Sandra Hyman

A Comparison of Methods to Detect Urinary Tract Infections Using Electronic Data

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.

Incidence and Risk Factors for and the Effect of a Program To Reduce the Incidence of Surgical Site Infection after Cardiac Surgery

BACKGROUND Surgical site infection (SSI) after cardiac surgery (CS) is a serious complication that increases hospital length of stay (LOS), has a substantial financial impact, and increases mortality. The study described here was done to evaluate the effect of a program to reduce SSI after CS. METHODS In January 2007, a multi-disciplinary CS infection-prevention team developed guidelines and implemented bundled tactics for reducing SSI. Data for all patients who underwent CS from 2006-2008 were used to determine whether there was: 1) A difference in the incidence of SSI in white patients and those belonging to minority groups; 2) a reduction in SSI after intervention; and 3) a statistically significant difference in the incidence of SSI in the third quarter of each year as compared with the other quarters of the year. RESULTS Of 3,418 patients who underwent CS; 1,125 (32.9%) were members of minority groups and 2,293 (67.1%) were white. Eighty (2.3%) patients developed SSI. There was no significant difference in the incidence of SSI in non-Hispanic white patients and all others (2.1% vs. 2.8%, p=0. 42). The incidence of SSI decreased significantly from 2006 (3.0%) to 2007 (2.5%) and 2008 (1.4%), (p=0.03). Surgical site infection occurred more often in the third quarter of each of the years of the study than in other quarters of each year (3.3 vs. 2.0%, p=0.038). CONCLUSIONS Implementation of a program to reduce SSI after CS was associated with a lower incidence of SSI across all racial and ethnic groups and over time, but was not associated with a lower incidence of SSI in the third quarter of each year than in the other quarters.

Improving Communication and Compliance: Role of a Perioperative Infection Prevention Committee

Sandra R. Hyman RN, MPA, CIC, Safety Specialist, NewYorkPresbyterian Columbia University Medical Center; Soon-Hye Shim RN, BSN, CNOR, Team Leader Neurosurgery, NewYorkPresbyterian; Louise Kertesz ANP, MSN, CNOR, Clinical Nurse Specialist, NewYork-Presbyterian Columbia University Medical Center; Nenita Nadera RN, MSN, CNOR, Clinical Nurse Specialist, NewYork-Presbyterian; Rochelle Alexander RN, BSN, Staff Nurse, NewYork Presbyterian; Mary Beth Wilheim ORT, Operating Room Technician, NewYork-Presbyterian/Columbia University Hospital

Gender Differences in Risk of Bloodstream Infection

Background/Objectives: This study aimed to determine the epidemiology of nosocomial infections (NIs), common microorganisms and cost. Patients included in the study were taken from a newborn intensive care unit (NICU), in Children hospital No.1. Methods: A prospective cohort study was performed. The subjects were 892 neonates who were admitted to the NICU, survived longer than 48 hours after transferred to another unit, between Jan. 1, 2008 to Sep. 30, 2008. NIs were identified according to the NNIS definition. Data were analyzed with descriptive statistics by Stata 10. Results: Cumulative incidence rate for NIs was 12,4 NIs of 100 admissions, with a total of 111 infections for 892 patients. The most common infections were pneumonia (50%), bloodstream infection (31%), and Surgical site infection (10%). Major pathogens were Gram-negative such as Klebsiella 87 (36,5%), Acinetobacter spp 49 (20,5%). The factors associated with NI was also associated with a significantly increased risk of definite infection (OR > 1.19, 95% CI > 1 and p 7 days of hospitalized, CVC, mechanical ventilation, surgical. hospital stay (25 days for Ni and 16 days for non Ni) and fiscal costs (19,9 million VN Ð for NI and 6,5 million VND for non NI) of these infections are high. Conclusions: Nosocomial infection is a serious problem for neonates who are admitted for intensive care. Since it is associated with increases in morbidity, both hospital stay and fiscal costs of these infections are high. we need strategies for the prevention and treatment of nosocomial infection.