonology, General Hospital of Larnaca, Cyprus
Maria Roumbelaki
Affiliation:
Infection Control Unit, University Hospital of Heraklion, Crete, Greece
Emelia Vounou
Affiliation:
Department of Internal Medicine, Limassol General Hospital, Cyprus
Maria Kontou
Affiliation:
Department of Internal Medicine, Nicosia General Hospital, Cyprus
Panikos Papakyriakou
Affiliation:
Department of Internal Medicine, General Hospital of Pafos, Cyprus
Maria Koliou-Mazeri
Affiliation:
Infectious Diseases and Immunology Unit, Archbishop Makarios Hospital of Nicosia, Cyprus
Ioannis Varthalitis
Affiliation:
Department of Oncology, General Hospital of Chania, Crete, Greece
George Vrouchos
Affiliation:
Intensive Care Unit, “Venizelion” General Hospital, Crete, Greece
George Troulakis
Affiliation:
Intensive Care Unit, General Hospital of Agios Nikolaos, Crete, Greece
Achilleas Gikas*
Affiliation:
Laboratory of Clinical Bacteriology, Parasitology, Zoonoses, and Geographical Medicine, University of Crete, Crete, Greece
*
University Hospital of Heraklion 1352/71110, Crete, Greece (gikas@med.uoc.gr)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

To examine the effect of heterogeneous case mix for a benchmarking analysis and interhospital comparison of the prevalence rates of nosocomial infection.

Design.

Cross-sectional survey.

Setting.

Eleven hospitals located in Cyprus and in the region of Crete in Greece.

Methods.

The survey included all inpatients in the medical, surgical, pediatric, and gynecology-obstetrics wards, as well as those in intensive care units. Centers for Disease Control and Prevention criteria were used to define nosocomial infection. The information collected for all patients included demographic characteristics, primary admission diagnosis, Karnofsky functional status index, Charlson comorbidity index, McCabe- Jackson severity of illness classification, use of antibiotics, and prior exposures to medical and surgical risk factors. Outcome data were also recorded for all patients. Case mix-adjusted rates were calculated by using a multivariate logistic regression model for nosocomial infection risk and an indirect standardization method.

Results.

The overall prevalence rate of nosocomial infection was 7.0% (95% confidence interval, 5.9%–8.3%) among 1,832 screened patients. Significant variation in nosocomial infection rates was observed across hospitals (range, 2.2%–9.6%). Logistic regression analysis indicated that the mean predicted risk of nosocomial infection across hospitals ranged from 3.7% to 10.3%, suggesting considerable variation in patient risk. Case mix-adjusted rates ranged from 2.6% to 12.4%, and the relative ranking of hospitals was affected by case-mix adjustment in 8 cases (72.8%). Nosocomial infection was significantly and independently associated with mortality (adjusted odds ratio, 3.6 [95% confidence interval, 2.1–6.1]).

Conclusion.

The first attempt to rank the risk of nosocomial infection in these regions demonstrated the importance of accounting for heterogeneous case mix before attempting interhospital comparisons.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 29 , Issue 8 , August 2008 , pp. 685 - 692
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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.Burke, JP. Infection control—a problem for patient safety. N Engl J Med 2003;348:651–656.Google Scholar
2.Gaynes, R, Richards, C, Edwards, J, et al.Feeding back surveillance data to prevent hospital-acquired infections. Emerg Infect Dis 2001;7:295–298.Google Scholar
3.Humphreys, H, Smyth, ET. Prevalence surveys of healthcare-associated infections: what do they tell us, if anything? Clin Microbiol Infect 2006;12:2–4.Google Scholar
4.Richardson, D, Tarnow-Mordi, WO, Lee, SK. Risk adjustment for quality improvement. Pediatrics 1999;103(suppl E):255–265.Google Scholar
5.Pittet, D, Harbarth, S, Ruef, C, et al.Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland. Infect Control Hosp Epidemiol 1999;20:37–42.Google Scholar
6.Sax, H, Pittet, D; Swiss-NOSO Network. Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002;162:2437–2442.Google Scholar
7.Sartor, C, Delchambre, A, Pascal, L, Drancourt, M, De Micco, P, Sambuc, R. Assessment of the value of repeated point-prevalence surveys for analyzing the trend in nosocomial infections. Infect Control Hosp Epidemiol 2005;26:369–373.Google Scholar
8.World Health Organization. International Statistical Classification of Diseases and Related Health Problems, 10th Revision. 2nd ed. Geneva: World Health Organization; 2006.Google Scholar
9.Mor, V, Laliberte, L, Morris, JN, Wiemann, M. The Karnofsky Performance Status Scale: an examination of its reliability and validity in a research setting. Cancer 1984;53:2002–2007.Google Scholar
10.Needham, DM, Scales, DC, Laupacis, A, Pronovost, PJ. A systematic review of the Charlson comorbidity index using Canadian administrative databases: a perspective on risk adjustment in critical care research. J Crit Care 2005;20:12–19.Google Scholar
11.McCabe, WR, Jackson, GG. Gram-negative bacteremia. I. Etiology and ecology. Arch Intern Med 1962;110:847–855.Google Scholar
12.Horan, TC, Gaynes, RP. Surveillance of nosocomial infections. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2004:1659–1702.Google Scholar
13.Hosmer, D, Lemeshow, S. Applied Logistic Regression. 2nd ed. New York: Wiley; 2000.Google Scholar
14.Kahn, HA, Sempos, CT. Statistical Methods in Epidemiology. New York: Oxford University Press; 1989.Google Scholar
15.Reilly, J, Stewart, S, Allardice, , et al. Health Protection Scotland. NHS Scotland National Hospital Acquired Infection Prevalence Survey. Final Report 2007. Available at: http://www.hps.scot.nhs.uk/haiic/sshaip/publications/national-prevalence-study/report/full-report.pdf. Accessed January 30, 2007.Google Scholar
16.Emmerson, AM, Enstone, JE, Griffin, M, Kelsey, MC, Smyth, ET. The Second National Prevalence Survey of infection in hospitals—overview of the results. J Hosp Infect 1996;32:175–190.Google Scholar
17.Christensen, M, Jepsen, OB. Reduced rates of hospital-acquired UTI in medical patients: prevalence surveys indicate effect of active infection control programmes. J Hosp Infect 2001;47:36–40.Google Scholar
18.Zotti, CM, Messori Ioli, G, Charrier, L, et al.Hospital-acquired infections in Italy: a region wide prevalence study. J Hosp Infect 2004;56:142–149.Google Scholar
19.Vaqué, J, Rosselló, J, Arribas, JL. Prevalence of nosocomial infections in Spain: EPINE study 1990-1997. EPINE Working Group. J Hosp Infect 1999;43(Suppl):105–lll.Google Scholar
20.The French Prevalence Survey Study Group. Prevalence of nosocomial infections in France: results of the nationwide survey in 1996. J Hosp Infect 2000;46:186–193.Google Scholar
21.Eriksen, HM, Iversen, BG, Aavitsland, P. Prevalence of nosocomial infections in hospitals in Norway, 2002 and 2003. J Hosp Infect 2005;60:40–45.Google Scholar
22.Klavs, I, Bufon Luznik, T, Skerl, M, et al.Prevalance of and risk factors for hospital-acquired infections in Slovenia—results of the first national survey, 2001. J Hosp Infect 2003;54:149–157.Google Scholar
23.Gastmeier, P, Kampf, G, Wischnewski, N, et al.Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 1998;38:37–49.Google Scholar
24.Ruef, C. Prevalence of nosocomial infections—who knows the true rates? Infection 1997;25:203–205.Google Scholar
25.Floret, N, Bailly, P, Bertrand, X, et al.Results from a four-year study on the prevalence of nosocomial infections in Franche-Comté: attempt to rank the risk of nosocomial infection. J Hosp Infect 2006;63:393–398.Google Scholar
26.Dodek, P, Keenan, S, Cook, D, et al.Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia. Ann Intern Med 2004;141:305–313.Google Scholar
27.Gikas, A, Pediaditis, J, Papadakis, JA, et al.Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. J Hosp Infect 2002;50:269–275.Google Scholar
28.Gikas, A, Roumbelaki, M, Pediaditis, J, et al.Prevalence of nosocomial infections after surgery in Greek hospitals: results of two nationwide surveys. Infect Control Hosp Epidemiol 2004;25:319–324.Google Scholar
29.Kritsotakis, EI, Assithianakis, P, Kanellos, P, Tzagarakis, N, Ioannides, MC, Gikas, A. Surveillance of monthly antimicrobial consumption rates stratified by patient-care area: a tool for triggering and targeting antibiotic policy changes in the hospital. J Chemother 2006;18:394–401.Google Scholar
30.Mangram, AJ, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Centers for Disease Control and Prevention (CDC) Hospital Infection Control Practices Advisory Committee. Am J Infect Control 1999;27:97–132.Google Scholar
31.Rello, J. Impact of nosocomial infections on outcome: myths and evidence. Infect Control Hosp Epidemiol 1999;20:392–394.Google Scholar
32.Norena, M, Wong, H, Thompson, WD, Keenan, SP, Dodek, PM. Adjustment of intensive care unit outcomes for severity of illness and comorbidity scores. J Crit Care 2006;21:142–150.Google Scholar
33.Gaynes, RP. Surgical-site infections (SSI) and the NNIS Basic SSI Risk Index, part II: room for improvement. Infect Control Hosp Epidemiol 2001;22:266–267.Google Scholar
34.Gastmeier, P, Sohr, D, Rath, A, et al.Repeated prevalence investigations on nosocomial infections for continuous surveillance. J Hosp Infect 2000;45:47–53.Google Scholar