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Surveillance for nosocomial infections: can the sources of data be reduced?
Abstract:
With the goal of achieving economy in infection control surveillance we tested the relative efficiency of the various surveillance sources for detecting nosocomial infections (NIs). We reviewed the initial and final surveillance sources of 415 NIs at Hackensack Hospital during an 11-month period; cultures were taken on most of the patients with NIs. Positive microbiology cultures were the initial sources in 64.8% of NIs and secondary sources in 23.6%. Chart review of patients with positive cultures added another 2.9%. Therefore, 91.3% of NIs could have been detected by positive culture reports. The remainder were discoverable by notification from nurses, or by studying admission cards or temperature rounds. Although the NIs missed by lack of a positive culture report often were significant infections, these alternate methods of surveillance did not help to detect any clusters of infections that could be traced to a particular source among the staff or the environment.
Insights
Positive microbiology cultures are the most efficient method for detecting nosocomial infections (NIs), identifying over 91% of cases. Other surveillance methods were less effective for early detection and cluster identification.
Area of Science:
- Healthcare Management
- Infectious Disease Epidemiology
- Clinical Microbiology
Background:
- Nosocomial infections (NIs) pose a significant challenge in healthcare settings, necessitating effective surveillance strategies.
- Optimizing infection control surveillance is crucial for resource allocation and timely intervention.
- Current surveillance methods vary in efficiency and cost-effectiveness.
Purpose of the Study:
- To evaluate the relative efficiency of different surveillance sources for detecting nosocomial infections (NIs).
- To determine the optimal approach for economical and effective infection control surveillance.
Main Methods:
- A retrospective review of 415 nosocomial infections (NIs) over an 11-month period at Hackensack Hospital.
- Analysis of initial and final surveillance sources, including microbiology cultures, chart reviews, nurse notifications, admission cards, and temperature rounds.
- Assessment of the percentage of NIs detected by each surveillance method.
Main Results:
- Positive microbiology cultures served as the primary or secondary source for 88.4% of NIs (64.8% initial, 23.6% secondary).
- Combining positive culture reports with chart reviews identified 91.3% of NIs.
- Alternative surveillance methods (nurse notification, admission cards, temperature rounds) detected the remaining NIs but did not identify infection clusters.
Conclusions:
- Positive microbiology culture reports are the most efficient and effective method for detecting nosocomial infections (NIs).
- Integrating chart reviews with culture reports further enhances detection rates.
- While alternative methods can detect some NIs, they are less effective for identifying sources of infection clusters.