Use of generic quality improvement chart review to recognize nosocomial infection.

BACKGROUND

Generic medical quality improvement concurrent chart review for adverse patient occurrences was introduced into our hospital. To determine whether this program could be used to augment the surveillance activities of the infection control program, an evaluation of this review was carried out and it was compared with existing surveillance methods.

METHODS

Analysts were provided with Centers for Disease Control definitions of site infections and were trained in identification. During a 6-month period (period 1) infections in this manner documented were reviewed by infection control program to confirm nosocomial infection as a measure of specificity. Data were also compared with infection control surveillance data when the two programs overlapped (nosocomial bloodstream infections and surgical wound infections) as a check on the sensitivity of the data generated in the medical quality improvement process. A second 6-month review of data (period 2), starting 3 months after completion of period 1, was carried out; this review was limited to areas of overlap and designed to determine whether changes in data occurred with experience.

RESULTS

In period 1, 72% (109/152) of infections detected by chart review were confirmed by infection control methods, and 51% (26/51) of infections detected by the infection control program were also detected by chart review. During period 2 the values were 73% (52/71) for confirmed infections and 61% (43/70) for detected infections. There was no statistical difference between periods 1 and 2. In the two periods 25 bacteremic infections went undetected by chart surveyors.

CONCLUSION

We conclude that this chart surveillance has only moderate sensitivity and specificity compared with our infection control surveillance methods. Improvements were not demonstrated with experience.