Showing papers on "Nosocomial infection control published in 1980"

Study on the efficacy of nosocomial infection control (senic project): summary of study design

Abstract: With the emergence of nosocomial infections as a serious problem among US hospitals, the Center for Disease Control undertook in 1974 a nationwide study to evaluate approaches to infection control. The three-phased project, now known as the Study on the Efficacy of Nosocomial Infection Control, or SENIC Project, was designed with three primary objectives: 1) to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate ofnosocomi al infection, 2) to describe the current status of ISCPs and infection rates, and 3) to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate. With data collection completed in a nationally representative sample of hospitals, analysis is underway to identify approaches to infection control that are most effective for the least cost to hospitals and to point out additional specific questions to be answered by future research.

The infection control nurse in us hospitals, 1976–1977: characteristics of the position and its occupant

Abstract: Within the past decade, the infection control nurse (ICN) has become an important element in organized infection surveillance and control programs. Before 1970, only a few hospitals (6%) had an ICN, but, by 1977, over 80% had hired at least one ICN, the majority of those hospitals having done so since 1973. To determine the characteristics of the position and its occupant, the authors analyzed data from interviews with a representative sample of ICNs from 347 hospitals nationwide, conducted in 1976-1977 as part of Phase II of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project), the Hospital Interview Survey. Results varied most widely by hospital size. The ICN in the smaller hospitals (less than or equal to 300 beds) typically worked only part time in infection control, spending the rest of her or his time as a nursing supervisor. The ICN in the larger hospitals (greater than 300 beds) generally worked full time but actually worked less time in relation to the number of beds; she or he also had completed a higher level of nursing education and had attended more infection control courses. The ICN was typically a woman in the young or middle age group who had worked in her current hospital six years altogether--two of them in infection control--and was receiving a supervisor's salary. Most ICNs were under the Nursing Service Department but generally looked to the physician in the infection control program for advice or supervision.

A method for classifying patients according to the nosocomial infection risks associated with diagnoses and surgical procedures

Abstract: To compare validly the nosocomial infection rates (NIRs) in groups of patients studied from different time periods and/or different hospitals, one must control for the important factors that influence a patient's susceptibility to infection. The authors developed a method for assessing one component of nosocomial infection risk, based on patients' diagnoses and surgical procedures. This method classifies patients according to their risk of developing a nosocomial infection at each of four infection sites and at all four sites combined. Applying the method to data collected on 136,516 patients from 276 hospitals studied in the SENIC Project (Study on the Efficacy of Nosocomial Infection Control), the authors found that NIRs increased according to the predicted ranking of risk categories, even when the analyses were stratified individually by age, sex, hospital service and exposure to urinary catheterization or continuous ventilatory support. Depending on the site of infection, the rate increased as much as 100-fold from low-risk to high-risk categories. The data indicate that infection risk as assessed with this classification method will account for some of the variation in NIRs due to differences in patients' clinical conditions. Further analyses using multivariate techniques must be performed to explore in detail the relative importance of this risk classification in comparison with other risk factors and to determine which factors must be controlled in SENIC analyses.

The "hospital epidemiologist" in U.S. hospitals, 1976-1977: a description of the head of the infection surveillance and control program. Report from the SENIC project.

Abstract: As part of the first two phases of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control), information was collected from the heads of the infection surveillance and control programs (ISCPs) in U.S. hospitals. The data were analyzed to describe these respondents and to determine whether differences among them were related to their areas of professional training or to characteristics of the hospitals where they were located. The findings indicate that the ISCP heads constitute a very heterogeneous group, with substantial differences in age, professional training (40% are pathologists), characteristics of their medical practices, memberships in professional organizations related to infection control, time spent in ISCP activities, approach to epidemiologic problems, and opinions on the preventability of nosocomial infections and the seriousness of infection problems in their hospitals. These differences are related strongly to the ISCP heads' professional training, size of hospital, and, to a lesser extent, medical school affiliation, but there is little evidence that the differences are related to regional or urban-rural location or type of ownership of the hospitals. The average ISCP head estimates that about half of all nosocomial infections are preventable, but these estimates vary inversely with tenure in the position and the tendency to approach a clinical problem epidemiologically.

The senic sampling process: design for choosing hospitals and patients and results of sample selection

Abstract: To achieve its primary objectives, the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) focused its attention on a target population of patients referred to as SENIC-eligible admissions in a target population of hospitals referred to as the "SENIC Universe." SENIC thus required a design for sampling hospitals and patients within these hospitals and a valid procedure for projecting sample results to the target population. This paper presents the details of the sampling design used, describes the actual process of selecting hospitals and patients for the surveys, explains the procedure used to project sample results to the target population, and examines the possibility of bias in the design and hospital selection process. As with most large-scale sample surveys, the design and sample selection processes for the surveys in Phases II and III of SENIC were complicated by incomplete frame, nonresponse and measurement problems. Nevertheless, adjustments to reduce the effects of some of these problems have been made through the development of a valid procedure for projecting sample results to the target population, and it appears unlikely that practically important nonsampling biases will result from the estimation procedures applied to this sample of hospitals.

Effects of method error on the power of a statistical test: implications of imperfect sensitivity and specificity in retrospective chart review

Abstract: Errors in classifying individuals as to whether they have a certain characteristic may adversely affect the power of a statistical test to detect differences in the incidence of that characteristic between groups or to detect changes in the incidence over time. To determine whether the classification method to be used in the Study on the Efficacy of Nosocomial Infection Control (SENIC Project)--retrospective chart review--would provide sufficient power for a test of the study's main hypothesis, the authors calculated power as a function of the sensitivity and specificity of the method. They then contrasted the case in which sensitivity and specificity are constant for all hospitals in the study with cases in which the measures vary between groups of hospitals or between time periods. It was found that variation within the observed ranges of sensitivity and specificity, even if systematic, has little effect on power unless it is related to the hypothesis under study. The authors thus concluded that SENICs study design is adequate to detect any substantial success of infection surveilliance and control programs in combatting nosocomial infection, unless such programs affect the accuracy of the chart review method.

Effect of an infection surveillance and control program on the accuracy of retrospective chart review

Abstract: The primary analyses of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) will test the association between the presence of infection surveillance and control programs (ISCPs) and changes in nosocomial infection rates (NIRs) as measured by retrospective chart review (RCR). If the establishment of an ISCP affects the quality or completeness of information important for diagnosing infection by RCR, the analyses could be biased (i.e., there could be an increased chance of a Type I or Type II error). To determine whether this type of "ISCP effect" on the accuracy of RCR is likely to occur, the authors carried out a prospective intervention study in one hospital where 1) nosocomial infections among a pre-ISCP cohort of patients were detected by prospective data collection (PDC), 2) the hospital's first ISCP was instituted, and 3) infections were identically studied by PDC exactly two years later. Several months after the end of the second PDC, a team of trained chart reviewers read the medical records of the patients in both study cohorts and abstracted all clinical data bits used for diagnosing nosocomial infection. By a nonparametric matched correlation analysis, no significant change was found in the amount of relevant clinical information recorded in the medical records, and sensitivity and specificity did not change significantly. The authors conclude that, if an ISCP effect on RCR accuracy is present at all, it must be small.

Infection control: old myths and new realities: N.F.I.D. lecture

Abstract: I am both pleased and honored to have been invited to present the third annual National Foundation for Infectious Diseases Lecture at this gathering. Following the trail blazed by my eminent predecessors, Dr. Jay P. Sanford and Dr. Theodore C. Eickhoff, is challenging and humbling. I have taken as my theme the interwoven myths and realities of infection control practice because I believe the new discipline of hospital infection control is at a delicate point in its development. Over the past decade the importance of identifying and controlling nosocomial infections has received wide recognition. A cadre of dedicated practitioners has been trained and employed? as this large, energetic organization attests. And the re sults of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) will be available soon. Thus, our discipline has available both trained people and a reservoir of information. Our progress during the coming decade will be measured by how successfully we act on the basis of what we know; the emphasis will be on control. The word "myth" could be defined in two ways: (1) a belief given uncritical acceptance by a group, especially in support of traditional practices; or (2) a notion held to be true but without factual basis. It might be useful to examine four notions held rather commonly by infection controllers?notions that I believe are mythical. Wide spread belief in them obstructs recognition of reality and, in doing so, obstructs progress in infection control. Because these notions are widely held, I suspect that what I am about to say will be provocative; certainly all of you will not agree with me. Nevertheless, we should have a good time discussing the issues.

Nosocomial infection control problems in neonates and infants.

Abstract: Nosocomial infection rates of 4-6% are standard in most general hospitals. Wound and urinary tract infections are most common on the Surgical Services. Respiratory tract infections cluster on the Medical Service. Programs of infection control should be Service-directed. Among pediatric patients, particular emphasis should be placed on monitoring colonization by S. aureus and antibiotic-resistant gram-negative rods. Control measures include maintenance of low colonization rates, development of an infection control team, and institution of restrictive practices when an outbreak occurs.