Detecting pediatric nosocomial infections: how do infection control and quality assurance personnel compare?
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D N Simonds1, T C Horan, R Kelley
1Hospital Infections Program, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
Insights
Infection control (IC) personnel demonstrated superior accuracy in identifying nosocomial infections and their sites compared to quality assurance (QA) personnel. Further training is recommended for both groups, particularly for QA staff, to enhance nosocomial infection detection capabilities.
Area of Science:
- Healthcare Quality Improvement
- Infectious Disease Epidemiology
- Pediatric Healthcare Management
Background:
- Accurate identification of healthcare-associated infections (HAIs) is crucial for patient safety and effective treatment.
- Distinguishing between nosocomial (hospital-acquired) and community-acquired infections is essential for appropriate management.
- The roles of infection control (IC) and quality assurance (QA) personnel in identifying infections require clear definition and comparison.
Purpose of the Study:
- To compare the diagnostic accuracy of infection control (IC) and quality assurance (QA) personnel in a pediatric specialty setting.
- To evaluate their ability to identify the presence, type (nosocomial vs. community-acquired), and specific site of infections.
- To inform training needs and delineate responsibilities for infection surveillance.
Main Methods:
- A survey with 21 pediatric case histories was mailed to IC and QA personnel in US pediatric hospitals in 1994.
- Respondents were asked to identify infection presence, acquisition source (nosocomial/community), and infection site if nosocomial.
- Data from 212 returned surveys (120 IC, 92 QA) were analyzed.
Main Results:
- Infection control personnel (92.3%) were significantly more accurate than quality assurance personnel (54.4%) in identifying nosocomial infections.
- Both groups showed similar accuracy in identifying community-acquired infections.
- IC personnel excelled in pinpointing specific infection sites, including respiratory, urinary tract, bloodstream, and surgical site infections.
Conclusions:
- Infection control personnel exhibit higher proficiency in detecting nosocomial infections and their sites compared to QA personnel.
- Both IC and QA personnel faced challenges identifying specific infections like venous and secondary bloodstream infections, indicating a need for enhanced training.
- Specialized training and validation for QA personnel in nosocomial infection detection are recommended, with surveillance best handled by trained IC professionals.
Objective:
To compare how well infection control (IC) and quality assurance (QA) personnel in a specialty setting identify the presence, type (nosocomial or community-acquired), and (if nosocomial) site of infection.
Methods:
In 1994, we mailed a survey that included 21 pediatric case histories to IC and QA personnel in pediatric settings in the United States (children's hospitals and medical school-affiliated hospitals with pediatric wards of > 30 beds). From the case histories presented, the respondents were asked to determine whether an infection was present and, if so, whether it was nosocomial or community-acquired. If the infection was nosocomial, the respondent was asked to determine the site of the infection (e.g., urinary tract, bloodstream).
Results:
From the 289 hospitals to which surveys were mailed, 131 respondents (45.3%) completed 212 surveys. Of the 212 returned surveys, 120 (56.6%) were completed by IC personnel and 92 (43.4%) were completed by QA personnel. Among the 183 respondents from acute care pediatric settings, 92.3% of IC personnel (96/104) and 54.4% of QA personnel (43/79) correctly identified at least 75% of the nosocomial infections (n = 14; p < 0.0001). IC and QA personnel were similar in ability to identify community-acquired infection (88/104 vs 70/79, respectively; p = 0.436). IC personnel were significantly more likely than QA personnel to accurately identify the following sites of infection: respiratory tract infection without secondary bloodstream infection, necrotizing enterocolitis, urinary tract infection with and without secondary bloodstream infection, primary bloodstream infection, surgical site infection, gastroenteritis, esophagitis, and clinical sepsis.
Conclusions:
Overall, IC personnel were more accurate than QA personnel in determining whether a nosocomial infection was present and in correctly determining most sites of infection. Both IC and QA personnel had difficulty identifying venous infection and respiratory tract infection with secondary bloodstream infection. Both IC and QA personnel could thus benefit from more concise definitions or further training in detection of these sites of nosocomial infections. In addition, QA personnel did not perform overall as well as IC personnel in identifying nosocomial infections and their sites; this finding suggests the need for QA personnel to be provided specific training on detection of nosocomial infections and validation of their ability to do so. Nosocomial infection surveillance should be the responsibility of those trained and proved capable of detecting these infections.