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Biomedical subjects

R W Haley

Publications and source records attributed to R W Haley.

At least 73 records · Page 4Linked to original sources
PubMed1981

The employee health service and infection control in US hospitals, 1976-1977. I. Screening procedures.

To assess the extent to which US hospitals have established employee health services with infection control functions, we analyzed information obtained in the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) from interviews with hospital officials and staff nurses in a representative sample of 433 hospitals. Sixty-eight percent of hospitals had a formal employee health service. The percentage routinely screening employees varied widely from the more common tests, such as the yearly chest roentgenogram (89%) and skin test (83%), to less common tests, including stool cultures (43%) and blood testing for hepatitis B (41%) and rubella (33%); 40% routinely obtained cultures of personnel. Although most hospitals appear to screen adequately, a sizeable minority either fail to employ recommended screening tests or continue unnecessary, expensive ones.

American Hospital Association↗
PubMed1981

Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison.

Using a standardized method, we estimated concurrently the prolongation of stay and extra charges attributable to nosocomial infection in three hospitals that differed in size, administrative characteristics and patients' economic status. Results showed the consequences in the three hospitals to have been similar in the degree to which nosocomial infection prolonged hospitalization (3.1 to 4.5 days) and added to the infected patients' charges ($590 to $641 in 1976 dollars). In all three hospitals, the extra charges were divided about equally between routine and ancillary charges, and a relatively small percentage of patients (10 percent) with nosocomial infection accounted for a disproportionately large share of the total extra charges--46, 65 and 38 percent in the three hospitals, respectively. The economic consequences were influenced more by site of infection than by differences among hospitals, and their magnitude emphasizes the need for continued preventive efforts.

Adult↗
PubMed1981

Techniques and uses of nosocomial infection surveillance in U.S. hospitals, 1976-1977.

From personal interviews in a representative sample of hospitals, we found that 97 per cent of them had some type of infection surveillance system; most involved continuous, hospital-wide surveillance, written definitions of infections, active case-finding methods and basic analytic techniques. Infection control nurses spent an average of about half of their time on surveillance. In larger hospitals (greater than or equal to 200 beds), the heads of the infection surveillance and control programs reported a greater awareness of most nosocomial infections if they were in hospitals with more intensive surveillance systems, and most indicated the surveillance data were used for a variety of specific purposes. Although 81 percent of persons who described surveillance reported using surveillance data in inservice education, only 31 percent of U.S. staff nurses recalled its having been presented. "Clean" wound, surgeon-specific rates of surgical wound infection were reported back to surgeons in only 16 percent of the hospitals. Ninety-seven percent of the hospital administrators believed that surveillance data are not a hindrance in defending the hospital against litigation for alleged malpractice, and 65 percent considered the information more often a help.

Cross Infection↗
PubMed1981

Microbiologic sampling of the inanimate environment in U.S. hospitals, 1976-1977.

Data obtained in the first two phases of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) indicate that in 1975 three-quarters of U.S. hospitals performed environmental culturing on a routine basis; however, between 1970 and 1975, one-quarter had reduced the extent of environmental culturing permanently. Large hospitals (greater than or equal to 200 beds) and those with an infection control nurse who had completed a training course in hospital epidemiology were more likely to have reduced the extent of culturing. In 1976-1977 hospitals that performed such culturing collected an average of 500 environmental cultures per year, whereas larger hospitals and those with an infection control nurse collected significantly fewer cultures. Only 28 percent of the approximately two million environmental cultures collected in U.S. hospitals in 1975 were indicated by recommendations of the Centers for Disease Control and the American Hospital Association current at the time.

Air Microbiology↗
PubMed1981

Nosocomial infections in U.S. hospitals, 1975-1976: estimated frequency by selected characteristics of patients.

To obtain estimates of the frequency of nosocomial infections nationwide, those occurring at the four major sites--urinary tract, surgical wound, lower respiratory tract and bloodstream--were diagnosed in a stratified random sample of 169,526 adult, general medical and surgical patients selected from 338 hospitals representative of the "mainstream" of U.S. hospitals. We estimate that in the mid-1970s one or more infections developed in 5.23 percent (+/- 0.16) of the patients and that 6.62 (+/- 0.24) infections occurred among every 100 admissions. Risks were significantly related to age, sex, service, duration of total and of preoperative hospitalization, presence of previous nosocomial or community-acquired infection, types of underlying illnesses and operations, duration of surgery, and treatment with urinary catheters, continuous ventilatory support or immunosuppressive medications. Seventy-one percent of the nosocomial infections occurred in the 42 percent of patients undergoing surgery and 56 percent in the 38 percent financed by Medicare, Medicaid or other public health care plans.

Adolescent↗
PubMed1981

The joint associations of multiple risk factors with the occurrence of nosocomial infection.

To compare nosocomial infection rates estimated in different time periods or in different hospitals, it is necessary to control for differences in the distribution of factors that substantially influence a patient's susceptibility to infection. To evaluate the associations of multiple risk factors with the occurrence of infection at each of four major sites and to develop composite measures for use in controlling for differences in the distribution of risk among groups of patients, we used a multivariate categorical data analysis technique to study the infection experience of 169,518 patients admitted in 1970 to the 338 hospitals studied in the Study on the Efficacy of Nosocomial Infection Control (SENIC, Project). The relative importance of risk factors and their complex interactions varied by site. The factors found to be highly important for one or more sites were duration of urinary catheterization, the patients' intrinsic risk as reflected in their diagnoses and types of surgical procedures, duration of preoperative hospitalization, duration of operation, anatomic location of surgical procedure, previous infection and steroid or immunosuppressive therapy. Site-specific risk strata and estimates of each patient's probability of acquiring infection were developed from these data for use in future SENIC analyses.

Age Factors↗
PubMed1981

Progress report on the evaluation of the efficacy of infection surveillance and control programs.

The main objective of the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) is to determine whether infection surveillance and control programs have reduced the rates of nosocomial infection in United States hospitals. To study this question, we stratified all hospitals in the SENIC target population into 16 design strata defined by categories of a surveillance and a control index derived from hospitals' responses to a preliminary screening questionnaire, and estimated the nosocomial infection rates among 339,044 randomly selected patients admitted in 1970 and 1975 through 1976 to 338 hospitals selected randomly from the 16 design strata. Finding that the over-all infection rates, standardized for important confounding variables or covariates, in hospitals with higher intensity programs had increased less from 1970 to 1975-1976 than those of hospitals with low intensity programs would indicate the efficacy of these programs. Potentially important confounding variables and covariates being studied include individual patient risk factors, hospital characteristics and the completeness of hospitals' medical records. Since only the first has been explored sufficiently, no conclusions on efficacy can yet be drawn. The analytic techniques were illustrated with preliminary data on infection rates at the four individual sites of infection.

Cross Infection↗
PubMed1981

Pseudobacteremia attributed to contamination of povidone-iodine with Pseudomonas cepacia.

Pseudomonas cepacia was recovered from the blood cultures of 52 patients in four hospitals in New York over 6 months from April through October 1980. Epidemiologic investigation in one hospital indicated that the positive results of blood culture represented pseudobacteremias and implicated a 10% povidone-iodine solution used as an antiseptic and disinfectant (Pharmadine; Sherwood Pharmaceutical Company, Mahwah, New Jersey) as the source of contamination. Physicians who drew blood cultures positive for P. cepacia were more likely to have left povidone-iodine on the skin before venipuncture (p = 0.026) and were more likely to have applied povidone-iodine to the blood culture bottle tops and to have left it there while inoculating the blood culture media (p = 0.007) than those who drew cultures negative for P. cepacia. Direct inoculation of Pharmadine into brain-heart infusion broth yielded P. cepacia; however, 2 weeks after the first cultures, the same Pharmadine bottles were culture negative. The iodine concentrations of the contaminated Pharmadine solutions were similar to those of 10% povidone-iodine solutions distributed by other manufacturers.

Blood Specimen Collection↗
PubMed1980

Nosocomial surgical infections: incidence and cost.

The data reported in this article support the findings of Dr. Altemeier; that is, infections among surgical patients remain a serious problem today. Urinary tract infections account for approximately 40 per cent of nosocomial infections among surgical patients. Surgical wound and skin infections account for one third of the nosocomial infections among surgical patients. Rates for wound infections rise with age, with increased length of hospitalization before surgery, and with increased duration of surgery. They are higher for patients who have an infection at a distant site and for those who have the more hazardous surgical procedures as determined by risk categories. Gram-negative organisms are more prevalent than gram-positive organisms. A nosocomial surgical wound infection lengthens the hospitalization by an average of 7.4 days and raises the cost of hospitalization by more than 800 dollars. Further analysis of the data is necessary in order to identify the risk factors likely to be most helpful in determining which patients are at increased risk of acquiring a nosocomial infection. Only when these factors are identified can the most direct and effective contact and preventive measures be implemented.

Aged↗
PubMed1980

Estimating the extra charges and prolongation of hospitalization due to nosocomial infections: a comparison of methods.

Estimates of the economic consequences of nosocomial infections were derived by studying the same patient population with two different methods: physician's assessment and comparisons of patients with nosocomial infection and those without, matched on five characteristics. Estimates of extra days and extra routine charges obtained by the comparison were about 2 1/2 times greater than those obtained by the physician's assessment (P less than 0.0001). Even when the match of patients was exact and measures were taken to avoid confounding, patients with nosocomial infection had more discharge diagnoses recorded (P = 0.02) and experienced more episodes of pulmonary embolism, renal failure, and death in the hospital than did their counterparts. These differences suggest that, despite careful matching, the members of the pairs were not comparable in their intrinsic predisposition to prolonged hospitalization. Unless patients can be matched on this prediposition, the estimates from a comparison study will be exaggerated.

Cost-Benefit Analysis↗
PubMed1980

The SENIC Project. Study on the efficacy of nosocomial infection control (SENIC Project). Summary of study design.

With the emergence of nosocomial infections as a serious problem among US hospitals, the Center for Disease Control undertook in 1974 a nationwide study to evaluate approaches to infection control. The three-phased project, now known as the Study on the Efficacy of Nosocomial Infection Control, or SENIC Project, was designed with three primary objectives: 1) to determine whether (and, if so, to what degree) the implementation of infection surveillance and control programs (ISCPs) has lowered the rate ofnosocomi al infection, 2) to describe the current status of ISCPs and infection rates, and 3) to demonstrate the relationships among characteristics of hospitals and patients, components of ISCPs, and changes in the infection rate. With data collection completed in a nationally representative sample of hospitals, analysis is underway to identify approaches to infection control that are most effective for the least cost to hospitals and to point out additional specific questions to be answered by future research.

Centers for Disease Control and Prevention, U.S.↗
PubMed1980

The SENIC sampling process: design for choosing hospitals and patients and results of sample selection.

To achieve its primary objectives, the Study on the Efficacy of Nosocomial Infection Control (SENIC Project) focused its attention on a target population of patients referred to as SENIC-eligible admissions in a target population of hospitals referred to as the "SENIC Universe." SENIC thus required a design for sampling hospitals and patients within these hospitals and a valid procedure for projecting sample results to the target population. This paper presents the details of the sampling design used, describes the actual process of selecting hospitals and patients for the surveys, explains the procedure used to project sample results to the target population, and examines the possibility of bias in the design and hospital selection process. As with most large-scale sample surveys, the design and sample selection processes for the surveys in Phases II and III of SENIC were complicated by incomplete frame, nonresponse and measurement problems. Nevertheless, adjustments to reduce the effects of some of these problems have been made through the development of a valid procedure for projecting sample results to the target population, and it appears unlikely that practically important nonsampling biases will result from the estimation procedures applied to this sample of hospitals.

Cross Infection↗
PubMed1980

Effects of misclassifications on statistical inferences in epidemiology.

Misclassification errors caused by imperfect sensitivity (U) and specificity (V) can affect statistical inferences in epidemiology. Such errors can lead to biases and increased standard errors in estimates of rates. Furthermore, low U and V can have a catastrophic effect on the power of a test to detect a change in rate, and, if U and V change even slightly as the rate changes, the effect on power may be dramatic.

Biometry↗
PubMed1980

The accuracy of retrospective chart review in measuring nosocomial infection rates. Results of validation studies in pilot hospitals.

To measure the accuracy and consistency of a standardized method--retrospective chart review (RCR)--for estimating nosocomial infection rates (NIRs) in individual hospitals, the authors performed a series of pilot studies in four hospitals of different types. In comparison with a standard based on diagnoses made by physician-epidemiologists supervising intensive prospective data collection teams, the RCR method was found to have an average sensitivity of 0.74 (+/- 0.02 SE; range 0.69-0.78) and an average specificity of 0.964 (+/- 0.002; 0.945-0.991). These values were comparable to those of the physician-epidemiologists' diagnoses and varied less among the hospitals. Two independent teams of chart reviewers were found to have similar levels of sensitivity and specificity, and the reliability of diagnosis at the level of the individual chart reviewer averaged 0.94. In a restudy at one of the pilot hospitals at the midpoint of the actual Medical Records Survey (MRS), there was a substantial increase in sensitivityand a slight increase in specificity as a result of improvements made in the RCR method after the original pilot studies.

Cross Infection↗
PubMed1980

Effects of method error on the power of a statistical test. Implications of imperfect sensitivity and specificity in retrospective chart review.

Errors in classifying individuals as to whether they have a certain characteristic may adversely affect the power of a statistical test to detect differences in the incidence of that characteristic between groups or to detect changes in the incidence over time. To determine whether the classification method to be used in the Study on the Efficacy of Nosocomial Infection Control (SENIC Project)--retrospective chart review--would provide sufficient power for a test of the study's main hypothesis, the authors calculated power as a function of the sensitivity and specificity of the method. They then contrasted the case in which sensitivity and specificity are constant for all hospitals in the study with cases in which the measures vary between groups of hospitals or between time periods. It was found that variation within the observed ranges of sensitivity and specificity, even if systematic, has little effect on power unless it is related to the hypothesis under study. The authors thus concluded that SENICs study design is adequate to detect any substantial success of infection surveilliance and control programs in combatting nosocomial infection, unless such programs affect the accuracy of the chart review method.

Cross Infection↗
PubMed1980

Effect of an infection surveillance and control program on the accuracy of retrospective chart review.

The primary analyses of the SENIC Project (Study on the Efficacy of Nosocomial Infection Control) will test the association between the presence of infection surveillance and control programs (ISCPs) and changes in nosocomial infection rates (NIRs) as measured by retrospective chart review (RCR). If the establishment of an ISCP affects the quality or completeness of information important for diagnosing infection by RCR, the analyses could be biased (i.e., there could be an increased chance of a Type I or Type II error). To determine whether this type of "ISCP effect" on the accuracy of RCR is likely to occur, the authors carried out a prospective intervention study in one hospital where 1) nosocomial infections among a pre-ISCP cohort of patients were detected by prospective data collection (PDC), 2) the hospital's first ISCP was instituted, and 3) infections were identically studied by PDC exactly two years later. Several months after the end of the second PDC, a team of trained chart reviewers read the medical records of the patients in both study cohorts and abstracted all clinical data bits used for diagnosing nosocomial infection. By a nonparametric matched correlation analysis, no significant change was found in the amount of relevant clinical information recorded in the medical records, and sensitivity and specificity did not change significantly. The authors conclude that, if an ISCP effect on RCR accuracy is present at all, it must be small.

Cross Infection↗
PubMed1980

A method for classifying patients according to the nosocomial infection risks associated with diagnoses and surgical procedures.

To compare validly the nosocomial infection rates (NIRs) in groups of patients studied from different time periods and/or different hospitals, one must control for the important factors that influence a patient's susceptibility to infection. The authors developed a method for assessing one component of nosocomial infection risk, based on patients' diagnoses and surgical procedures. This method classifies patients according to their risk of developing a nosocomial infection at each of four infection sites and at all four sites combined. Applying the method to data collected on 136,516 patients from 276 hospitals studied in the SENIC Project (Study on the Efficacy of Nosocomial Infection Control), the authors found that NIRs increased according to the predicted ranking of risk categories, even when the analyses were stratified individually by age, sex, hospital service and exposure to urinary catheterization or continuous ventilatory support. Depending on the site of infection, the rate increased as much as 100-fold from low-risk to high-risk categories. The data indicate that infection risk as assessed with this classification method will account for some of the variation in NIRs due to differences in patients' clinical conditions. Further analyses using multivariate techniques must be performed to explore in detail the relative importance of this risk classification in comparison with other risk factors and to determine which factors must be controlled in SENIC analyses.

Adolescent↗