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Once health care professionals understand the significance of nosocomial infections, they will alter their care giving practices to bring reductions, according to a recent evaluation of the Centers for Disease Control and Prevention’s National Nosocomial Infections Surveillance system (NNIS). But even though improving caregiver practices clearly improves patient care, it will hardly solve the problem. The best current estimates are that only about a third of nosocomial infections are preventable. Overall, nosocomials cause 44,000-98,000 deaths and cost $17-29 billion per year when calculated with other medical errors.
To lower these figures, the CDC recommends establishing a multicenter monitoring system that uses standard definitions, data fields, protocols, and names an aggregating institution to standardize definitions and protocols, receive and assess data, and standardize the approach to risk-adjusting the benchmarks.
NNIS has been monitoring ICU patients since 1987, using site-specific, risk-adjusted infection rates by ICU type. CDC researchers found that from 1990 through 1999, participating NNIS hospitals decreased risk-adjusted patient respiratory, urinary, and bloodstream infection rates. Substantial decreases in bloodstream infection rates occurred in medical (44%), surgical (31%), and pediatric (32%) ICUs.
The NNIS system uses the endemic-disease rate of nosocomial infection as a measure of ongoing infection risks to hospitalized patients when no recognized outbreaks are in process. However, researchers point out that no single source of information allows for accurately identifying nosocomial infections.
Researchers found that once patient-care personnel saw value in the data collected, they altered behaviors in ways that may have reduced the incidence of nosocomial infections in NNIS hospitals. In fact, the key to NNIS’s success is the willingness of infection-control practitioners to develop preventive measures using the monitoring data. Developing better measures for preventable nosocomials should help increase monitoring efficiency and usefulness.
Mandatory Reporting, Public Access Could Cause Problems
According to a recent Institute of Medicine report, even though the NNIS is apparently successful, such success isn’t definitive because reporting medical errors is not mandatory. And even mandatory reporting is no guarantee the data will be accurate. In fact, mandatory reporting would probably make assessing data from self-reporting institutions more difficult and expensive, the IOM report says.
Though NNIS evaluations suggest that nosocomial infections generally are accurately reported, underreporting of infections was a more serious problem than other measures of accuracy, such as predictive value positive or specificity. If reported nosocomial data became publicly accessible, underreporting could become a major concern.
Determining nosocomial infection rates is time-consuming and made more difficult by earlier patient discharge and because there is no universal method for continuing surveillance after discharge. Still, post-discharge and outpatient surveillance will become increasingly important as more health care is provided outside the hospital setting.
The CDC says that a good surveillance system for reducing nosocomial infection rates has these elements:
• voluntary participation and confidentiality;
• standard definitions and protocols;
• defined populations at high risk;
• site-specific, risk-adjusted infection rates comparable across institutions;
• adequate numbers of trained infection control practitioners;
• dissemination of data to health care providers;
• a link between monitored rates and prevention efforts, or patient-care personnel relying on the data to alter their behavior in ways that may have reduced the incidence of nosocomial infections.
Risk-adjusted benchmark infection rates and device-use ratios, reported annually, are available online to both NNIS and non-NNIS hospitals at www.cdc.gov/ncidod/hip/surveill/NNIS.htm.
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