Infection control link nurse program: an interdisciplinary approach in targeting health care-acquired infection.

BACKGROUND: We describe a successful interdisciplinary liaison program that effectively reduced health care-acquired (HCA), methicillin-resistant Staphylococcus aureus (MRSA) in a university hospital setting. METHODS: Baseline was from January 2006 to March 2008, and intervention period was April 2008 to September 2009. Staff nurses were trained to be liaisons (link nurses) to infection prevention (IP) personnel with clearly defined goals assigned and with ongoing monthly education. HCA-MRSA incidence per 1,000 patient-days (PD) was compared between baseline and intervention period along with total and non-HCA-MRSA, HCA and non-HCA-MRSA bacteremia, and hand soap/sanitizer usage. Hand hygiene compliance was assessed. RESULTS: A reduction in MRSA rates was as follows in intervention period compared with baseline: HCA-MRSA decreased by 28% from 0.92 to 0.67 cases per 1,000 PD (incidence rate ratio, 0.72; 95% confidence interval: 0.62-0.83, P < .001), and HCA-MRSA bacteremia rate was reduced by 41% from 0.18 to 0.10 per 1,000 PD (incidence rate ratio, 0.59; 95% confidence interval: 0.42-0.84, P = .003). Total MRSA rate and MRSA bacteremia rate also showed significant reduction with nonsignificant reductions in overall non-HCA-MRSA and non-HCA-MRSA bacteremia. Hand soap/sanitizer usage and compliance with hand hygiene also increased significantly during IP. CONCLUSION: Link nurse program effectively reduced HCA-MRSA. Goal-defined metrics with ongoing re-education for the nurses by IP personnel helped drive these results.

Administrative coding data, compared with CDC/NHSN criteria, are poor indicators of health care-associated infections.

BACKGROUND: ICD-9-CM coding alone has been proposed as a method of surveillance for health care-associated infections (HAIs). The accuracy of this method, however, relative to accepted infection control criteria is not known. METHODS: Retrospective analysis of patients at an academic medical center in 2005 who underwent surgical procedures or who were at risk for catheter-associated bloodstream infections or ventilator-associated pneumonia was performed. Patients previously identified with HAIs by Centers for Disease Control and Prevention's National Healthcare Safety Network surveillance methods were compared with those of the same risk group identified by secondary infection ICD-9-CM codes. Discordant cases identified by only coding were all rereviewed and adjusted prior to final analysis. When coding and surveillance were both negative, a sample of patients was used to estimate the proportion of false negatives in this group. RESULTS: The positive predictive values (PPVs) ranged from 0.14 to 0.51 with an aggregate of 0.23, even after adjustment for additional cases detected on subsequent medical record review. The negative predictive values (NPVs) ranged from 0.91 to 1.00, with an aggregate of 0.96. The estimates of the true variance of PPVs and NPVs across surgical procedures were small (0.0129, standard error, 0.009; 0.000145, standard error, 0.00019, respectively) and could be mostly explained by variation in prevalence of surgical site infections. CONCLUSION: Administrative coding alone appears to be a poor tool to be used as an infection control surveillance method. Its proposed use for routine HAI surveillance, public reporting of HAIs, interfacility comparisons, and nonpayment for performance should be seriously questioned.