Severity of illness scoring systems to adjust nosocomial infection rates: A review and commentary

Keïta-Perse, Olivia; Gaynes, Robert P.

doi:10.1016/s0196-6553(96)90036-x

Cited by 56 publications

(19 citation statements)

References 17 publications

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“…Nevertheless, the Charlson index was chosen because it was developed to assess underlying illness in a general medicine population rather than acuity of current illness. Most acuity of illness scores were developed for ICU patients and do not predict nosocomial infection rates well (12).…”

Section: Discussionmentioning

confidence: 99%

Effects of Rapid Detection of Bloodstream Infections on Length of Hospitalization and Hospital Charges

Beekmann¹,

et al. 2003

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Current automated continuous-monitoring blood culture systems afford more rapid detection of bacteremia and fungemia than is possible with non-instrument-based manual methods. Use of these systems has not been studied objectively with respect to impact on patient outcomes, including hospital charges and length of hospitalization. We conducted a prospective, two-center study in which the time from the obtainment of the initial positive blood culture until the Gram stain was called was evaluated for 917 cases of bloodstream infection. Factors showing univariate associations with a shorter time to notification included higher body temperature and respiratory rate and higher percentage of immature neutrophils. Multiple linear regression models determined that the primary predictors of both increased microbiology laboratory and total hospital charges for patients with bloodstream infection were nonmicrobiologic and included length of stay and host factors such as the admitting service and underlying illness score. Significant microbiologic predictors of increased charges included the number of blood cultures obtained, nosocomial acquisition, and polymicrobial bloodstream infections. Accelerated failure time regression analysis demonstrated that microbiologic factors, including time until notification, organism group, and nosocomial acquisition, were independently associated with length of hospitalization after bacteremia, as were the factors of admitting service, gender, and age. Our data suggest that an increased time to notification of bloodstream infection is independently associated with increased length of stay. We conclude that the time to notification is an obvious target for efforts to shorten length of stay. The newest generation of automated continuous-monitoring blood culture systems, which shorten the time required to obtain a positive result, should impact length of hospitalization.Bloodstream infections (BSIs) are now ranked as the 10th leading cause of death in the United States, with a recent increase in age-adjusted death rates (19). BSIs also have been associated with increased rates of hospitalization (2, 18), increased length of stay (23,25), and increased hospital costs (1,7,21). The earliest possible identification of BSI allows for prompt optimization of antimicrobial therapy and diminished need for additional diagnostic studies, which in turn may serve to decrease both length of stay and cost.Current automated continuous-monitoring blood culture systems afford more rapid detection of bacteremia and fungemia than is possible with non-instrument-based manual methods (5,13,14,24,27). Detection with continuous-monitoring systems has been estimated to be 1 to 1.5 days sooner than with instrumented blood culture systems that do not employ continuous monitoring (17). While such a decrease in detection time may seem intuitively important, use of these systems has not been studied objectively with respect to impact on patient outcomes, including hospital charges and length of hospitalization. Additiona...

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Section: Discussionmentioning

confidence: 99%

Effects of Rapid Detection of Bloodstream Infections on Length of Hospitalization and Hospital Charges

Beekmann¹,

et al. 2003

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“…Intrinsic factors generally include age, gender, nutritional status, underlying disease and severity of the illness. To assess disease severity and to predict the risk of death, scores such as the Paediatric Risk of Mortality (PRISM), or its modified PRISM III version, and the Paediatric Index of Mortality (PIM) or its PIM II modification have been used 9,10,11,12,13,14,15 . Extrinsic factors such as aspects of treatment, available structure and the quality of care have been studied as well 16 .…”

Section: Introductionmentioning

confidence: 99%

“…Extrinsic factors such as aspects of treatment, available structure and the quality of care have been studied as well 16 . These include common invasive procedures (mechanical ventilation, central venous catheter, urinary catheter), the use of medication (antimicrobial agents, immunosuppressors, gastric acid blockers), parenteral nutrition and blood products, for example 14,15 .…”

Section: Introductionmentioning

confidence: 99%

Risk factors for healthcare-associated infection in pediatric intensive care units: a systematic review

et al. 2009

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“…According to some reports, 2 million patients acquired hospital infections in the USA in 1996 at a cost of US$ 4.5 million [7,9], whilst surgical site infections (SSIs) affected 325,000 hospitalised patients giving rise to an average extra expenditure of US$ 1 to 2 billion [9]. In England, the cost of hospital infections reached £111 million (ca.…”

mentioning

confidence: 99%

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

Ercole¹,

Starling²,

Chianca³

et al. 2007

Braz J Infect Dis

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. 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.

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Severity of illness scoring systems to adjust nosocomial infection rates: A review and commentary

Cited by 56 publications

References 17 publications

Effects of Rapid Detection of Bloodstream Infections on Length of Hospitalization and Hospital Charges

Effects of Rapid Detection of Bloodstream Infections on Length of Hospitalization and Hospital Charges

Risk factors for healthcare-associated infection in pediatric intensive care units: a systematic review

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

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