Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-21T08:28:09.376Z Has data issue: false hasContentIssue false
  • English
  • Français

Analysis of Infection Control Surveillance Data in a Long-Term–Care Facility: Use of Threshold Testing

Published online by Cambridge University Press:  02 January 2015

Joseph M. Mylotte
Joseph M. Mylotte*
Affiliation:
Departments of Medicine and Microbiology, School of Medicine and Biomedical Sciences, State University of New York, and the Department of Medicine, Division of Infectious Diseases, Erie County Medical Center, Buffalo, New York
*
Infectious Diseases, Erie County Medical Center, 462 Grider St, Buffalo, NY 14215
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To describe long-term trends in nosocomial infection rates and the threshold testing method for evaluating nosocomial sur veillance data in a long-term–care facility (LTCF).

Design:

Descriptive epidemiology of prospectively collected infection control sur veillance data and application of threshold testing for detecting possible outbreaks. Threshold testing uses the binomial distribution to calculate probabilities of infection frequency at selected endemic levels (mean number of infections per month) and compares these probabilities to obser ved infection frequency.

Setting:

One hundred twenty-bed LTCF located within a public, university-affiliated hospital.

Patients And Methods:

The study period was 1987 through 1994. Yearly endemic levels of specific types of infection were calculated and threshold levels were determined using a previously published method. In this study, a probability of P=.01 was chosen to determine the threshold at a specific endemic level; if the observed number of infections in a month reached or exceeded the threshold level, the likelihood that this occurred by chance alone was 1% or less.

Interventions:

None.

Results:

The overall mean nosocomial infection rate ranged from three to five episodes per 1,000 resident care days per year; mean yearly rates from 1990 onward were higher and more stable than those from 1987 to 1989. The most common infections identified were lower respiratory tract, skin and soft tissue, urinary tract, and conjunctivitis. For each of these infections, threshold levels were calculated periodically, using only the monthly frequency of infection. Despite variations in the yearly mean endemic level of various infections, threshold levels were stable except for skin and soft-tissue infection.

Conclusions:

Threshold testing for analysis of infection control sur veillance data in the LTCF setting is straightfor ward and does not require knowledge of statistics, special computer software, or calculation of rates; given the stable population in the typical LTCF, threshold testing can be based on variations in the monthly count of infections and provides an objective evaluation of surveillance data and a method to identify when outbreaks may be occurring.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 2 , February 1996 , pp. 101 - 107
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Crossley, DB, Irvine, P, Kaszar, DJ, Loewensen, RB. Infection control practices in Minnesota nursing homes. JAMA 1985;254:2918–2921.10.1001/jama.1985.03360200070029CrossRefGoogle ScholarPubMed
2. Price, LE, Sarubbi, FA, Rutala, WA. Infection control programs in twelve North Carolina extended care facilities. Infect Control 1985;6:437–441.10.1017/S0195941700064778Google Scholar
3. Scheckler, WE, Peterson, PJ. Infections and infection control among residents of eight rural Wisconsin nursing homes. Arch Intern Med 1986;146:1981–1984.10.1001/archinte.1986.00360220141024Google Scholar
4. Khabbaz, RF, Tenney, JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988;9:159–162.10.2307/30145424CrossRefGoogle ScholarPubMed
5. Smith, PW. Consensus conference on nosocomial infections in long-term care facilities. Am J Infect Control 1987;15:97–100.10.1016/0196-6553(87)90162-3Google Scholar
6. Campbell, BA, Wells, GA, Rahman, M. Infection control in Canadian long-term care facilities. Infect Control Canada 1989; 12:6–12.Google Scholar
7. Pearson, DA, Checko, PJ, Hierholzer, WJ, Jekel, JF. Infection control practices in Connecticut's skilled nursing facilities. Am J Infect Control 1990;18:269–276.10.1016/0196-6553(90)90168-RCrossRefGoogle ScholarPubMed
8. Pearson, DA, Checko, PJ, Hierholzer, WJ, Jekel, JF. Infection control practitioners and committees in skilled nursing facilities in Connecticut. Am J Infect Control 1990;18:167–175.10.1016/0196-6553(90)90182-RCrossRefGoogle ScholarPubMed
9. Smith, PW, Daly, PB, Roccaforte, JS. Current status of nosocomial infection control in extended care facilities. Am J Med 1991;91(suppl 3B):281S–285S.10.1016/0002-9343(91)90382-8Google Scholar
10. Smith, PW. Infection surveillance in long-term care facilities. Infect Control Hosp Epidemiol 1991;12:55–58.10.2307/30147089Google Scholar
11. Mylotte, JM. The hospital epidemiologist in long-term care: practical considerations. Infect Control Hosp Epidemiol 1991;12:439–442.10.2307/30148307CrossRefGoogle ScholarPubMed
12. Smith, PW, Rusnak, PG. APIC guideline for infection prevention and control in the long-term care facility. Am J Infect Control 1991;19:196–215.10.1016/0196-6553(91)90004-VCrossRefGoogle ScholarPubMed
13. Satterfield, N. Infection control in long-term care facilities: the hospital-based practitioner's role. Infect Control Hosp Epidemiol 1993;14:40–47.10.2307/30146512Google Scholar
14. Cohen, ED, Hierholzer, WJ, Schilling, CR, Snydman, DR. Nosocomial infections in skilled nursing facilities: a preliminary survey. Public Health Rep 1979;94:162–165.Google Scholar
15. Magnussen, MH, Robb, SS. Nosocomial infections in a longterm care facility. Am J Infect Control 1980;8:12–17.10.1016/S0196-6553(80)80073-3Google Scholar
16. Garibaldi, RA, Brodine, S, Matsumiya, S. Infections among patients in nursing homes. Policies, prevalence, and problems. N Engl J Med 1981;305:731–735.10.1056/NEJM198109243051304CrossRefGoogle ScholarPubMed
17. Gambert, SR, Duthie, EH, Priffer, B, Rabinovitch, RA. Bacterial infections in a hospital-based skilled nursing facility. J Chron Dis 1982;35:781–786.10.1016/0021-9681(82)90089-3Google Scholar
18. Farber, BR, Brennen, C, Puntereri, AJ, Brody, J. A prospective study of nosocomial infections in a chronic care facility. J Am Geriatr Soc 1984;32:499–502.10.1111/j.1532-5415.1984.tb02234.xGoogle Scholar
19. Nicolle, LE, McIntyre, M, Zacharias, H, MacDonell, JA. Twelvemonth surveillance of infections in institutionalized elderly men. J Am Geriatr Soc 1984;32:513–519.10.1111/j.1532-5415.1984.tb02236.xCrossRefGoogle ScholarPubMed
20. Standfast, SJ, Michelsen, PB, Baltch, AL, et al. A prevalence survey of infections in a combined acute- and long-term care hospital. Infect Control 1984;5:177–184.10.1017/S019594170005918XGoogle Scholar
21. Jackson, MM, Fierer, J. Infections and infection risk in residents of long-term care facilities: a review of the literature 1970-1984. Am J Infect Control 1985;13:63–77.Google Scholar
22. Setia, U, Serventi, I, Lorenz, P. Nosocomial infections among patients in a long-term care facility: spectrum, prevalence, and risk factors. Am J Infect Control 1985;13:57–62.10.1016/0196-6553(85)90083-5Google Scholar
23. Franson, TR, Duthie, EH, Cooper, JE, van Oudenhoven, G, Hoffmann, RG. Prevalence survey of infections and their predisposing factors at a hospital-based nursing home care unit. J Am Geriatr Soc 1986;34:95–100.10.1111/j.1532-5415.1986.tb05475.xCrossRefGoogle Scholar
24. Vlahov, D, Tenney, JH, Cervino, KW, et al. Routine surveillance for infections in nursing homes: experience at two facilities. Am J Infect Control 1987;15:47–53.CrossRefGoogle ScholarPubMed
25. Alvarez, S, Shell, CG, Woolley, TW, Berk, SL, Smith, JK. Nosocomial infections in long-term care facilities. J Gerontol 1988;43:M9–17.Google Scholar
26. Jacobson, C, Strausbaugh, LJ. Incidence and impact of infection in a nursing home care unit. Am J Infect Control 1990;18:151–159.10.1016/0196-6553(90)90180-ZGoogle Scholar
27. Darnowski, SH, Gordon, M, Simor, AE. Two years of infection surveillance in a geriatric long-term care facility. Am J Infect Control 1991;19:185–190.10.1016/0196-6553(91)90002-TGoogle Scholar
28. Michel, J-P, Lesourd, B, Conne, P, Richard, D, Rapin, C-H. Prevalence of infections and their risk factors in geriatric institutions: a one-day multicentre survey. Bull World Health Organ 1991;69:35–41.Google Scholar
29. Magaziner, J, Tenney, JH, DeForge, B, Helbel, JR, Muncie, HL, Warren, JW. Prevalence and characteristics of nursing homeacquired infections in the aged. J Am Geriatr Soc 1991;39:1071–1078.10.1111/j.1532-5415.1991.tb02871.xGoogle Scholar
30. Steinmiller, AM, Robb, SS, Muder, RR. Prevalence of nosocomial infection in long-term care Veterans Administration medical centers. Am J Infect Control 1991;19:143–146.10.1016/0196-6553(91)90020-DGoogle Scholar
31. Beck-Sague, C, Banerjee, S, Jarvis, WR. Infectious diseases and mortality among US nursing home residents. Am J Public Health 1993;83:1739–1742.10.2105/AJPH.83.12.1739Google Scholar
32. Smith, PW. Infection control in nursing homes. JAMA 1985;254:2951–2952.10.1001/jama.1985.03360200103041Google Scholar
33. Bentley, DW. Current challenges and future opportunities. Infect Control Hosp Epidemiol 1989;10:481–483.10.2307/30146839Google Scholar
34. Childress, JA, Childress, JD. Statistical test for possible infection outbreaks. Infect Control 1981;2:247–249.10.1017/S0195941700055144Google Scholar
35. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.10.1016/0196-6553(88)90053-3CrossRefGoogle ScholarPubMed
36. McGeer, A, Campbell, B, Emori, TG, et al. Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 1991;19:1–7.10.1016/0196-6553(91)90154-5Google Scholar
37. Rusnak, PG, Horning, LA. Surveillance in the long-term care facility. In: Smith, PW, ed. Infection Control in Long-Term Care Facilities. 2nd ed. Albany, NY: Delmar Publishers, Inc; 19941:117–126.Google Scholar
38. Lewis, SM. The effect of surveillance definitions on nosocomial urinary tract infection rates in a rehabilitation hospital. Infect Control Hosp Epidemiol 1995;16:43–48.Google Scholar