Center for Healthcare Improvement and Patient Safety, Division of Infectious Diseases, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19103, USA.
Infect Control Hosp Epidemiol. 2013 Jul;34(7):678-86. doi: 10.1086/670999. Epub 2013 May 21.
Little is known about whether those performing healthcare-associated infection (HAI) surveillance vary in their interpretations of HAI definitions developed by the Centers for Disease Control and Prevention's National Healthcare Safety Network (NHSN). Our primary objective was to characterize variations in these interpretations using clinical vignettes. We also describe predictors of variation in responses.
Cross-sectional study.
United States.
A sample of US-based members of the Society for Healthcare Epidemiology of America (SHEA) Research Network.
Respondents assessed whether each of 6 clinical vignettes met criteria for an NHSN-defined HAI. Individual- and institutional-level data were also gathered.
Surveys were distributed to 143 SHEA Research Network members from 126 hospitals. In total, 113 responses were obtained, representing at least 61 unique hospitals (30 respondents did not identify a hospital); 79.2% (84 of 106 nonmissing responses) were infection preventionists, and 79.4% (81 of 102 nonmissing responses) worked at academic hospitals. Among the 6 vignettes, the proportion of respondents correctly characterizing the vignettes was as low as 27.3%. Combining all 6 vignettes, the mean percentage of correct responses was 61.1% (95% confidence interval, 57.7%-63.8%). Percentage of correct responses was associated with presence of a clinical background (ie, nursing or physician degrees) but not with hospital size or infection prevention and control department characteristics.
Substantial heterogeneity exists in the application of HAI definitions in this survey of infection preventionists and hospital epidemiologists. Our data suggest a need to better clarify these definitions, especially when comparing HAI rates across institutions.
目前尚不清楚进行医疗保健相关感染（HAI）监测的人员在解释疾病预防控制中心的国家医疗保健安全网络（NHSN）制定的 HAI 定义方面是否存在差异。我们的主要目的是使用临床案例来描述这些解释中的差异。我们还描述了反应变化的预测因素。
横断面研究。
美国。
美国医疗机构流行病学协会（SHEA）研究网络的成员样本。
受访者评估了 6 个临床案例中的每一个是否符合 NHSN 定义的 HAI 标准。还收集了个人和机构层面的数据。
向 126 家医院的 143 名 SHEA 研究网络成员分发了调查。共收到 113 份回复，代表至少 61 家不同的医院（30 名回复者未识别出医院）；79.2%（106 份非缺失回复中的 84 份）为感染预防员，79.4%（102 份非缺失回复中的 81 份）在学术医院工作。在 6 个案例中，正确描述案例的受访者比例低至 27.3%。将所有 6 个案例结合起来，正确回复的平均百分比为 61.1%（95%置信区间，57.7%-63.8%）。正确回复的百分比与临床背景（即护理或医师学位）有关，但与医院规模或感染预防和控制部门特征无关。
在这项对感染预防员和医院流行病学家的调查中，HAI 定义的应用存在很大的异质性。我们的数据表明，需要更好地澄清这些定义，尤其是在比较机构之间的 HAI 率时。
