Developing indicators to suit the needs of small hospitals in a large multihospital system

ISSUE: The infection control and hospital epidemiology consortium (ICHEC) was formed in 1997 when infection control practitioners (ICPs) from 13 hospitals in a newly formed hospital system met monthly to reduce and prevent healthcare-associated infections. The system included four large hospitals, both university affiliated and community based, eight small hospitals (60-225 beds), and one pediatric hospital. Bloodstream infections (BSI), ventilator-associated pneumonia (VAP), coronary artery bypass (CABG), and total hip and total knee replacement surgical site infection (SSI) data were collected. In 2000, in addition to the group consortium meetings, the small hospital (SH) ICPs began to meet separately to choose indicators that would be more meaningful for small facilities. Until recently, the National Nosocomial Infections Surveillance System (NNIS) excluded hospitals with <100 beds, and so there are no recognized infection benchmarks for small hospitals. PROJECT: SH ICPs focused on hospital-associated pneumonia (HAP), which was more prevalent than VAP. In late 2001, the SH ICPs began to collect whole-house HAP data. In January–March 2003, a HAP education module was implemented in four of eight small hospitals. ICPs focused their efforts on pneumonia surveillance processes; they spent 6 months studying how cases are found in each facility. Of the surveillance methods used (including lab reports, ICD-9 codes, antibiotic usage, and chart review), radiology reports were most easily obtainable for all ICPs. Data analysis revealed that radiology report review led to the most specific and sensitive case finding. HAP cases are entered into handheld computers and information is electronically transferred to the ICHEC database. With 2 years of data compiled, the SH ICPs are reviewing HAP rates routinely and benchmarking against a pooled system mean. RESULTS: The mean for HAP was 0.5 per 1000 patient days at the start of this project. While rates initially increased as case finding and education improved (mean = 0.75), rates have decreased over 2004 (mean = 0.6). LESSONS LEARNED: Small hospitals have unique needs within large hospital systems. The SH ICPsʹ interest in and support of one another led to this collaboration that served not only their own needs to collect an indicator useful to their facilities, but also provided a product that is useful to larger hospitals.