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W J Hierholzer

Publications and source records attributed to W J Hierholzer.

At least 37 records · Page 2Linked to original sources
PubMed1989

Utilization review and management: a brief analysis of a growth industry.

Current evidence concerning the prevalence of inappropriate care indicates that there is an opportunity for significant utilization and cost reductions. Although the efficacy of some methods of utilization control has been demonstrated, the clinical impact and safety of these techniques are unclear. Although financial incentives have been successful in nonhealth industries, there is no evidence that fiscal rewards will eliminate inappropriate use rather than necessary care. Both short- and long-term quality assurance monitors should be combined with any utilization control method promoting "appropriate" use of inpatient beds and hospital services.

Cost Control↗
PubMed1989

Surveillance for quality assessment: I. Surveillance in infection control success reviewed.

This review of the use of surveillance by infection control practitioners (ICPs) in nosocomial infection control programs has identified key components that have led to and supported its continued application and success. These include: Surveillance targeting of events (diseases); Early development of standardized definitions; Wide acceptance of these criteria; Advocacy, leadership and education of methodology and; A high level of effectiveness in program practice.

Communicable Disease Control↗
PubMed1989

Analytic strategies in hospital epidemiology: cross-sectional studies.

Prevalence studies have long been a cornerstone of chronic disease epidemiology and infectious hospital epidemiology. However, application of cross-sectional techniques to non-infectious areas of hospital epidemiology has been limited to large scale period prevalence studies of mortality. The architecture of cross-sectional studies was reviewed in detail, highlighting the descriptive power of such studies and acknowledging problems in proving causation as opposed to association. An application of cross-sectional methodology in evaluating blood product use, which takes advantage of the descriptive strengths of the method and availability of information concerning indications for blood use, was outlined. The cross-sectional method should be as useful a tool in evaluating non-communicable disease quality of care as it has been in infectious disease-related hospital epidemiology.

Blood Transfusion↗
PubMed1989

Evaluation of restriction endonuclease analysis as an epidemiologic typing system for Branhamella catarrhalis.

Restriction endonuclease analysis (REA) was evaluated as an epidemiologic typing tool to distinguish Branhamella catarrhalis strains. Fourteen beta-lactamase-producing strains were collected over a 16-month period at a hospital where a nosocomial outbreak of this organism was previously documented by REA. REA produced 12 distinct patterns which correlated with epidemiologic data. Chromosomal REA appears to be a useful technique for distinguishing B. catarrhalis strains.

Bacterial Infections↗
PubMed1988

Organization and operation of the hospital-infection-control program of the University of Iowa Hospitals and Clinics.

The University of Iowa Hospitals and Clinics is located in the center of the United States in Eastern Iowa, has 1,000 hospital beds, and is the largest university owned teaching hospital in the country. Over 35,000 patients are admitted each year. The infection control efforts began in 1969 and were broadened in 1976 with the establishment and implementation of the Program of Epidemiology directed by W.J. Hierholzer, Jr., M.D., hospital epidemiologist. Hospital-wide surveillance is routinely performed by three and a half full-time equivalent LPN practitioners who assess problems and evaluate data essential to realistic identification of nosocomial infection rates, implementation of controls and evaluation of control measures. Nosocomial infection surveillance, utilizing modified CDC criteria, has been performed since July 1976. Ward rounds are made by staff, utilizing nursing care and medication Kardex's, microbiology, hematology and X-ray reports. Importantly, the surveillance system is being validated by concurrent prospective surveys to determine the sensitivity and specificity of reporting data. Outbreaks/epidemics of infections, such as Legionella pneumonia, diarrhea of unknown species, and wounds, as well as burns from manufactured changes in cautery grounds, have been identified and controlled before they have become major epidemics. Surveillance has identified one epidemic per 10,000 patients admitted.(ABSTRACT TRUNCATED AT 250 WORDS)

Cross Infection↗
PubMed1988

Along the data-information continuum: pitfalls and opportunities.

Opportunities and problems in hospital information have been reviewed. At this juncture, it is clear that problems exist in much of the data that administrators and regulators accept as valid. This is due in part to the lack of attention to clinical information systems compared with financial and other management systems. At individual institutions, opportunities exist not only to upgrade the quality of data collected, but also to enhance the integration of these data to provide better clinical information. If this process can occur in an environment of cooperation between larger teaching institutions, larger clinically sophisticated databases can be constructed to better evaluate medical practice and clinical care.

Commission on Professional and Hospital Activities↗
PubMed1988

Description of case-mix adjusters by the Severity of Illness Working Group of the Society of Hospital Epidemiologists of America (SHEA).

Hospitals, insurance companies, and federal and state governments are increasingly concerned about reducing patient cost expenditures while maintaining high quality patient care. One method of reducing expenditures has been to tie hospital reimbursement with a prospective payment system based on diagnosis-related groups (DRGs). However, reimbursement under the DRG system is not acceptable for all patients in all hospitals because it is neither an accurate predictor of costs nor of clinical outcome. This deficiency poses significant problems for hospitals because DRGs are used nationwide as the prospective payment system for inpatients covered by Medicare. Several case-mix adjusters have been proposed to modify DRGs to improve their accuracy in predicting costs and outcome. We reviewed five of the most widely available indices: Acute Physiologic and Chronic Health Evaluation (APACHE II), Coded Disease Staging, Computerized Severity Index (CSI), Medical Illness Severity Group System (MEDISGROUPS), and Patient Management Categories (PMC). Recommendations for the use of a single case-mix adjuster cannot be made at this time because all indices have not been compared in sufficiently diverse settings and because some are better predictors of costs while others are better predictors of clinical outcome. Hospital epidemiologists and other infection control practitioners should be informed about these indices and their potential applications as they expand their role beyond infection control problems to issues concerning cost containment, quality assurance, and reimbursement.

Cost Control↗
PubMed1988

Mortality rates as a quality indicator: a simple answer to a complex question.

Clinical, administrative, and information issues have been reviewed that may impact on the sensitivity of mortality rates as a quality indicator. It is clear that current technology cannot necessarily identify high-risk institutions through the use of abstracted discharge data. Furthermore, even if this screening capability is improved, verification of quality problems still requires detailed chart review. Quality of health care delivery will continue to be scrutinized by various groups, only some familiar with clinical risk adjustment and the actual process of care. In order to promote the accuracy and fairness of the review process, objective, outcome-based criteria for high-quality care must be developed for many clinical situations, and clinicians must continue to be involved in quality assessment.

Cause of Death↗
PubMed1988

A nosocomial outbreak of ampicillin-resistant Haemophilus influenzae type b in a geriatric unit.

A nosocomial outbreak of Haemophilus influenzae type b (Hib) bronchitis occurred in a geriatric unit. The three infected patients were grouped together in an isolation unit and treated. A prevalence survey was done by obtaining pharyngeal cultures from patients and staff in the unit. One patient and a nurse were asymptomatic pharyngeal carriers of Hib. One infected patient was bedridden, and his only known Hib contact was the nurse. Geographic clustering was the only significant risk factor, as determined by a case-control study. Carriers were treated with rifampin. The isolates were characterized for strain relatedness by using three methods. All produced beta-lactamase and all were serotype b. Plasmid profiles and restriction endonuclease analysis of bacterial DNA were performed; chromosomes were digested with the restriction endonucleases HindIII and HaeIII. Strains were confirmed as identical by using these methods and were different from two Hib control strains producing beta-lactamase. This study documents nosocomial transmission of Hib, by using molecular typing methods.

Aged↗
PubMed1988

A nosocomial outbreak of Branhamella catarrhalis confirmed by restriction endonuclease analysis.

An outbreak of respiratory illness due to Branhamella catarrhalis occurred in the intermediate care unit of a Veterans Administration hospital and involved patients and staff members. Four patients had pneumonia and four had bronchitis. Infected patients were placed in a cohort separated from noninfected patients and were treated. Pharyngeal culture was used to survey prevalence in staff and all other patients on the unit; three of 18 staff members and two of 19 asymptomatic patients were positive for B. catarrhalis. A case-control study showed that respiratory therapy, steroid use, and location within the unit were significant risk factors for B. catarrhalis infection or colonization. Strains from five patients and two staff members had identical bacterial restriction endonuclease digestion patterns with three different enzymes; these patterns were distinct from those of control strains. This study is the first to document an outbreak of B. catarrhalis infection confirmed with a typing system and thus establishes B. catarrhalis as a nosocomial pathogen.

Adult↗
PubMed1988

Linking hospital epidemiology and quality assurance: seasoned concepts in a new role.

In this initial presentation, certain concepts central to infection control epidemiology have been discussed and related to the evaluation of noninfectious events in medical care. While most of the examples have focused on parallels in noninfectious hazards of hospital care, a more global evaluation of the functional benefit(s) and cost-effectiveness of medical care intervention using similar epidemiologic principles is possible and of equal value. These issues will be discussed in future presentations. It will be our continuing thesis that the current infection control practitioner and hospital epidemiologist will need to become more involved in the quality assurance and risk management activities of their institutions and that training in all fields of medical care evaluation will need to be founded in epidemiology. Programs in quality assurance and risk management must adopt the use of these standard methods and must generate the databases to allow variations from norms in clinical practice to be evaluated. Those in infection control will need to broaden their expertise to include more sophisticated statistical methods, newer strategies in the observational studies of clinical care, the fundamentals of clinical information systems and data handling, and the appropriate national and regional sources of comparative clinical data. Future articles in the Topics series will provide reviews in these areas and serve as a forum for issues in the changing field of hospital epidemiology. The editors welcome comments on the series or manuscripts for review for possible publication.

Cross Infection↗
PubMed1987

Reliability of reporting nosocomial infections in the discharge abstract and implications for receipt of revenues under prospective reimbursement.

Proper reporting of discharge diagnoses, including complications of medical care, is essential for maximum recovery of revenues under the prospective reimbursement system. To evaluate the effectiveness of abstracting techniques in identifying nosocomial infections at discharge, discharge abstracts of patients with nosocomial infections were reviewed during September through November of 1984. Patients with nosocomial infections were identified using modified Centers for Disease Control (CDC) definitions and trained surveillance technicians. Records which did not include the diagnosis of nosocomial infections in the discharge abstract were identified, and potential lost revenues were estimated. We identified 631 infections in 498 patients. On average, only 57 per cent of the infections were properly recorded and coded in the discharge abstract. Of the additional monies which might be anticipated by the health care institution to assist in the cost of care of adverse events, approximately one-third would have been lost due to errors in coding in the discharge abstract. Although these lost revenues are substantial, they constitute but a small proportion of the potential costs to the institution when patients acquire nosocomial infections.

Cross Infection↗
PubMed1986

Certification: philosophy, goals, and methods, with application to the discipline of infection control practice.

The philosophy, goals, and methods of certification are complex and need to be understood in general before they can be applied to a specific practice discipline. This article is intended to provide background information about certification, summarize the history of credentialing for health occupations, and briefly describe methods for test design and construction. Philosophy, goals, methods, and preparation for certification are then applied to the discipline of infection control practice, with specific reference to the Infection Control Certification Examination, offered for the first time in November 1983 and in each subsequent year.

Certification↗
PubMed1986

Numbers that count: analytic methods for hospital epidemiology, Part 1.

The hospital epidemiologist is responsible for generating information that will be used to evaluate and assure high quality, minimal risk medical care. To accomplish this objective, the epidemiologist uses standard epidemiologic methods. Although used primarily in infection control, these methods are also applicable in the analysis of other types of institutional risks and in the assessment of quality of care. This review provides the reader, who we assume has minimal formal training in epidemiology and statistics, with some basic tools for analyzing data and generating useful information. We consider three major topic areas: basic concepts regarding numbers and data, analysis of nominal data, and analysis of discrete and continuous data. Hypothetical problems that may be encountered in the hospital illustrate the application of epidemiologic methods to studies of risk control, quality assurance, and infection control. The infection control practitioner who is adept in using epidemiologic methods to solve infection control problems should be able to adapt these methods to other programs in her or his institution.

Abortion, Spontaneous↗
PubMed1986

Usefulness of a test for slime production as a marker for clinically significant infections with coagulase-negative staphylococci.

The usefulness of a test for slime production as a marker for clinically significant infections with coagulase-negative staphylococci and its implications for therapy were examined. Hospital records were reviewed for 59 patients from each of whom more than one isolate of coagulase-negative staphylococci was obtained. In patients with a prosthetic device, 81% of 59 infectious episodes were due to a slime-positive coagulase-negative staphylococci. In contrast, 22 noninfectious episodes (in which the organisms were contaminants) were equally distributed between episodes due to slime-positive or slime-negative isolates (P = .005). Only 32% of infections caused by slime-positive organisms, in contrast to 100% of infections caused by slime-negative organisms, were improved by treatment with antibiotics alone (P = .02). Prosthetic device removal in addition to antibiotic treatment significantly improved the outcome in patients with infections due to slime-positive organisms when compared with treatment with antibiotics alone (93% vs. 32% improvement; P = .00025).

Anti-Bacterial Agents↗
PubMed1983

Legionnaires' disease associated with a hospital water system: a cluster of 24 nosocomial cases.

Over a 10-month period, 24 cases of Legionnaires' disease pneumonia occurred among patients admitted to an Iowa hospital, most of whom were immunosuppressed. Eleven patients died. Twenty-one patients were admitted to a recently completed hospital addition, 16 of these to a new hematology-oncology unit. Legionella pneumophila serogroup 1 was isolated from the patients, water outlets, and hot water in the new addition. Water quality variables in the hospital addition were adequate. Shock chlorination, temporary elevation of the hot water temperature, and continuous chlorination of hospital water decreased the frequency of isolation of Legionella. Water use by patients in the hematology-oncology unit was restricted until the water was free of Legionella. The incidence of Legionnaires' disease decreased. Indirect evidence supports an hypothesis of water-borne disease in this cluster of cases. Current variables of acceptable water potability may not guarantee water free of L. pneumophila.

Cross Infection↗