Efficacy Of Nosocomial Infection Control Research Articles

Monitoring Multidrug-Resistant Acinetobacter baumannii Infections in the Neurosurgery ICU Using a Real-Time Surveillance System.

Multidrug-resistant Acinetobacter baumannii (MDR-AB) infections are becoming increasingly common. The Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was used to monitor MDR-AB NI in intensive care units (ICUs) to prevent NI outbreaks. Therefore, the RT-NISS was used in the current study to monitor MDR-AB infections in a neurosurgery ICU. Clinical interventions, including recommended antibiotics, bacterial distribution in the patient analysis, and bed adjustments, were carried out based on the monitoring results. The RT-NISS was also used to monitor clinical data, implement, and provide training on NI control. The RT-NISS detected a potential cluster of XDR-AB when five patients admitted to the neurosurgery ICU were tested positive for AB between 11 and 17 June 2019. Only two infected cases originated in the hospital, and there was no NI outbreak. The hospital Infection Control Department took appropriate measures to prevent cross-infection; specifically, an epidemiologic investigation and environmental assessment were conducted, and NI prevention and outbreak management training was provided. In summary, the RT-NISS enhanced the timeliness and efficacy of NI control and surveillance in a neurosurgery ICU. In order to prevent NI outbreaks, the Real-Time Nosocomial Infection (NI) Surveillance System (RT-NISS) was employed to monitor MDR-AB NI in critical care units (ICU). Based on the monitoring data, clinical actions such as required antibiotics, bacterial distribution in the patient analysis, and bed changes were carried out. In a neurosurgery ICU, the RT-NISS improved the timeliness and efficacy of NI control and surveillance.

Surveillance Method for Surgical Site Infection

Surgical Site Infection (SSI) is the third most commonly reported Nosocomial infection and accounts for 14–16% of all Nosocomial infections among hospital inpatients. The morbidity, mortality and the cost to health services of surgical site infections is huge. In addition, many workers have shown that feedback of appropriate data to surgeons has been an indispensable component of strategies to reduce SSI rates. The elements essential for a successful programmed of prevention of SSIs include intensive surveillance, infection control activities and regular feedback of SSI rates to surgeons. Surveillance with information feedback to surgeons and other medical staff has been shown to be an important element in the overall strategy to reduce the numbers of SSIs. Despite the apparent effectiveness in lowering SSI rates when surgeons receive feedback, however, there has been no consensus on which surveillance methods are best for collecting data on SSIs. A successful SSI surveillance program should include standardized definitions of infection, effective surveillance methods and stratification of the SSI rates according to risk factors associated with the development of SSI. For many years wound contamination class was the only factor that was well described for predicting the risk for SSI. During the Study on the Efficacy of Nosocomial Infection Control (SENIC) Project, an index was developed that provided a better assessment of the risk of SSIs than had the traditional wound classification system. In 1991, a modification of the SENIC risk index by Culver et al. led to the National Nosocomial Infections Surveillance (NNIS) System risk index. This review examines the best surveillance method for surgical site infection.

Is accounting for acute care beds enough? A proposal for measuring infection prevention personnel resources

There is still little known about how infection prevention (IP) staffing affects patient outcomes across the country. Current evaluations mainly focus on the ratio of IP resources to acute care beds (ACBs) and have not strongly correlated with patient outcomes. The scope of IP and the role of the infection preventionist in health care have expanded and changed dramatically since the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) recommended a 1 IP resource to 250 ACB ration in the 1980s. Without a universally accepted model for accounting for additional IP responsibilities, it is difficult to truly assess IP staffing needs. A previously suggested alternative staffing model was applied to acute care hospitals in our organization to determine its utility.

Predictive model for surgical site infection risk after surgery for high-energy lower-extremity fractures

Current infection risk scores are not designed to predict the likelihood of surgical site infection after orthopedic fracture surgery. We hypothesized that the National Nosocomial Infections Surveillance (NNIS) System and the Study on the Efficacy of Nosocomial Infection Control (SENIC) scores are not predictive of infection after orthopedic fracture surgery and that risk factors for infection can be identified and a new score created (Emerg Infect Dis. 2003;9:196-203). We conducted a secondary analysis of data from a trial involving internal fixation of 235 tibial plateau, pilon, and calcaneus fractures treated between 2007 and 2010 at a Level I trauma center. The predictive value of the NNIS System and SENIC scores was evaluated based on areas under the receiver operating characteristic (ROC) curve. Bivariate and multiple logistic regression analyses were used to build an improved prediction model, creating the Risk of Infection in Orthopedic Trauma Surgery (RIOTS) score. The predictive value of the RIOTS score was evaluated via the ROC curve. NNIS System and SENIC scores were not predictive of surgical site infection after orthopedic fracture surgery. In our final regression model, the relative odds of infection among patients with AO [Arbeitsgemeinschaft für Osteosynthesefragen] type C3 or Sanders type 4 fractures compared with fractures of lower classification was 5.40. American Society of Anesthesiologists class 3 or higher and body mass index less than 30 were also predictive of infection, with odds ratios of 2.87 and 3.49, respectively. The area under the ROC curve for the RIOTS score was 0.75, significantly higher than the areas for the NNIS System and SENIC scores. The NNIS System and SENIC scores were not useful in predicting the risk of infection after fixation of fractures. We propose a new score that incorporates fracture classification, American Society of Anesthesiologists classification, and body mass index as predictors of infection. Prognostic study, level II.

Moving into the future: electronic surveillance for healthcare-associated infections

Measurement is an essential component for any successful performance improvement programme. Accurate measurement for the prevention of healthcare-associated infection (HAI) requires a surveillance programme. The importance of surveillance in preventing HAIs can be seen going back a century and a half in the seminal work of Semmelweis on puerperal sepsis.1 The central role of surveillance as a component of an effective hospital infection prevention programme was further validated in the modern era by the landmark Study on the Efficacy of Nosocomial Infection Control (SENIC).

Recent Insights into Nosocomial Infections : A Neglected Condition

Nosocomial infections (NI), also known as hospital acquired infection (HAI), is infection whose development is favoured by a hospital environment, such as one acquired by a patient during a hospital visit or one developing among hospital staff. Such infections include fungal and bacterial infections and are aggravated by the reduced resistance of individual patients. Nosocomial infections continues to be of major clinical and epidemiologic importance in developing countries as it constitutes a major source of morbidity, mortality and significant incremental health care expense for the hospitalized patient, despite major advances in clinical sciences. As per the Study on the Efficacy of Nosocomial Infection Control (SENIC) routine surveillance of NI has become an integral part of infection control and quality assurance in US hospitals because it's potential of reducing nosocomial infections. Studies performed in the United States have demonstrated that an integrated infection control program that includes targeted device-associated surveillance can reduce the incidence of nosocomial infection by as much as 30% and lead to reduced health care costs.

Prevalence of Healthcare-Associated Infections in Acute Care Hospitals in Jacksonville, Florida

To determine healthcare-associated infection (HAI) prevalence in 9 hospitals in Jacksonville, Florida; to evaluate the performance of proxy indicators for HAIs; and to refine methodology in preparation for a multistate survey. Point prevalence survey. Acute care inpatients of any age. HAIs were defined using National Healthcare Safety Network criteria. In each facility a trained primary team (PT) of infection prevention (IP) staff performed the survey on 1 day, reviewing records and collecting data on a random sample of inpatients. PTs assessed patients with one or more proxy indicators (abnormal white blood cell count, abnormal temperature, or antimicrobial therapy) for the presence of HAIs. An external IP expert team collected data from a subset of patient records reviewed by PTs to assess proxy indicator performance and PT data collection. Of 851 patients surveyed by PTs, 51 had one or more HAIs (6.0%; 95% confidence interval, 4.5%-7.7%). Surgical site infections ([Formula: see text]), urinary tract infections ([Formula: see text]), pneumonia ([Formula: see text]), and bloodstream infections ([Formula: see text]) accounted for 75.8% of 58 HAIs detected by PTs. Staphylococcus aureus was the most common pathogen, causing 9 HAIs (15.5%). Antimicrobial therapy was the most sensitive proxy indicator, identifying 95.5% of patients with HAIs. HAI prevalence in this pilot was similar to that reported in the 1970s by the Centers for Disease Control and Prevention's Study on the Efficacy of Nosocomial Infection Control. Antimicrobial therapy was a sensitive screening variable with which to identify those patients at higher risk for infection and reduce data collection burden. Additional work is needed on validation and feasibility to extend this methodology to a national scale.

Advancing the science of ventilator-associated pneumonia surveillance

The landmark Study on the Efficacy of Nosocomial Infection Control definitively demonstrated that infection surveillance and control programs prevent hospital-acquired infections. The rise of public reporting, benchmarking, and pay for performance movements, however, has considerably changed the infection surveillance landscape in the 27 years since this study was published. Clinically nuanced surveillance definitions that served the profession well for many years have fallen into disfavor because their complexity and subjectivity allow for conscious and subconscious gaming. These limitations make it very difficult to determine whether changes in surveillance rates represent true changes in disease incidence or artifacts of definition subjectivity, external reporting pressures, and internal biases. Surveillance definitions need to be revised to enhance objectivity and to ensure that they detect clinically meaningful events associated with compromised outcomes. The US Centers for Disease Control and Prevention recently released modified definitions for ventilator-associated events that have the potential to make safety surveillance for ventilated patients more credible and useful once again.

External Validation of SENIC and NNIS Scores for Predicting Wound Infection in Colorectal Surgery

Objective: We aimed to identify the ratio of Surgical Site Infection (SSI) and also the validity of the National Nosocomial Infection Survellance (NNIS) and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk indexes in colorectal surgery, among Turkish population. Background: Some problems have been reported with the power of NNIS risk index to predict the risk of surgical site infection. We aimed to validate theNNIS and SENIC risk indexes in colorectal surgery. Methods: Between January 2003 and December 2006, surgical site ?nfection survellance was performed to 107 patient who undergo colorectal surgery with NNIS and SENIC risk scales. The mean patient age was 48 years (range, 17 to 86), and 61.7% of the group (66) was female. For this patient cohort, 6 (5.6%) were diagnosed with incisional SSI. While the mean Body Mass Index (BMI) of all patients was 26.6; mean value of BMI among the patiens with SSI was 27.8.Results: 6 insicional surgical site infection were observed during the study. According to Receiver Operating Characteric (ROC) curve analyze neither NNIS with avalue of 0.70, nor SENIC with a value of 0.67 are perfect risk indexes. Conclusion: As a result both NNIS and SENIC ?s a good risk indexes but not perfect. Scarcely when NNIS and SENIC is used together to predict the SSI they forecast the development of infection better. But there is a lot of other factors that effect the development of SSI, so for excellent surveillance risk index those factors known by everyone must be added to risk index scales.

Catheter-Acquired Urinary Tract Infection: The Once and Future Guidelines

From the Department of Internal Medicine and Medical Microbiology, University of Manitoba Health Sciences Centre, Winnipeg, Manitoba, Canada Received December 21, 2009; accepted December 27, 2009; electronically published February 15, 2010. Infect Control Hosp Epidemiol 2010; 31:327-329 2010 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2010/3104-0002$15.00. DOI: 10.1086/651092 Catheter-acquired urinary tract infection (CAUTI) is one of the most common hospital-acquired infections. The rate of acquisition of new infection is 3%–7% per day while the indwelling urinary catheter remains in place. More than 80% of hospital-acquired urinary tract infections are catheter associated, and 12%–16% of patients who are admitted to acute care hospitals have an indwelling catheter placed at some time during hospitalization. In addition, approximately 5% of longterm care facility residents have voiding managed with a chronic indwelling catheter. However, morbidity or mortality with catheter use is modest, compared with other deviceassociated infections. Infection with an indwelling urethral catheter is overwhelmingly asymptomatic. Symptomatic infection is uncommon, and the severe manifestation of bacteremia attributable to CAUTI is reported in prospective studies for less than 1% of patients with catheters and less than 5% of patients with CAUTI. Costs directly attributable to CAUTI are also modest and are estimated to average only $589 per infection. Despite these considerations, the intensity of urinary catheter use in healthcare settings means that the cumulative contribution of CAUTI to the burden of hospitalacquired infections is substantial. In addition, there are adverse effects of indwelling urethral catheters beyond infection. Trauma and inflammation from the catheter or complications from patient immobility are other patient-specific adverse effects, and urine drainage bags are a reservoir for drugresistant bacteria in the healthcare environment. In 1981, the Centers for Disease Control and Prevention developed guidelines for the prevention of CAUTI. Now, in 2010, almost 30 years later, the Healthcare Infection Control Practices Advisory Committee (HICPAC) has updated these guidelines. For many of us, the interval from publication of the initial guideline to this first revision spans the greater part of a professional career. Even more extraordinary, the 1981 guideline did not simply fade away as it was eclipsed by time but continued to be a reference for appropriate practice. It is only recently that alternate guidelines addressing CAUTI have been developed, such as the Department of Health of Great Britain guidelines published in 2001 and updated in 2007 and the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America/Association for Professionals in Infection Control Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals published in 2008. Why has there been such an extraordinary lapse of time before this revision? Limited substantive change in practices to prevent CAUTI during the past 3 decades meant there was never any urgent need to update the document, because the initial guidelines were never incorrect. This is, itself, a distressing observation. In an interval of 30 years during which there has been intense interest and continuing progress in addressing hospital-acquired infections, one would have hoped for some meaningful advances in the prevention of CAUTI. A second likely explanation for the delayed revision is that CAUTI has been considered a relatively unimportant hospital-acquired infection. Morbidity with symptomatic urinary infection is uncommon relative to the intensity of urinary catheter use, and attributable mortality is rare, compared with the attributable mortality of other device-related infections, such as central-line bacteremia and ventilator-associated pneumonia. The landmark Study on the Efficacy of Nosocomial Infection Control by Haley et al, published in the 1980s, was important in encouraging this perspective. This study reported that nosocomial urinary infection could be decreased by 31%–41% with an intense infection control program and would achieve the greatest absolute number of infections potentially prevented, compared with programs to prevent surgical wound, lower respiratory, or bloodstream infections. However, the mean extra length of stay was only 2 days for symptomatic urinary infection and 0.4 days for asymptomatic infection, compared with 5.2 days for lower respiratory infection, 7.4 days for bloodstream infection, and 7.7 days for surgical wound infection. With the introduction of surveillance by objective, CAUTI became the most dispensable component. Why are the guidelines updated now? The revision itself

Impact of Surgical Site Infections on Length of Stay and Costs in Selected Colorectal Procedures

Length of stay (LOS) and inpatient costs for open-abdomen colorectal procedures have not been examined recently. The aim of this study was to determine LOS and costs for several colorectal procedures in the context of factors potentially associated with surgical site infection (SSI). We used a large U.S. hospital database to identify the variables associated with longer LOS and higher costs for colorectal procedures from January 1, 2005, through June 30, 2006. The study population consisted of all patients >18 years, identified via International Classification of Disease, Ninth Revision, procedural codes for elective colorectal surgery. Patient demographics, surgical procedure, and a modified Study of the Efficacy of Nosocomial Infection Control (SENIC) infection risk score were examined using logistic regression as predictors of LOS >or=1 week and cost >or=$15,000. Patients given cefotetan as surgical prophylaxis were compared with patients given cefazolin/metronidazole. Superficial and deep SSIs were considered; intra-abdominal infection was not. The 25,825 patients were of average age 63 years, with 53% being female and 75% being Caucasian. The overall infection rate was 3.7%. The mean LOS was 7.25 days, and the mean +/- standard deviation total cost per patient $13,746 +/- $13,330. Rates of infection, LOS, and mean hospital costs were all greater for patients with a high SENIC score and increasing disease acuity. Values for these outcome variables were highest for procedures involving stoma formation, followed by operations on the small bowel and large bowel. Variables independently predictive of longer LOS were SSI (odds ratio [OR] 11.74; 95% confidence interval [CI] 9.67, 14.26), age >or=65 years (OR 1.90; 95% CI 1.81, 2.01), and high SENIC score (OR 1.79; 95% CI 1.67, 1.92), whereas Caucasian race (OR 0.86; 95% CI 0.81, 0.91) was predictive of a shorter LOS. Cefazolin/metronidazole was not predictive of a shorter LOS compared with cefotetan (OR 1.06; 95% CI 0.96, 1.17) but was associated with significantly more hospitalizations with costs >or=$15,000 (OR 1.39; 95% CI 1.23, 1.56). Length of stay and cost rise proportionally with SENIC score, disease acuity, and patient characteristics such as age. Surgical site infections are significantly and independently associated with LOS and cost and contribute to inpatient morbidity and expense. Cefotetan has limited availability, and substitutions are utilized increasingly. Although equally efficacious in elective colon procedures, cefotetan used as surgical prophylaxis was associated with lower hospitalization costs than cefazolin plus metronidazole.

French National Program for Prevention of Healthcare-Associated Infections and Antimicrobial Resistance, 1992–2008: Positive Trends, But Perseverance Needed

To describe the French program for the prevention of healthcare-associated infections and antibiotic resistance and provide results for some of the indicators available to evaluate the program. In addition to structures and process indicators, the 2 outcome indicators selected were the rate of surgical site infection and the proportion of methicillin-resistant Staphylococcus aureus (MRSA) isolates among the S. aureus isolates recovered. Descriptive study of the evolution of the national structures for control of healthcare-associated infections since 1992. Through national surveillance networks, process indicators were available from 1993 to 2006, surgical site infection rates were available from 1999 to 2005, and prevalence rates for MRSA infection were available from 2001 to 2007. A comprehensive national program has gradually been set up in France during the period from 1993 to 2004, which included strengthening of organized infection control activities at the local, regional, and national levels and developing large networks for surveillance of specific infections and antibiotic resistance. These achievements were complemented by instituting mandatory notification for unusual nosocomial events, especially outbreaks. The second phase of the program involved the implementation of 5 national quality indicators with public reporting. Surgical site infection rates decreased by 25% over a 6-year period. In France, the median proportion of MRSA among S. aureus isolates recovered from patients with bacteremia decreased from 33.4% to 25.7% during the period from 2001 to 2007, whereas this proportion increased in many other European countries. Very few national programs have been evaluated since the Study on the Efficacy of Nosocomial Infection Control. Although continuing efforts are required, the French program appears to have been effective at reducing infection rates.

Validación de Índices Pronósticos e Infección del Sitio Quirúrgico en Hospitales de Colombia

Establishing the effectiveness of the National Nosocomial Infection Surveillance System (NNIS) and Study of the Efficacy of Nosocomial Infection Control's (SENIC) prognostic surgical site infection (SSI) indices in Colombian hospitals and assessing the influence of other risk factors. A prospective, multicentre cohort study was conducted in five Colombian hospitals. All patients undergoing surgery requiring hospitalisation or ambulatory surgeries having a greater risk of infection were enrolled. A case was defined as being those subjects who presented the CDC diagnostic criteria of incisional superficial, deep incisional or organ-space SSI. Age, gender, co-morbidities, type of surgery, procedures, medical specialty, type of wound, surgical time, antibiotic prophylaxis and patient outcome were used for developing a predictive model of SSI using logistical regression analysis. The indexes' predictive ability was assessed by using the area under the receiver operating curve (ROC). 7,022 surgical procedures were evaluated and SSI rate was 2.9%. NNIS and SENIC risk index performance was similar to that for predicting SSI (0.68 cf 0.66 area under ROC, respectively). The new predictive model involved other factors such as age, diabetes mellitus, transfusions and surgical specialty showing 0.74 operating performance. Existing SSI predictive models have a moderate ability for predicting SSI but this can be improved with some local factors.

SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008.

SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008.

Correlation of Risk and Postoperative Assessment Methods in Wound Surveillance

Various surveillance methods have been described for surveillance of surgical site infections (SSI). The aim of this study was to examine practicality of SSI risk assessment methods (Study on the Efficacy of Nosocomial Infection Control [SENIC] and National Nosocomial Infections Surveillance [NNIS]) with a postoperative wound monitoring scale (ASEPSIS) as an outcome assessment measure. Patients were followed with a prospective data chart from January 1, 2003, to December 31, 2005. Correlation of SENIC and NNIS together with ASEPSIS were performed. During the study period, 222 SSI occurred. SSIs were determined within the 21-d period after operations. Correlation between SENIC with ASEPSIS (r(s) = 0.47, P < 0.001) was found better than that for NNIS with ASEPSIS (r(s) = 0.41, P < 0.001). Type of operation (emergency versus elective), body mass index, operation class, and American Society of Anesthesiologists scores were found independently predictive factors for SSI. This study indicates weak but significant correlation between preoperative risk assessment methods for SSI and ASEPSIS.

Development and Application of Evaluation Indices for Hospital Infection Surveillance and Control Programs in the Republic of Korea

To develop new evaluation indices of infection control and to use them to evaluate Korean infection surveillance and control programs (ISCPs). We performed a questionnaire-based survey to 164 acute care general hospitals throughout the Republic of Korea that had more than 300 beds. Study methods were based completely on those of the Study on the Efficacy of Nosocomial Infection Control (SENIC). Four SENIC indices (hospital epidemiologist index, infection control nurse index, surveillance index, and control index) and 4 newly developed indices (healthcare worker index, quality improvement index, resource index, and hand hygiene facilities index) were used to evaluate Korean ISCPs. Data were collected by questionnaire from June 17 to October 11, 2003. One hundred sixty-four general hospitals with more than 300 beds in the Republic of Korea. Personnel from 85 general hospitals responded to the study questionnaire. The reliability and validity of the evaluation indices were statistically significant (P<.05). The 8 evaluation indices were categorized into 2 factor groups: personnel factors (hospital epidemiologist index and infection control nurse index) and activity factors (the remaining 6 indices). Korean ISCPs showed a major weakness in surveillance. The scores for the newly developed evaluation indices were better than those for the SENIC evaluation indices. However, most Korean hospitals were estimated to have had only slight reductions in nosocomial infection rates. The evaluation indices were influenced significantly by the number of beds in the hospital, whether the hospital was located in the Seoul-Gyonggi region, the presence of full-time infection control nurses at the hospital, the education level of the infection control nurses, and the nurses' experience in infection control (P<.05). The reliability and validity of the SENIC evaluation indices and the newly developed evaluation indices were satisfactory in evaluating Korean ISCPs. However, surveillance should be improved to increase the efficacy of Korean ISCPs.

Applicability of the national nosocomial infections surveillance system risk index for the prediction of surgical site infections: a review

This review outlines the evolution of risk rates of surgical site infection adopted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) system, and evaluates their advantages and limitations. The types of surgical procedures for which the NNIS index has proven to be an efficient system for the classification of patients are presented. The necessity of adapting the NNIS index to take into account specific characteristics associated with hospitals and practices in various regions and countries is stressed. The requirement for further testing and development of the rate concerning specific procedures, particularly those involving orthopaedic surgery, is discussed.

Indices of Surgical Site Infection Risk and Prediction of Other Adverse Outcomes During Hospitalization

To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index. Prospective cohort study. The service of general surgery at a tertiary care hospital. A consecutive series of patients hospitalized for more than 1 day (n=2,989). The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P<.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve+/-SE, 0.836+/-0.022 vs 0.689+/-0.017; P=.001). The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection.

Indices of Surgical Site Infection Risk and Prediction of Other Adverse Outcomes During Hospitalization

Objective.To assess which adverse postsurgical outcomes are best predicted by the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance system (NNIS) index.Design.Prospective cohort study.Setting.The service of general surgery at a tertiary care hospital.Patients.A consecutive series of patients hospitalized for more than 1 day (n = 2,989).Results.The outcome best predicted by the SENIC and NNIS indices was assessed by estimating the area under the receiver operating characteristic (ROC) curve. The areas under the ROC curves for nosocomial infection and in-hospital death were higher for the NNIS index than they were for the SENIC index (P&lt;.05). The NNIS index predicted in-hospital death better than it predicted surgical site infection (area under the ROC curve ± SE, 0.836 ± 0.022 vs 0.689 ± 0.017; P = .001).Conclusions.The NNIS index is superior to the SENIC index for all adverse postsurgical outcomes. Its ability to predict in-hospital mortality is clearly better than its ability to predict surgical site infection.

National survey of the status of infection surveillance and control programs in acute care hospitals with more than 300 beds in the Republic of Korea

This study was conducted to assess the status of infection surveillance and control programs (ISCPs) and to analyze the trends associated with ISCP implementation since the first program was established in Korea in 1991. A questionnaire modified from the Study on the Efficacy of Nosocomial Infection Control was mailed 4 times nationwide to acute care hospitals (n = 164) with more than 300 beds between June and October 2003. Eighty-five hospitals participated (52%). The mean number of beds (649) in the responding hospitals was significantly greater than in nonresponding hospitals. Of the participating hospitals, 92% had educational functions, 40% to 90% used hand hygiene resources, and 100% had infection control committees; 86% had infection control doctors, 98% had infection control nurses (ICNs), 89% employed only 1 ICN, and 59% employed an ICN only part-time; 68% performed surveillance, undertaking 2.7 epidemic investigations per year and 8.4 teaching programs per year; 88% undertook needlestick prevention programs; 58% performed regular air culture; and 64% discarded ineffective ISCPs. Annual trends analysis of ISCPs indicated that accreditation and legislation impact strongly on Korean ISCPs. The figures for ISCPs in this study indicate that improvements have been made since the 1990s. Legislation and accreditation have strongly influenced ISCPs. Much consideration should be given to the weaknesses in Korean ISCPs: surveillance, insufficient hand hygiene resources, and shortage of ICNs.