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PubMed2002

Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level.

A prevalence study of hospital-acquired infections (HAI) was carried out in 14 of 112 Greek hospitals (15.7%), scattered throughout Greece. Five of seven Greek university hospitals and nine regional hospitals participated in the one-day study, and 3925 hospitalized patients (10.5% of the total hospital beds in Greece) were recorded. The aim of this project was to organize a surveillance of HAI with the participation of the greatest possible number of Greek hospitals, transferring the experience from the local Cretan infection control network in an effort to create a nationwide network. Special attention was paid to recruit all Greek university hospitals in our attempt to expand the study base. Co-ordination of the participating centres, education of the infection control teams on surveillance methods, preparation of agreed definitions, and elaboration of the protocol for the collection of the data were the major objectives of this study. The difficulties, however, were limited resources and the lack of skilled personnel. The overall prevalence of HAI was found to be 9.3%. The most common HAI recorded involved lower respiratory tract infections (30.3%), followed by urinary tract infections (22.7%), bloodstream infections (15.8%), and surgical site infections (14.8%). The greatest prevalence rate was found in the adult ICU (48.4%), followed by the neonatal ICU (30.3%). The duration of hospitalization, the number of operations, the total number of used devices and invasive procedures were significantly correlated with HAI. Positive cultures were found in 51.5% of the cases. The most frequently isolated micro-organisms were: Pseudomonas aeruginosa (16.6%), Escherichia coli (10.8%), Klebsiella pneumoniae (10.3%), Staphylococcus epidermidis (8.1%) and Staphylococcus aureus (7.6%). The administration of antibiotics was also recorded. The prevalence of antibiotic use was 51.4%.

Adolescent↗
PubMed1990

Seroprevalence rates of human immunodeficiency virus infection at sentinel hospitals in the United States. The Sentinel Hospital Surveillance Group.

BACKGROUND AND METHODS: To evaluate the epidemiology of infection with human immunodeficiency virus type 1 (HIV-1) in selected urban communities in the United States, we instituted active surveillance at sentinel hospitals by anonymous testing of samples of blood specimens for HIV-1 antibody. To reflect better the rates of HIV-1 seroprevalence in the communities served by the sentinel hospitals, we excluded specimens from all patients with diagnoses that are often associated with HIV infection. RESULTS: From January 1988 to June 1989, 89,547 specimens were tested at 26 hospitals in 21 cities. The overall rate of HIV-1 seroprevalence was 1.3 percent, but it ranged from 0.1 to 7.8 percent according to hospital (median, 0.7 percent). The age distribution of persons seropositive for HIV-1 was similar across hospitals and closely paralleled that of persons with the acquired immunodeficiency syndrome (AIDS). In areas of low seroprevalence, HIV-1 infections were highly concentrated among men. However, the male-to-female ratio (median, 7.0) decreased steadily with an increasing overall rate of seroprevalence (P less than 0.001); at the five hospitals with the highest rates of seroprevalence, the median male-to-female ratio was only 2.9. The median black-to-white ratio of HIV-1 seroprevalence was 1.8, but at hospitals with low rates of seroprevalence the rates in blacks and whites were nearly equal. At two hospitals in the communities with the highest prevalence of AIDS, 1.1 to 3.8 percent of adolescents 15 to 19 years old and 18 to 22 percent of all men 25 to 44 years old were seropositive for HIV-1. CONCLUSIONS: In these sentinel, urban populations there is tremendous variation in the rate of HIV-1 infection (over 70-fold). The very high seroprevalence at some sentinel hospitals indicates the need for routine screening for HIV-1 infection among some groups of patients, regardless of clinical presentation.

AIDS Serodiagnosis↗
PubMed2004

Predicting hospital rates of fluoroquinolone-resistant Pseudomonas aeruginosa from fluoroquinolone use in US hospitals and their surrounding communities.

Rates of fluoroquinolone resistance among Pseudomonas aeruginosa in hospitals are increasing, but interhospital variability is great. We sought to determine whether this variability correlated to fluoroquinolone use in hospitals and in the surrounding community. Hospital quinolone use in 1999 (24 hospitals) through 2001 (35 hospitals) was determined from billing records. The number of fluoroquinolone prescriptions within a 10-mile (approximately 16-km) radius of each hospital was determined for 1999 and 2000. Hospital fluoroquinolone use increased from 1999 through 2001, from 137 to 163 defined daily doses (DDD)/1000 patient-days (P=.01). The rate of community fluoroquinolone use also increased, from 2.3 to 2.8 DDD/1000 inhabitant-days (P<.001). Rates of fluoroquinolone-resistant P. aeruginosa increased from 29% in 1999 to 36% in 2001 (P=.003). Both community and hospital fluoroquinolone use were predictive of rates of fluoroquinolone-resistant P. aeruginosa. Levofloxacin was associated with resistance, but ciprofloxacin was not. Most of the variability in resistance rates is explained by volume of fluoroquinolone use, both in the hospital and the surrounding community.

Adolescent↗
PubMed1987

Routine culturing for Legionella in the hospital environment may be a good idea: a three-hospital prospective study.

The source for nosocomial Legionnaires' disease is the water distribution system. However, the implications for legionella contamination in a hospital without known Legionnaires' disease is unclear. Therefore, culturing for Legionella pneumophila in the environment has not been routinely recommended. The authors conducted a prospective pneumonia study in three hospitals, none of which was known to have a major problem with endemic legionellosis. The water system of Hospital 1 was colonized with L. pneumophila, serogroup 1; Hospital 2 was colonized by L. pneumophila, serogroup 5 (which is rarely associated with disease); Hospital 3 was essentially free of L. pneumophila. Sputum culture on selective legionella media, direct fluorescent antibody testing, and serology were performed for all nosocomial pneumonias regardless of clinical impression. At the end of the study the incidence of nosocomial legionnaires' disease was found to be 9%, 0%, and 0% in Hospitals 1, 2, and found to be 9%, 0%, and 0% in Hospitals 1, 2, and 3, respectively. In Hospital 1, monoclonal antibody subtyping confirmed that the patient isolates were identical to the environmental isolates. The authors conclude that environmental culturing, despite the absence of known Legionnaires' disease, is useful. Positive cultures from the hospital water supply would mandate the introduction of legionella testing into the laboratory and stimulate physicians to consider Legionnaires' disease when encountering nosocomial pneumonias.

Cross Infection↗
PubMed2006

Validation of the potentially avoidable hospital readmission rate as a routine indicator of the quality of hospital care.

BACKGROUND: The hospital readmission rate has been proposed as an important outcome indicator computable from routine statistics. However, most commonly used measures raise conceptual issues. OBJECTIVES: We sought to evaluate the usefulness of the computerized algorithm for identifying avoidable readmissions on the basis of minimum bias, criterion validity, and measurement precision. RESEARCH DESIGN AND SUBJECTS: A total of 131,809 hospitalizations of patients discharged alive from 49 hospitals were used to compare the predictive performance of risk adjustment methods. A subset of a random sample of 570 medical records of discharge/readmission pairs in 12 hospitals were reviewed to estimate the predictive value of the screening of potentially avoidable readmissions. MEASURES: Potentially avoidable readmissions, defined as readmissions related to a condition of the previous hospitalization and not expected as part of a program of care and occurring within 30 days after the previous discharge, were identified by a computerized algorithm. Unavoidable readmissions were considered as censored events. RESULTS: A total of 5.2% of hospitalizations were followed by a potentially avoidable readmission, 17% of them in a different hospital. The predictive value of the screen was 78%; 27% of screened readmissions were judged clearly avoidable. The correlation between the hospital rate of clearly avoidable readmission and all readmissions rate, potentially avoidable readmissions rate or the ratio of observed to expected readmissions were respectively 0.42, 0.56 and 0.66. Adjustment models using clinical information performed better. CONCLUSION: Adjusted rates of potentially avoidable readmissions are scientifically sound enough to warrant their inclusion in hospital quality surveillance.

Adolescent↗
PubMed2004

Early hospital discharge followed by outpatient management versus continued hospitalization of children with cancer, fever, and neutropenia at low risk for invasive bacterial infection.

PURPOSE: To compare outcome and cost of ambulatory versus hospitalized management among febrile neutropenic children at low risk for invasive bacterial infection (IBI). PATIENTS AND METHODS: Children presenting with febrile neutropenia at six hospitals in Santiago, Chile, were categorized as high or low risk for IBI. Low-risk children were randomly assigned after 24 to 36 hours of hospitalization to receive ambulatory or hospitalized treatment and monitored until episode resolution. Outcome and cost were determined for each episode and compared between both groups using predefined definitions and questionnaires. RESULTS: A total of 161 (41%) of 390 febrile neutropenic episodes evaluated from June 2000 to February 2003 were classified as low risk, of which 149 were randomly assigned to ambulatory (n = 78) or hospital-based (n = 71) treatment. In both groups, mean age (ambulatory management, 55 months; hospital-based management, 66 months), sex, and type of cancer were similar. Outcome was favorable in 74 (95%) of 78 ambulatory-treated children and 67 (94%) of 71 hospital-treated children (P = NS). Mean cost of an episode was US 638 dollars (95% CI, 572 dollars to 703 dollars) and US 903 dollars (95% CI, 781 dollars to 1,025 dollars) for the ambulatory and hospital-based groups, respectively (P =.003). CONCLUSION: For children with febrile neutropenia at low risk for IBI, ambulatory management is safe and significantly cost saving compared with standard hospitalized therapy.

Ambulatory Care↗
PubMed1991

The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.

The objective of this study was to refine the APACHE (Acute Physiology, Age, Chronic Health Evaluation) methodology in order to more accurately predict hospital mortality risk for critically ill hospitalized adults. We prospectively collected data on 17,440 unselected adult medical/surgical intensive care unit (ICU) admissions at 40 US hospitals (14 volunteer tertiary-care institutions and 26 hospitals randomly chosen to represent intensive care services nationwide). We analyzed the relationship between the patient's likelihood of surviving to hospital discharge and the following predictive variables: major medical and surgical disease categories, acute physiologic abnormalities, age, preexisting functional limitations, major comorbidities, and treatment location immediately prior to ICU admission. The APACHE III prognostic system consists of two options: (1) an APACHE III score, which can provide initial risk stratification for severely ill hospitalized patients within independently defined patient groups; and (2) an APACHE III predictive equation, which uses APACHE III score and reference data on major disease categories and treatment location immediately prior to ICU admission to provide risk estimates for hospital mortality for individual ICU patients. A five-point increase in APACHE III score (range, 0 to 299) is independently associated with a statistically significant increase in the relative risk of hospital death (odds ratio, 1.10 to 1.78) within each of 78 major medical and surgical disease categories. The overall predictive accuracy of the first-day APACHE III equation was such that, within 24 h of ICU admission, 95 percent of ICU admissions could be given a risk estimate for hospital death that was within 3 percent of that actually observed (r2 = 0.41; receiver operating characteristic = 0.90). Recording changes in the APACHE III score on each subsequent day of ICU therapy provided daily updates in these risk estimates. When applied across the individual ICUs, the first-day APACHE III equation accounted for the majority of variation in observed death rates (r2 = 0.90, p less than 0.0001).

Age Factors↗
PubMedDate not supplied

The prevalence of hypokalemia in hospitalized patients with infectious diseases problem at Cipto Mangunkusumo Hospital, Jakarta.

AIM: to know the prevalence of hypokalemia that occurs in hospitalized patients with infectious diseases. METHODS: a cross sectional study was carried out in the internal ward Cipto Mangunkusumo General Hospital in Jakarta from December 2005 until June 2006. All hospitalized patients with infectious diseases receiving "replacement solution" were included in this study. We collected the blood sample to perform the serum potassium level at the time of admission and discharge. RESULTS: one hundred and five patients were enrolled in this study; consisting of 44 males and 61 females. The age ranged from 14 to 70 years old. The most common infectious diseases were dengue fever, while the underlying diseases were hepatobiliary disorders. "Replacement solutions" which were given, were ringer's lactate 91%, normal saline 8%, and ringer's acetate 1%. Prevalence of hypokalemia among the hospitalized patients, on admission was 24 patients (23%) and during hospitalization was 39 patients (37%). The mean level of hypokalemia on admission was 3.11 + SD 0.37 mEq/L (range from 1.7 to 3.4 mEq/L) and during hospitalization was 3.13 + SD 0.25 mEq/L (range from 2.5 to 3.4 mEq/L). On admission, the ratio of mild : moderate : severe hypokalemia is 22 : 2 : 1. And at discharge the ratio of mild to moderate hypokalemia becomes 19 : 6. CONCLUSION: the prevalence of hypokalemia in hospitalized patients with infectious disease in Cipto Mangkunkusumo's Hospital, Jakarta is 23%. Further studies are needed to know the contributing factors including the usage of 'intravenous fluid' in relations to hypokalemic state during hospitalization.

Adolescent↗
PubMed1983

Changing hospitals: the role of hospital accreditation.

Participation in the Australian Council on Hospital Standards' accreditation program provides one of the important stimuli for change in Australian hospitals. This article analyses the impact of the accreditation program upon a random sample of 23 Australian hospitals which were monitored for two years. At the conclusion of the study, those hospitals which had applied for accreditation were compared and contrasted with those hospitals which had not applied. It was found that those hospitals which applied could be differentiated from those hospitals which had not by significant changes in six areas. The areas which showed the least change were those most directly associated with the medical staff. 'Nursing Organisation' and 'Physical Facilities and Safety' were the areas most affected by accreditation.

Accreditation↗
PubMed1999

Episiotomy in NSW hospitals 1993-1996: towards understanding variations between public and private hospitals.

Episiotomy rates for women experiencing childbirth in New South Wales (NSW) hospitals are another indicator that private insurance may be a risk factor for obstetric intervention. A recent comparison of episiotomy rates in NSW public and private hospitals between 1993 and 1996 revealed that episiotomy rates were 12 to 15 percentage points higher in NSW private hospitals than in public hospitals studied. Rates also appear to be declining in NSW public hospitals, yet this trend is not evident in the NSW private hospitals studied. Although private hospital patients were almost twice as likely to experience forceps or vacuum delivery (often associated with episiotomy), this leaves a 6 to 8 percentage point difference unexplained. Given the potential health-related quality of life issues associated with perineal trauma during childbirth, further analysis of the clinical make-up of privately insured women may help determine the extent to which clinical explanations exist to support the differences in this childbirth intervention.

Adult↗