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Nosocomial Infection Rates for Interhospital Comparison: Limitations and Possible Solutions

Published online by Cambridge University Press:  21 June 2016

A Report From the National Nosocomial Infections Surveillance (NNIS) System
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Extract

Improvement in quality of patient care has received increasing attention in the last decade, with emphasis in infection control and interhospital comparison of infection rates. One of the main objectives of the National Nosocomial Infections Surveillance (NNIS) system is to provide hospitals with comparative nosocomial infection data that at least partially adjust for patients' intrinsic and extrinsic risks for infection. This article summarizes the methods and results of analyses from the NNIS system and describes their application to future surveillance in US hospitals. We emphasize the importance of nosocomial infection surveillance data that adjust for specific infection risks in order to provide better interhospital comparison of infection rates. Traditional rates that do not provide such adjustment include the crude overall nosocomial infection rate of a hospital or service and site-specific infection rates by service. Because these inadequately adjusted rates are potentially misleading, they should not be used for interhospital comparison. This article describes several new infection rates, including device-associated, device-day infection rates for intensive care units and high-risk nurseries, and an NNIS surgical wound infection risk index. These rates appear to be better for interhospital comparison. NNIS data also suggest the importance of examining interventions (devices and operative procedures) that increase patient risk for infection. Failure to use appropriately adjusted rates and to examine the intervention experience may make interhospital comparisons meaningless or even misleading.

Type
Report From the CDC
Information
Infection Control & Hospital Epidemiology , Volume 12 , Issue 10 , October 1991 , pp. 609 - 621
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1991

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Footnotes

*

NNIS Personnel: William J. Marione, MD, Director, Hospital infections Program (HIP); Robert I? Gaynes, MD, Chief Nosocomial Infections Surveillance Activity (NISA), HIP; Teresa C. Horan, MPH, CIC, NNIS Coordinator, NISA, HIP; T Grace Emori, RN, MS, Nurse Epidemiologist, NISA, HIP; William R. Jarvis, MD, Chief, Epidemiology Branch, HIP; Mary Elaine Bennett, Secretary, NISA, HIP; Statistics: David H. Culver, PhD, Chief, Statistics and Information Systems Branch (SISB). HIP; Shailen N. Banerjee, PhD, Mathematical Statistician, SISB, HIP; Jonathan R. Edwards, MS, Mathematical Statistician, SISB, HIP; Tonya S. Henderson, BS, Mathematical Statistician, SISB, HIP; James S. Tolson, BS, Computer Programmer, SISB, HIP; Casetta R. Reid, Statistical Assistant, SISB, HIP

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