Continuous quality improvement in a hospital system: implications for hospital epidemiology

Process surveillance: an epidemiologic challenge for all health care organizations

Historically, qualitative and quantitative monitoring of patient care practices related to infection control may have been only marginally correlated with findings of nosocomial infection surveillance. More recent developments in health care have included an emphasis on "outcome management," as well as an enthusiasm for applying industrial process improvement methods. Health care organizations may choose to incorporate process surveillance as an adjunct to or a surrogate for outcome measurement. An essential characteristic of a well-designed process surveillance program is a direct relationship with clearly articulated and logically prioritized outcome objectives. To optimize value and efficacy, the program design should be consistent with the organizational strategic plan and sensitive to the needs of members of the health care team to which the data would be reported. Process data must be objectively and consistently measurable, feasible to collect, and, ideally, expressed as rates or ratios to support valid comparative analyses. Infection control professionals should approach development of process surveillance systems with a logical and organized construct.

An approach to the evaluation of quality indicators of the outcome of care in hospitalized patients, with a focus on nosocomial infection indicators. The Quality Indicator Study Group

The Quality Indicator Study Group was created by the governing boards of three national professional organizations that have interest and experience in epidemiology, nosocomial infection control and prevention, and quality of care improvement. The Study Group has reviewed the existing literature concerning quality indicators (QIs), interviewed experts in the field, and focused on how best to evaluate such indicators, with an emphasis on nosocomial infection indicators as a paradigm for all QIs. In this report, we review pertinent issues and, where possible, provide specific advice on how to evaluate QIs and QI systems.

An overview of nosocomial infections, including the role of the microbiology laboratory

An estimated 2 million patients develop nosocomial infections in the United States annually. The increasing number of antimicrobial agent-resistant pathogens and high-risk patients in hospitals are challenges to progress in preventing and controlling these infections. While Escherichia coli and Staphylococcus aureus remain the most common pathogens isolated overall from nosocomial infections, coagulase-negative staphylococci (CoNS), organisms previously considered contaminants in most cultures, are now the predominant pathogens in bloodstream infections. The growing number of antimicrobial agent-resistant organisms is troublesome, particularly vancomycin-resistant CoNS and Enterococcus spp. and Pseudomonas aeruginosa resistant to imipenem. The active involvement and cooperation of the microbiology laboratory are important to the infection control program, particularly in surveillance and the use of laboratory services for epidemiologic purposes. Surveillance is used to identify possible infection problems, monitor infection trends, and assess the quality of care in the hospital. It requires high-quality laboratory data that are timely and easily accessible.