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Experience With Two Validation Methods in a Prevalence Survey on Nosocomial Infections

Published online by Cambridge University Press:  02 January 2015

Petra Gastmeier ,
Günter Kampf ,
Thomas Hauer ,
Jürgen Schlingmann ,
Martin Schumacher ,
Franz Daschner  and
Henning Rüden
Petra Gastmeier*
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Günter Kampf
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Thomas Hauer
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
Jürgen Schlingmann
Affiliation:
Institute for Medical Biometry and Medical Informatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
Martin Schumacher
Affiliation:
Institute for Medical Biometry and Medical Informatics, Albert-Ludwigs-University Freiburg, Freiburg, Germany
Franz Daschner
Affiliation:
Institute of Environmental Medicine and Hospital Epidemiology, Albert-Ludwigs-University Freiburg, Freiburg, Germany
Henning Rüden
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
*
Institut für Hygiene, Freie Universität Berlin, Virchow-Klinikum, Augustenburger Platz 1, D 13 353 Berlin, Germany
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Abstract

Objective:

To determine whether an investigator effect remained on the first German study on the prevalence of nosocomial infections Nosokomiale Infektionen in Deutschland Erfassung und Prävention (NIDEP), despite extensive validation efforts.

Design:

Two validation methods were applied: bedside validation and validation by case studies. In both cases, the results of the four investigators were compared with the diagnosis of gold standard observers.

Setting:

Validation measures were applied before, intermittently, during, and at the end of the surveillance period in 72 acute-care hospitals with 14,966 patients.

Results:

The overall sensitivity in the bedside-validation periods was 89.0%; the overall specificity was 99.5%. For validation by case studies, overall sensitivity was 95.6%, and overall specificity was 92.8%. At the end of the surveillance, a remarkable investigator effect was found.

Conclusion:

Despite validation results that were assessed as satisfactory, based on available literature, an investigator effect was observed. This underlines the need for data validation and the formulation of recommendations for data validation. Clarification of the Centers for Disease Control and Prevention criteria for pneumonia and primary bloodstream infection and the inclusion of some diagnostic test results may reduce or prevent an investigator effect in future studies.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 19 , Issue 9 , September 1998 , pp. 668 - 673
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1998

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References

1. Haley, RW, Schaberg, DR, McClish, DK, Quade, D, Crossley, KB, Culver, DH, et al. The accuracy of retrospective chart review in measuring nosocomial infection rates. Am J Epidemiol 1980;111:516–533.CrossRefGoogle ScholarPubMed
2. Glenister, HM, Taylor, LJ, Bartlett, CLR, Cooke, EM, Sedgwick, JA, Mackintosh, CA. An evaluation of surveillance methods for detecting infections in hospital inpatients. J Hosp Infect 1993;23:229–242.CrossRefGoogle ScholarPubMed
3. Laxson, L, Blaser, M, Parkhurst, S. Surveillance for the detection of nosocomial infections and the potential for nosocomial outbreaks, I: microbiology culture surveillance is an effective method of detecting nosocomi- al infection. Am J Infect Control 1984;12:318–324.CrossRefGoogle Scholar
4. Lima, NL, Pereira, CRB, Souza, IC, Facanha, MC, Lima, AAM, Guerrant, RL, et al. Selective surveillance for nosocomial infections in a Brazilian hospital. Infect Control Hosp Epidemiol 1993;14:197–202.CrossRefGoogle Scholar
5. Wenzel, RP, Osterman, CA, Hunting, KJ, Gwaltney, JM. Hospital-acquired infections, I: surveillance in a university hospital. Am J Epidemiol 1976;103:251–260.CrossRefGoogle ScholarPubMed
6. Hirschhorn, L, Currier, J, Platt, R. Electronic surveillance of antibiotic exposure and coded discharge diagnosis as indicator of postoperative infection and other quality assurance measures. Infect Control Hosp Epidemiol 1993;14:21–28.CrossRefGoogle Scholar
7. Eickhoff, T, Brachman, P, Bennett, J, Brown, J. Surveillance of nosocomial infections in community hospitals, I: surveillance methods, effectiveness, and initial results. J Infect Dis 1969;12:305–317.CrossRefGoogle Scholar
8. Hargreaves, JE, Mann, C, Hansen, S. Validation of unit-based infection control instituted by staff nursing to identify nosocomial infections in the surgical patient. Infect Control Hosp Epidemiol 1995;16(suppl 2):27.Google Scholar
9. Wenzel, RP, Osterman, CA, Townsend, TR, Veazey, JM, Servis, KH, Miller, LS, et al. Development of a statewide program for surveillance and reporting of hospital-acquired infections. J Infect Dis 1979;140:741–746.CrossRefGoogle ScholarPubMed
10. Broderick, A, Motomi, M, Nettleman, MD, Streed, SA, Wenzel, RP. Nosocomial infections: validation of surveillance and computer modelling to identify patients at risk. Am J Epidemiol 1990;131:734–742.CrossRefGoogle ScholarPubMed
11. Ehrenkranz, NJ, Schulz, JM, Richter, EI. Recorded criteria as a ‘gold standard’ for sensitivity and specificity estimates of surveillance of nosocomial infection: a novel method to measure job performance. Infect Control Hosp Epidemiol 1995;16:697–702.CrossRefGoogle Scholar
12. Gastmeier, P, Kampf, G, Wischnewski, N, Hauer, T, Schulgen, G, Schumacher, M, et al. Prevalence of nosocomial infections in representative German hospitals. J Hosp Infect 1998;38:37–49.CrossRefGoogle ScholarPubMed
13. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed
14. Larson, E, Horan, T, Cooper, B, Kotilainen, HR, Landry, S, Terry, B. Study of the definition of nosocomial infections. Am J Infect Control 1991;19:259–267.CrossRefGoogle ScholarPubMed
15. McCullagh, P, Nelder, JA. Generalized Linear Models. Cambridge, MA: University Press; 1989.CrossRefGoogle Scholar
16. Cardo, DM, Falk, PS, Mayhall, CG. Validation of surgical wound surveillance. Infect Control Hosp Epidemiol 1993;14:211–215.CrossRefGoogle ScholarPubMed
17. Emori, TG, Edwards, JR, Culver, DH, Sartor, C, Stroud, LM, Gaunt, EE, et al. Accuracy of reporting nosocomial infections in intensive-care unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 1998;19:308–316.CrossRefGoogle Scholar
18. Freeman, J, McGowan, JE. Methodologic issues in hospital epidemiology, I: rates, case-finding, and interpretation. Rev Infect Dis 1981;3:658–667.CrossRefGoogle ScholarPubMed
19. Tablan, OC, Anderson, LJ, Arden, NH, Breiman, RF, Butler, JC, McNeil, MM, the Hospital Infection Control Practices Advisory Committee. Guideline for the prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994;15:587–627.CrossRefGoogle ScholarPubMed
20. A'Court, C, Garrard, CS. Nosocomial pneumonia in the intensive care unit: mechanisms and significance. Thorax 1992;47:465–473.CrossRefGoogle ScholarPubMed
21. Fagon, JY, Hance, AJ, Montraves, P, Novara, A, Gilbert, C. Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay. Am J Med 1993;94:281–288.CrossRefGoogle ScholarPubMed
22. Meduri, GU. Ventilator-associated pneumonia in patients with respiratory failure. Chest 1990;97:1208–1219.CrossRefGoogle ScholarPubMed
23. Hospitals in Europe Link for Infection Control Through Surveillance. HELICS protocol for nosocomial infection surveillance in intensive care units. Brussels, Utrecht, Copenhagen, Lyon; 1995.Google Scholar
24. Horan, TC, Emori, TG, Stroud, LA, Edwards, JR, Culver, DH, Gaynes, RP. CDC definitions of nosocomial infections (NI): clarifications and revisions based on the National Nosocomial Surveillance (NNIS) system evaluation study. Infect Control Hosp Epidemiol 1997;18(suppl 2):49.Google Scholar