Study On The Efficacy Of Nosocomial Infection Control Research Articles

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.

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.

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.

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.

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.

Risk Factors for Surgical Site Infection in Children

To assess the appropriateness of using the indices developed by the Study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance (NNIS) project to determine risk factors for surgical site infection (SSI) in children and, if not appropriate, to explore the factors related to SSI in children so these factors could be used in a risk index for pediatric patients. Cohort study during more than 4 years. La Paz University Hospital, a national reference center that serves Health Area 5 of Madrid, Spain, which has approximately 500,000 inhabitants. Convenience sample consisting of the 3,646 children admitted for surgery who had a postsurgical stay of more than 2 days. A model with 8 predictive factors (degree of surgical contamination; duration of surgery; type of surgery; use of a peripheral venous catheter, central venous catheter, or urinary catheter; number of diagnoses; and SSI exposition time) was created. Its relation to the SSI rate was better than that of the SENIC or NNIS indices. Its sensitivity, specificity, and area under the receiver-operating characteristic curve were higher than that of the SENIC index. The model that we created seems to be more adequate for predicting SSI and evaluating pediatric patients' intrinsic risk than the SENIC and NNIS indices.

When continuous surgical site infection surveillance is interrupted: The Royal Hobart Hospital experience

The prevalence of surgical site infections (SSI) is second only to urinary tract infections in hospitalized patients. They continue to threaten the health of hospitalized patients and impact negatively on the financial solvency of hospitals through prolonged hospitalization, increased rates of rehospitalization, and significantly increased health care costs. We describe the effect of a 12-year surveillance program that included postdischarge follow-up and feedback to clinicians on the rate of SSI and the effect when surveillance is interrupted. Surgical procedures performed at the Royal Hobart Hospital (RHH), a university teaching hospital in Australia, between 1988 and 2001 were monitored for evidence of SSI in hospitals and for up to 30 days postoperatively. The surveillance program was inadvertently disrupted for 15 months from October 1990 to January 1992 and then recommenced. It has been ongoing since that time, apart from a 3-month interruption in 1998. Infection rates were determined on a regular basis, and these results were provided to surgeons, theatre staff, and surgical ward staff every 6 months. Patients included all adult surgical patients with an incisional wound, excluding burn patients and day-only surgical patients. Over the 12-year active surveillance period, 47,581 surgical procedures were followed for SSI. In-hospital SSI rates declined significantly over the study period from 4.7% (95% CI: 3.9%-5.6%) in 1988-1989 to 1.2% (95% CI: 0.8%-1.7%) in 2001 (P < .0001). Infection rates fell rapidly following the commencement of the program. This decline was halted during the period from October 1990 to January 1992 when the program was suspended. In-hospital SSI rates declined once again following the recommencement of the surveillance program, and these lower rates have been maintained. In contrast, postdischarge infection rates rose significantly from 1.2% (95% CI: 0.8%-1.7%) in 1988-1989 to 2.1% (95% CI: 1.6%-2.7%) in 2001 (P < .0001). The introduction of a program of continuous SSI surveillance at the RHH was associated with a reduction in the in-hospital and total SSI rate. This phenomenon was repeated following the recommencement of the program after a temporary interruption. Increasing numbers of SSIs are arising after hospital discharge. Many of these patients are readmitted to the hospital for further management of the SSI. Surveillance programs that do not perform postdischarge surveillance will have difficulty in capturing this data. Our experience supports the Study on the Efficacy of Nosocomial Infection Control (SENIC) findings, showing that health care facilities can achieve improved levels of infection management with active surveillance programs.

Surgeons' perspectives on surgical wound infection rate data in Queensland, Australia

The results of the Study on the Efficacy of Nosocomial Infection Control (SENIC) project demonstrated that hospitals with active infection control programs had lower rates of nosocomial infection than those without such programs. A key component of these programs was the inclusion of a systematic method for monitoring nosocomial infection and reporting these infections to clinicians. To identify the perspectives of surgeons in Queensland, Australia, regarding infection rate data in terms of its accuracy and usefulness as well as their perceptions regarding acceptable infection rates for surgical procedures classified as "clean" or "contaminated." A postal survey was conducted, with a convenience sample of 510 surgeons. More than 40% (n = 88) of respondents believed that the acceptable infection rate associated with clean surgical procedures should be less than 1%, a rate much lower than the threshold of 1.4% to 4.1% set by the Australian Council on Healthcare Standards (ACHS). Almost 30% (n = 55) of respondents reported that they would accept infection rates of 10% or higher for contaminated surgical procedures, which is higher than the ACHS threshold of 1.4% to 7.9%. Respondents identified failure to include postdischarge infections in the data and difficulties standardizing criteria for diagnosis of infection as the major impediments to the accuracy and usefulness of data provided. The results of this study have significant implications in relation to the preparation of surgical site infection reports, especially in relation to the inclusion of postdischarge surveillance data and information regarding pathogens, antibiotic sensitivities, and comorbidities of patients developing surgical site infection. Surgeons also identified the need to include information regarding the use of standardized definitions in the diagnosis of wound infection and parameters that allow comparison of infection rates to improve their perceptions regarding data accuracy and usefulness.

Analysis of risk factors for nosocomial sepsis in surgical patients.

This study aimed to identify patients at high risk for developing sepsis following surgery according to criteria determined by the American College of Chest Physicians and the Society of Critical Care Medicine Consensus Conference on sepsis. A prospective case-control study was performed in surgical patients in a tertiary care centre over 1 year. Patients were identified by a daily prospective surveillance. Controls were selected randomly from the daily list of surgical inpatients. Data were collected prospectively. Crude and adjusted odds ratios (ORs) and their 95 per cent confidence intervals were computed using logistic regression analysis. During follow-up, 99 cases and 99 controls were identified. The main risk factors for sepsis found in the multivariate analysis were coma within 48 h before sepsis (OR 13.5, 95 per cent confidence interval 3.6-50.8), low serum albumin level at admission (OR 15.8, 5.4-46.4), two or more intrinsic co-morbidities (OR 11.8, 2.8-49.4) and parenteral nutrition (OR 5.1, 1.5-17.1). Emergency surgery (OR 3.0, 1.4-6.4), abdominal surgery (OR 2.6, 1.0-6.8) and number of surgical interventions (OR 2.5, 1. 1-6.1) were the variables related to surgery that significantly increased the risk of sepsis. Both the study on the Efficacy of Nosocomial Infection Control (SENIC) and the National Nosocomial Infections Surveillance indices showed a statistically significant trend with sepsis. Patient-related factors appear to represent the greatest risk for developing postoperative nosocomial sepsis, rather than factors associated with the surgery.

From expert data collectors to interventionists: Changing the focus for infection control professionals

The current economic and political environments challenge health care organizations in the United States to provide affordable, accessible, and comprehensive health services. However, changes in reimbursement to health care providers can affect their ability to offer access to cutting-edge services while reducing costs. Consequently, organizations are restructuring, re-engineering, right-sizing, downsizing, and redesigning, all in an effort to save money while also hoping to maintain a reputation for quality and customer service. Dr Vicky Fraser, in her keynote address at the APIC conference in 2000, reminded us that ICHE programs are cost centers rather than revenue generators, and are often targets for budget cuts. Although Haley's Study on the Efficacy of Nosocomial Infection Control (SENIC) , published in 1985, was a landmark event demonstrating the importance of our profession's mission, it is becoming dated. Infection control professionals (ICPs) must continue Haley's work, finding innovative ways to market or demonstrate the value of ICHE programs to health care executives. Closing the 1999 APIC conference with a symposium entitled “Breaking Out of the Box,” Jackson and Massanari challenged ICPs to educate themselves about the changing health care environment, to be proactive, and constructively help organizations “re-engineer” more efficiently, rather than feel victimized and helplessly await being re-engineered out of existence. The threat of downsizing prompted ICPs at BJC HealthCare to realize that the time had come to change their own culture and attitudes and to focus on the business of infection control. This change required challenging the traditional roles of solo practitioner, data collector, and keeper of infection control data and knowledge. The goals now include leading intervention teams committed to reducing health care-associated infections, partnering rather than accepting sole responsibility for lowering infection rates, and learning to influence without authority. Staying focused on quality and cost-effectiveness and demonstrating improvements in clinical outcomes became a commitment. This article discusses BJC HealthCare's journey through change so that it may provide useful information and tools for ICPs in any setting looking for the necessary change strategies that might keep them in business. (Am J Infect Control 2002;30:120-32.)

Efficacy of surveillance in nosocomial infection control in a surgical service

Objective: The purpose of this study was to assess the efficacy of surveillance of nosocomial infection in infection control at a service of general surgery. Design: A surveillance study that included 1483 patients with a prospective identification of nosocomial infection was carried out. Its results were discussed with the staff, and a program on nosocomial infection control was implemented. One year after the preintervention study, a similar study that included 1506 patients was done. The main outcome measure was nosocomial infection. Incidence rates, incidence rate ratios, crude and multiple-risk factor adjusted for by Poisson regression analysis, and their 95% confidence interval rates were estimated. Results: The characteristics of the patients enrolled in both studies were compared. After the intervention, the trend was to attend patients with more severe conditions: higher frequency of liver failure, chronic obstructive lung disease, higher proportion of dirty surgical wounds, and higher scores of both Study on the Efficacy of Nosocomial Infection Control (SENIC) and National Nosocomial Infections Surveillance indices. There were no significant differences in emergency surgery, duration of surgery, age, and sex. After the intervention, unnecessary chemoprophylaxis was drastically reduced, and a significant reduction in preoperative stay was observed. The nosocomial incidence rate fell from 18.4 to 14 per 1000 patient-days. This reduction yielded an incidence rate ratio of 0.56 (95% confidence interval, 0.43-0.74%) adjusted for several variables (SENIC index, serum creatinine level, serum albumin level, antihistamine H2 level, surgical wound, body mass index, chemoprophylaxis, and community-acquired infection). Significant reductions in surgical site infection and urinary tract infection were observed, but the rate of respiratory tract infection remained unchanged. Conclusions: Surveillance was effective in reducing nosocomial infection.

Incidence and predictors of surgical-site infections in Vietnam.

To determine the incidence of, and risk factors for, surgical-site infections (SSIs). Prospective observational study of all patients undergoing surgery during a 3-month period. Two urban hospitals in Hanoi, Vietnam. All 697 patients admitted for emergent and elective surgery. Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model. During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46; P<.01) and wound class IV (OR, 5.67; P<.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene. There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.

Hospital infection prevention and control: A global perspective

Hospital infection prevention and control: A global perspective

Nosocomial Infections in Surgical Patients: Comparison of Two Measures of Intrinsic Patient Risk

To compare, in subjects undergoing general surgery, two measures of intrinsic patients risk for nosocomial infection: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) System index.Prospective cohort study, with follow-up for 1 month after hospital discharge.The general surgery service of a tertiary hospital.Surgical-site infection.1,483 subjects aged 10 to 92 years.During follow-up, 155 patients developed nosocomial infection, yielding a cumulative incidence of 10.5%. The NNIS index showed a linear trend with both crude and adjusted (for SENIC index) rates of surgical-wound infection. The SENIC index did not exhibit any linear trend with adjusted (for NNIS index) rates of surgical-wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed each variable on the other. Logistic regression analyses confirmed the results of stratified analysis: residuals of the NNIS index added discriminating ability to the SENIC index, whereas residuals of the SENIC index did not improve the predictive power of the NNIS index.The NNIS index had a better ability than the SENIC index for discriminating and predicting risk of surgical-wound infection.

Assessment of infection control programs in Maryland skilled-nursing long-term care facilities

Background: Nosocomial infections cause substantial morbidity adn mortality among residents in long-term care facilities (LTCFs). Although infection control programs now exist in many LTCFs in the United States, little has been published regarding the effectiveness of these programs. The 1976 Centers for Disease Control and Prevention Study on the Efficacy of Nosocomial Infection Control (SENIC) established the effectiveness of infection control programs in acute care facilities. However, a limitation of that study was the exclusion of LTCFs. Methods: The purpose of this pilot study was to assess infection control prorams in LTCFs through the use of an Infection Surveillance and Control Questionnaire adapted from SENIC. The samle consisted of 123 skilled-nursing LTCFs in the State of Maryland. The questionnaire was completed by the person responsible for infection control activities in each LTCF. Results: Results of the study show the following: (1) an upward trend in infection control activity in Maryland LTCFs, with the majority having medium activity, and (2) an estimated overall prevalence rate of infection of 4% on the basis of total resident census. Conclusion: The findings indicated that the Infection Surveillance and Control Questionnaire is a reliable instrument to assess infection control programs in LTCFs. A nationwide study is planned to examine the relationship between infection control activity and the risk of nosocomial infection among skilled-nursing LTCFs throughout the United States.