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Treglia M, Pallocci M, Passalacqua P, Sabatelli G, De Luca L, Zanovello C, Messineo A, Quintavalle G, Cisterna AM, Marsella LT. Medico-Legal Aspects of Hospital-Acquired Infections: 5-Years of Judgements of the Civil Court of Rome. Healthcare (Basel) 2022; 10:healthcare10071336. [PMID: 35885861 PMCID: PMC9322800 DOI: 10.3390/healthcare10071336] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 07/15/2022] [Accepted: 07/17/2022] [Indexed: 11/16/2022] Open
Abstract
Introduction: Healthcare-associated infections (HAIs) represent a risk to patients’ health, as well as being an issue of worldwide relevance in terms of public health and increased healthcare costs. The occurrence of a complication causally related to the development of an infection contracted during a hospital stay, or in any event during a healthcare activity, may represent a source of liability for the healthcare facility itself and, therefore, lead to compensation for the injured patient. The aim of this research is to analyze the phenomenon of professional liability related to HAIs, to emphasize its economic and juridical aspects and, at the same time, highlight the clinical-managerial issues deserving attention, in order to guarantee the safety of care for patients. Methods: The retrospective review concerned all the judgments regarding HAIs drawn up by the Judges of the Civil Court of Rome, published between January 2016 and December 2020. Results: In the five-year period considered, 140 verdicts were issued in which the liability for which compensation was sought was related to the occurrence of healthcare-related infections. Convictions were recognized in 62.8%. The most involved branches were those related to the surgical areas: orthopedics, heart surgery, and general surgery. The three most frequently isolated organisms were Staphylococcus aureus, Pseudomonas aeruginosa, and Klebsiella pneumoniae. The total amount of compensation paid was EUR 21.243.184,43. Conclusions: The study showed how the analysis of the juridical and medico legal aspects of HAIs may represent not only a helpful tool for healthcare performance assessment, but also a data source usable in clinical risk management and in the implementation of patient safety.
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Affiliation(s)
- Michele Treglia
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Margherita Pallocci
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
- Correspondence:
| | - Pierluigi Passalacqua
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | | | - Lucilla De Luca
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Claudia Zanovello
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | - Agostino Messineo
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
| | | | | | - Luigi Tonino Marsella
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy; (M.T.); (P.P.); (L.D.L.); (C.Z.); (A.M.); (L.T.M.)
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Barranco R, Vallega Bernucci Du Tremoul L, Ventura F. Hospital-Acquired SARS-Cov-2 Infections in Patients: Inevitable Conditions or Medical Malpractice? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020489. [PMID: 33435324 PMCID: PMC7827479 DOI: 10.3390/ijerph18020489] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/02/2021] [Accepted: 01/07/2021] [Indexed: 12/13/2022]
Abstract
Despite numerous measures to contain the infection and limit its spread, cases of SARS-CoV-2 infections acquired in hospitals have been reported consistently. In this paper, we will address issues of hospital-acquired COVID-19 in hospitalized patients as well as medico-legal implications. After having conducted a literature search, we will report on papers on hospital-acquired SARS-CoV-2 infections. Ten scientific papers were selected and considered suitable for further analysis. According to several reports, the SARS-CoV-2 hospital-acquired infection rate is 12–15%. Hospital-acquired COVID-19 represents a serious public health issue, which is a problem that could create reluctance of patients to seek hospital treatment for fear of becoming infected. Healthcare personnel should do all that is necessary to address the problem and prevent further spreading, such as rigorous compliance with all procedures for containing the spread. From a medical-legal point of view, multiple aspects must be considered in order to understand whether the infection is a result of “malpractice” or an inevitable condition.
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Chehab O, Morsi RZ, Kanj A, Rachwan RJ, Pahuja M, Mansour S, Tabaja H, Ahmad U, Zein SE, Raad M, Saker A, Alvarez P, Briasoulis A. Incidence and clinical outcomes of nosocomial infections in patients presenting with STEMI complicated by cardiogenic shock in the United States. Heart Lung 2020; 49:716-723. [PMID: 32866743 DOI: 10.1016/j.hrtlng.2020.08.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES This study addresses the incidence, trends, and impact of nosocomial infections (NI) on the outcomes of patients admitted with ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (STEMI-CS) using the United States National Inpatient Sample (NIS) database. METHODS We analyzed data from 105,184 STEMI-CS patients using the NIS database from the years 2005-2014. NI was defined as infections of more than or equal to three days, comprising of central line-associated bloodstream infection (CLABSI), urinary tract infection (UTI), hospital-acquired pneumonia (HAP), Clostridium difficile infection (CDI), bacteremia, and skin related infections. Outcomes of the impact of NI on STEMI-CS included in-hospital mortality, length of hospital stay (LOS) and costs. Significant associations of NI in patients admitted with STEMI-CS were also identified. RESULTS Overall, 19.1% (20,137) of patients admitted with STEMI-CS developed NI. Trends of NI have decreased from 2005-2014. The most common NI were UTI (9.2%), followed by HAP (6.8%), CLABSI (1.5%), bacteremia (1.5%), skin related infections (1.5%), and CDI (1.3%). The strongest association of developing a NI was increasing LOS (7-9 days; OR: 1.99; 95% CI: 1.75-2.26; >9 days; OR: 4.51; 95% CI: 4.04-5.04 compared to 4-6 days as reference). Increased mortality risk among patients with NI was significant, especially those with sepsis-associated NI compared to those without sepsis (OR: 2.95; 95% CI: 2.72-3.20). Patients with NI were found to be associated with significantly longer LOS and higher costs, irrespective of percutaneous mechanical circulatory support placement. CONCLUSIONS NI were common among patients with STEMI-CS. Those who developed NI were at a greater risk of in-hospital mortality, increased LOS and costs.
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Affiliation(s)
- Omar Chehab
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA.
| | - Rami Z Morsi
- Department of Neurology, University of Chicago, Chicago, Illinois, USA
| | - Amjad Kanj
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Rayan Jo Rachwan
- Department of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Mohit Pahuja
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Shareef Mansour
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Hussam Tabaja
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Usman Ahmad
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Said El Zein
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Mohammad Raad
- Division of Cardiology, Department of Medicine, Henry Ford Hospital, Detroit, Michigan, USA
| | - Ali Saker
- Department of Medicine, Detroit Medical Center/Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Paulino Alvarez
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
| | - Alexandros Briasoulis
- Division of Cardiovascular Medicine, Department of Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA.
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Di Paolo M, Papi L, Malacarne P, Gori F, Turillazzi E. Healthcare-Associated Infections: Not Only a Clinical Burden, But a Forensic Point of View. Curr Pharm Biotechnol 2020; 20:658-664. [PMID: 31258073 DOI: 10.2174/1389201020666190618122649] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 11/27/2018] [Accepted: 04/05/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Healthcare-associated infections (HCAIs) occur when patients receiving treatment in a health care setting develop an infection. They represent a major public health problem, requiring the integration of clinical medicine, pathology, epidemiology, laboratory sciences, and, finally, forensic medicine. METHODS The determination of cause of death is fundamental not only in the cases of presumed malpractice to ascertain the causal link with any negligent behavior both of health facilities and of individual professionals, but also for epidemiological purposes since it may help to know the global burden of HCAIs, that remains undetermined because of the difficulty of gathering reliable diagnostic data. A complete methodological approach, integrating clinical data by means of autopsy and histological and laboratory findings aiming to identify and demonstrate the host response to infectious insult, is mandatory in HCAIs related deaths. RESULTS Important tasks for forensic specialists in hospitals and health services centers are the promotion of transparency and open communication by health-care workers on the risk of HCAIs, thus facilitating patients' engagement and the implementation of educational interventions for professionals aimed to improve their knowledge and adherence to prevention and control measures. CONCLUSION HCAIs are a major problem for patient safety in every health-care facility and system around the world and their control and prevention represent a challenging priority for healthcare institution and workers committed to making healthcare safer. Clinicians are at the forefront in the war against HCAIs, however, also forensic pathologists have a remarkable role.
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Affiliation(s)
- Marco Di Paolo
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Luigi Papi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Paolo Malacarne
- Unit of Anesthesia and Resuscitation, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy, University of Pisa, Via Roma 55, 56126 Pisa, Italy
| | - Federica Gori
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
| | - Emanuela Turillazzi
- Section of Legal Medicine, Department of Surgical, Medical, Molecular Pathology and Critical Medicine, University of Pisa, Pisa, Italy
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5
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Yu KC, Moisan E, Tartof SY, Nguyen HM, Rieg G, Ramaprasad C, Jones J. Benchmarking Inpatient Antimicrobial Use: A Comparison of Risk-Adjusted Observed-to-Expected Ratios. Clin Infect Dis 2019; 67:1677-1685. [PMID: 29688279 DOI: 10.1093/cid/ciy354] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 04/20/2018] [Indexed: 12/14/2022] Open
Abstract
Background Increasing antibiotic resistance has made benchmarking appropriate inpatient antibiotic use a worldwide priority supported by expert societies and regulatory bodies; however, standard risk adjustment for fair interfacility comparison has been elusive. We describe a risk-adjusted antibiotic exposure ratio that may help facilitate assessment of antimicrobial use. Methods This was a retrospective cohort study of 2.7 million admissions evaluating a wide array of potential explanatory variables for correlation with expected antibiotic consumption in a 2-step approach using recursive partitioning and Poisson regression. Observed-to-expected ratios of risk-adjusted antibiotic use were calculated. Three models of varying complexity were compared: (1) a complex ratio consisting of all available antibiotic use risk factors in a hierarchical model; (2) a simplified antimicrobial stewardship program (ASP) ratio using common facility and encounter factors in a single-level model; and (3) a facility ratio using only broad hospital characteristics. Results Diagnosis-related groups, infection present on admission, patient class, and unit type were the major predictors of expected antibiotic use. Aside from a history of gram-positive resistance in the prior 12 months for anti-methicillin-resistant Staphylococcus aureus drugs, additional clinical and comorbid history information did not improve the model. The simplified ASP ratio demonstrated higher Pearson correlation (R2 = 0.97-0.99) to the complex ratio than the facility ratio (R2 = 0.57-0.85) and provided clinical explanations when discordant. Conclusions The simplified ASP ratio is derived from a parsimonious model that incorporates disease burden through patient-level risk adjustment and better informs stewardship assessment. This may allow for improved comparison of antibiotic use between healthcare facilities.
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Affiliation(s)
- Kalvin C Yu
- Quality Department, Infectious Diseases, Kaiser Permanente Southern California, Pasadena
| | - Elizabeth Moisan
- Utility for Care Data Analysis Department, Kaiser Foundation Health Plan, Oakland
| | - Sara Y Tartof
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Hien M Nguyen
- Department of Infectious Diseases, Kaiser Permanente Northwest, Portland, Oregon
| | - Gunter Rieg
- Department of Infectious Diseases, Kaiser Permanente Southern California, Harbor City
| | | | - Jason Jones
- Information Support for Care Transformation, Kaiser Permanente, Oakland, California
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6
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Oliveira M, Amorim A. Microbial forensics: new breakthroughs and future prospects. Appl Microbiol Biotechnol 2018; 102:10377-10391. [PMID: 30302518 PMCID: PMC7080133 DOI: 10.1007/s00253-018-9414-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/14/2018] [Accepted: 09/16/2018] [Indexed: 12/17/2022]
Abstract
Recent advances in genetic data generation, through massive parallel sequencing (MPS), storage and analysis have fostered significant progresses in microbial forensics (or forensic microbiology). Initial applications in circumstances of biocrime, bioterrorism and epidemiology are now accompanied by the prospect of using microorganisms (i) as ancillary evidence in criminal cases; (ii) to clarify causes of death (e.g., drownings, toxicology, hospital-acquired infections, sudden infant death and shaken baby syndromes); (iii) to assist human identification (skin, hair and body fluid microbiomes); (iv) for geolocation (soil microbiome); and (v) to estimate postmortem interval (thanatomicrobiome and epinecrotic microbial community). When compared with classical microbiological methods, MPS offers a diverse range of advantages and alternative possibilities. However, prior to its implementation in the forensic context, critical efforts concerning the elaboration of standards and guidelines consolidated by the creation of robust and comprehensive reference databases must be undertaken.
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Affiliation(s)
- Manuela Oliveira
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal. .,Ipatimup - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho,45, 4200-135, Porto, Portugal. .,Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4200-135, Porto, Portugal.
| | - António Amorim
- i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, 4200-135, Porto, Portugal.,Ipatimup - Instituto de Patologia e Imunologia Molecular da Universidade do Porto, Rua Júlio Amaral de Carvalho,45, 4200-135, Porto, Portugal.,Departamento de Biologia, Faculdade de Ciências, Universidade do Porto, 4200-135, Porto, Portugal
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7
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Zgleszewski SE, Graham DA, Hickey PR, Brustowicz RM, Odegard KC, Koka R, Seefelder C, Navedo AT, Randolph AG. Anesthesiologist- and System-Related Risk Factors for Risk-Adjusted Pediatric Anesthesia-Related Cardiac Arrest. Anesth Analg 2016; 122:482-9. [DOI: 10.1213/ane.0000000000001059] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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8
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Schaefer MK, Ellingson K, Conover C, Genisca AE, Currie D, Esposito T, Panttila L, Ruestow P, Martin K, Cronin D, Costello M, Sokalski S, Fridkin S, Srinivasan A. Evaluation of International Classification of Diseases, Ninth Revision,
Clinical Modification Codes for Reporting Methicillin-Resistant Staphylococcus
aureus Infections at a Hospital in Illinois. Infect Control Hosp Epidemiol 2015; 31:463-8. [DOI: 10.1086/651665] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background.
States, including Illinois, have passed legislation mandating the use of
International Classification of Diseases, Ninth Revision,
Clinical Modification (ICD-9-CM) codes for reporting
healthcare-associated infections, such as methicillin-resistant
Staphylococcus aureus (MRSA).
Objective.
To evaluate the sensitivity of ICD-9-CM code
combinations for detection of MRSA infection and to understand implications for
reporting.
Methods.
We reviewed discharge and microbiology databases from July through August
of 2005, 2006, and 2007 for ICD-9-CM codes or
microbiology results suggesting MRSA infection at a tertiary care hospital near
Chicago, Illinois. Medical records were reviewed to confirm MRSA infection.
Time from admission to first positive MRSA culture result was evaluated to
identify hospital-onset MRSA (HO-MRSA) infections. The sensitivity of MRSA code
combinations for detecting confirmed MRSA infections was calculated using all
codes present in the discharge record (up to 15); the effect of reviewing only
9 diagnosis codes, the number reported to the Centers for Medicare and Medicaid
Services, was also evaluated. The sensitivity of the combination of diagnosis
codes for detection of HO-MRSA infections was compared with that for
community-onset MRSA (CO-MRSA) infections.
Results.
We identified 571 potential MRSA infections with the use of screening
criteria; 403 (71%) were confirmed MRSA infections, of which 61 (15%) were
classified as HO-MRSA. The sensitivity of MRSA code combinations was 59% for
all confirmed MRSA infections when 15 diagnoses were reviewed compared with 31%
if only 9 diagnoses were reviewed (P < .001).
The sensitivity of code combinations was 33% for HO-MRSA infections compared
with 62% for CO-MRSA infections (P <
.001).
Conclusions.
Limiting analysis to 9 diagnosis codes resulted in low sensitivity.
Furthermore, code combinations were better at revealing CO-MRSA infections than
HO-MRSA infections. These limitations could compromise the validity of
ICD-9-CM codes for interfacility comparisons and
for reporting of healthcare-associated MRSA infections.
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Pogorzelska M, Stone PW, Larson EL. Wide variation in adoption of screening and infection control interventions for multidrug-resistant organisms: a national study. Am J Infect Control 2012; 40:696-700. [PMID: 23021413 DOI: 10.1016/j.ajic.2012.03.014] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2012] [Revised: 02/09/2012] [Accepted: 03/02/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND We performed a survey of National Healthcare Safety Network hospitals in 2008 to describe adoption of screening and infection control policies aimed at multidrug-resistant organisms (MDRO) in intensive care units (ICUs) and identify predictors of their presence, monitoring, and implementation. METHODS Four hundred forty-one infection control directors were surveyed using a modified Dillman technique. To explore differences in screening and infection control policies by setting characteristics, bivariate and multivariable logistic regression models were constructed. RESULTS In total, 250 hospitals participated (57% response rate). Study ICUs (n = 413) routinely screened for methicillin-resistant Staphylococcus aureus (59%); vancomycin-resistant Enterococcus (22%); multidrug-resistant, gram-negative rods (12%); and Clostridium difficile (11%). Directors reported ICU policies to screen all admissions for any MDRO (40%), screen periodically (27%), utilize presumptive isolation/contact precautions pending a screen (31%), and cohort colonized patients (42%). Several independent predictors of the presence and implementation of different interventions including mandatory reporting and teaching status were identified. CONCLUSION This study found wide variation in adoption of MDRO screening and infection control interventions, which may reflect differences in published recommendations or their interpretation. Further research is needed to provide additional insight on effective strategies and how best to promote compliance.
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10
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Krein SL, Kowalski CP, Hofer TP, Saint S. Preventing hospital-acquired infections: a national survey of practices reported by U.S. hospitals in 2005 and 2009. J Gen Intern Med 2012; 27:773-9. [PMID: 22143455 PMCID: PMC3378739 DOI: 10.1007/s11606-011-1935-y] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Revised: 10/25/2011] [Accepted: 11/01/2011] [Indexed: 01/23/2023]
Abstract
BACKGROUND Hospital-acquired infection (HAI) is common, costly, and potentially lethal. Whether initiatives to reduce HAI--such as the Centers for Medicare and Medicaid Services (CMS) no payment rule--have increased the use of preventive practices is not known. OBJECTIVE To examine the use of infection prevention practices by U.S. hospitals and trends in use between 2005 and 2009. DESIGN, SETTING, AND PARTICIPANTS Surveys of infection preventionists at non-federal general medical/surgical hospitals and Department of Veterans Affairs (VA) hospitals, which are not subject to the CMS no payment rule, in 2005 and 2009. MAIN MEASURES Percent of hospitals using practices to prevent central line-associated bloodstream infection (CLABSI), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI). KEY RESULTS Survey response was approximately 70%. More than 1/2 of non-federal hospitals reported a moderate or large increase in CLABSI, VAP and CAUTI prevention as a facility priority due to the non-payment rule; over 60% of VA hospitals reported no change in priority. However, both non-federal and VA hospitals reported significant increases in use of most practices to prevent CLABSI, VAP and CAUTI from 2005 to 2009, with 90% or more using certain practices to prevent CLABSI and VAP in 2009. In contrast, only one CAUTI prevention practice was used by at least 50% of hospitals. CONCLUSIONS Since 2005, use of key practices to prevent CLABSI, VAP and CAUTI has increased in non-federal and VA hospitals, suggesting that despite its perceived importance, the non-payment rule may not be the primary driver. Moreover, while 65% of non-federal hospitals reported a moderate or large increase in preventing CAUTI as a facility priority, prevention practice use remains low.
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Affiliation(s)
- Sarah L Krein
- VA Ann Arbor Healthcare System, VA Ann Arbor Center for Clinical Management Research and the Hospital Outcomes Program of Excellence, Ann Arbor, MI, USA.
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11
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Frei CR, Daniels KR. Potential complications of Medicare reimbursement policy regarding health-care-associated infections. Am J Health Syst Pharm 2012; 69:190, 192. [DOI: 10.2146/ajhp110137] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Christopher R. Frei
- College of Pharmacy University of Texas at Austin Austin, TXAssistant Professor Pharmacotherapy Education and Research Center, School of Medicine University of Texas Health Science Center at San Antonio 7703 Floyd Curl Drive, MSC-6220 San Antonio, TX 78229-3900
| | - Kelly R. Daniels
- College of Pharmacy University of Texas at Austin University of Texas Health Science Center at San Antonio
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Integrated Multilevel Surveillance of the World's Infecting Microbes and Their Resistance to Antimicrobial Agents. Clin Microbiol Rev 2011; 24:281-95. [PMID: 21482726 DOI: 10.1128/cmr.00021-10] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Microbial surveillance systems have varied in their source of support; type of laboratory reporting (patient care or reference); inclusiveness of reports filed; extent of microbial typing; whether single hospital, multihospital, or multicountry; proportion of total medical centers participating; and types, levels, integration across levels, and automation of analyses performed. These surveillance systems variably support the diagnosis and treatment of patients, local or regional infection control, local or national policies and guidelines, laboratory capacity building, sentinel surveillance, and patient safety. Overall, however, only a small fraction of available data are under any surveillance, and very few data are fully integrated and analyzed. Advancing informatics and genomics can make microbial surveillance far more efficient and effective at preventing infections and improving their outcomes. The world's microbiology laboratories should upload their reports each day to programs that detect events, trends, and epidemics in communities, hospitals, countries, and the world.
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13
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Duffy J, Sievert D, Rebmann C, Kainer M, Lynfield R, Smith P, Fridkin S. Effective state-based surveillance for multidrug-resistant organisms related to health care-associated infections. Public Health Rep 2011; 126:176-85. [PMID: 21387947 DOI: 10.1177/003335491112600208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In September 2008, the Council of State and Territorial Epidemiologists and the Centers for Disease Control and Prevention sponsored a meeting of public health and infection-control professionals to address the implementation of surveillance for multidrug-resistant organisms (MDROs)-particularly those related to health care-associated infections. The group discussed the role of health departments and defined goals for future surveillance activities. Participants identified the following main points: (1) surveillance should guide prevention and infection-control activities, (2) an MDRO surveillance system should be adaptable and not organism specific, (3) new systems should utilize and link existing systems, and (4) automated electronic laboratory reporting will be an important component of surveillance but will take time to develop. Current MDRO reporting mandates and surveillance methods vary across states and localities. Health departments that have not already done so should be proactive in determining what type of system, if any, will fit their needs.
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Affiliation(s)
- Jonathan Duffy
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Landers T, Apte M, Hyman S, Furuya Y, Glied S, Larson E. A comparison of methods to detect urinary tract infections using electronic data. Jt Comm J Qual Patient Saf 2010; 36:411-7. [PMID: 20873674 PMCID: PMC2948408 DOI: 10.1016/s1553-7250(10)36060-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The use of electronic medical records to identify common health care-associated infections (HAIs), including pneumonia, surgical site infections, bloodstream infections, and urinary tract infections (UTIs), has been proposed to help perform HAI surveillance and guide infection prevention efforts. Increased attention on HAIs has led to public health reporting requirements and a focus on quality improvement activities around HAIs. Traditional surveillance to detect HAIs and focus prevention efforts is labor intensive, and computer algorithms could be useful to screen electronic data and provide actionable information. METHODS Seven computer-based decision rules to identify UTIs were compared in a sample of 33,834 admissions to an urban academic health center. These decision rules included combinations of laboratory data, patient clinical data, and administrative data (for example, International Statistical Classification of Diseases and Related Health Problems, Ninth Revision [ICD-9] codes). RESULTS Of 33,834 hospital admissions, 3,870 UTIs were identified by at least one of the decision rules. The use of ICD-9 codes alone identified 2,614 UTIs. Laboratory-based definitions identified 2,773 infections, but when the presence of fever was included, only 1,125 UTIs were identified. The estimated sensitivity of ICD-9 codes was 55.6% (95% confidence interval [CI], 52.5%-58.5%) when compared with a culture- and symptom-based definition. Of the UTIs identified by ICD-9 codes, 167/1,125 (14.8%) also met two urine-culture decision rules. DISCUSSION Use of the example of UTI identification shows how different algorithms may be appropriate, depending on the goal of case identification. Electronic surveillance methods may be beneficial for mandatory reporting, process improvement, and economic analysis.
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Affiliation(s)
- Timothy Landers
- School of Nursing, Columbia University, New York City, NY, USA.
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Use of surveillance data for prevention of healthcare-associated infection: risk adjustment and reporting dilemmas. Curr Opin Infect Dis 2009; 22:359-63. [DOI: 10.1097/qco.0b013e32832d04c0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Gisselquist D. A good example! Int J Infect Dis 2009; 13:535-6. [PMID: 19261503 DOI: 10.1016/j.ijid.2008.11.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/08/2008] [Indexed: 10/21/2022] Open
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