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National nosocomial infections surveillance system (NNIS): Description of surveillance methods

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      Abstract

      The National Nosocomial Infections Surveillance System (NNIS) is an ongoing collaborative surveillance system sponsored by the Centers for Disease Control (CDC) to obtain national data on nosocomial infections. The CDC uses the data that are reported voluntarily by participating hospitals to estimate the magnitude of the nosocomial infection problem in the United States and to monitor trends in infections and risk factors. Hospitals collect data by prospectively monitoring specific groups of patients for infections with the use of protocols called surveillance components. The surveillance components used by the NNIS are hospital wide, intensive care unit, high-risk nursery, and surgical patient. Detailed information including demographic characteristics, infections and related risk factors, pathogens and their antimicrobial susceptibilities, and outcome, is collected on each infected patient. Data on risk factors in the population of patients being monitored are also collected; these permit the calculation of risk-specific rates. An infection risk index, which includes the traditional wound class, is being evaluated as a predictor of the likelihood that an infection will develop after an operation. A major goal of the NNIS is to use surveillance data to develop and evaluate strategies to prevent and control nosocomial infections. The data collected with the use of the surveillance components permit the calculation of risk-specific infection rates, which can be used by individual hospitals as well as national health-care planners to set priorities for their infection control programs and to evaluate the effectiveness of their efforts. The NNIS will continue to evolve in finding more effective and efficient ways to assess the influence of patient risk and changes in the financing of health care on the infection rate.
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      References

      1. Centers for Disease Control. National Nosocomial Infections Study reports, issued January 1970 through March 1982 Atlanta: Centers for Disease Control.

        • Hughes J.M.
        • Culver D.H.
        • White J.W.
        • et al.
        Nosocomial infection surveillance.
        in: CDC Surveillance Summaries. 32A. U.S. Department of Health and Human Services, PHS, 1980–1982: 4SS
        • Hughes J.M.
        • Culver D.H.
        • White J.W.
        • et al.
        Nosocomial infection surveillance.
        in: CDC Surveillance Summaries. 32. 1980–1982: 1SS, 16SS
        • Jarvis W.R.
        • White J.W.
        • Munn V.P.
        • et al.
        Nosocomial infections surveillance.
        in: CDC Surveillance Summaries. 33. U.S. Department of Health and Human Services, PHS, 1983: 2SS
        • Jarvis W.R.
        • White J.W.
        • Munn V.P.
        • et al.
        Nosocomial infections surveillance.
        in: CDC Surveillance Summaries. 33. 1983: 9SS, 21SS
        • Horan T.C.
        • White J.W.
        • Jarvis W.R.
        • et al.
        Nosocomial infection surveillance.
        in: CDC Surveillance Summaries. 35. U.S. Department of Health and Human Services, PHS, 1984: 1SS
        • Horan T.C.
        • White J.W.
        • Jarvis W.R.
        • et al.
        Nosocomial infection surveillance.
        in: 1989–1990 edition. CDC Surveillance Summaries. 35. 1984: 17SS, 29SS
        • Centers for Disease Control
        Outline for surveillance and control of nosocomial infections.
        Centers for Disease Control, Atlanta1970
        • Eickhoff T.C.
        • Brachman P.S.
        • Bennett J.V.
        • Brown J.F.
        Surveillance of nosocomial infections in community hospitals. I. Surveillance methods, effectiveness, and initial results.
        J Infect Dis. 1969; 120: 305-317
        • Garner J.S.
        • Bennett J.V.
        • Scheckler W.E.
        • Maki D.G.
        • Brachman P.S.
        Surveillance of nosocomial infections.
        in: Proceedings of the International Conference on Nosocomial Infections, Center for Disease Control, August 3–6, 1970 American Hospital Association, Chicago1971: 277-281
        • American Hospital Association
        Hospital Statistics.
        1989–1990 edition. American Hospital, Association, Chicago1989
        • Garner J.S.
        • Jarvis W.R.
        • Emori T.G.
        • Horan T.C.
        • Hughes J.M.
        CDC definitions for nosocomial infections 1988.
        Am J Infect Control. 1988; 16: 128-140
        • Health Care Financing Administration
        • Department of Health and Human Services
        Medicare program: changes to the inpatient hospital prospective payment system and fiscal year 1989 rates.
        Federal Register. 1989; 54: 36542-3658610
        • Yeh T.S.
        • Pollack M.M.
        • Holbrook P.R.
        • Fields A.I.
        • Ruttiman U.
        Assessment of pediatric intensive care-application of the therapeutic intervention scoring system.
        Crit Care Med. 1982; 10: 497-500
        • American Academy of Pediatrics and the American College of Obstetricians and Gynecologists
        Guidelines for perinatal care.
        in: American Academy of Pediatrics, Evanston, Ill1983: 42-43
        • Owens W.D.
        • Felts J.A.
        • Spitznagel E.L.
        ASA physical status classifications: a study of consistency of ratings.
        Anesthesiology. 1978; 49: 239-243
        • Brachman P.S.
        Surveillance of institutionally-acquired infections.
        in: Proceedings of the national conference on institutionally-acquired infections, Sept. 4–16 Department of Health, Education and Welfare. USPHS, 1963: 138-147
        • Eickhoff T.C.
        Hospital infection control begins with good surveillance.
        Hospitals. 1967; 41: 118-120
        • Haley R.W.
        • Culver D.H.
        • White J.W.
        • et al.
        The efficacy of infection surveillance and control programs in preventing nosocomial infections in U.S. hospitals.
        Am J Epidemiol. 1985; 121: 182-205
        • Shoji K.T.
        • Axnick K.
        • Rytel M.W.
        Infections and antibiotic use in a large municipal hospital 1970–1972: a prospective analysis of the effectiveness of a continuous surveillance program.
        Health Lab Sci. 1974; 11: 283-292
        • Brewer G.E.
        Studies in aseptic technic, with a report of some recent observations at the Roosevelt Hospital.
        JAMA. 1915; 64: 1369-1372
        • Olson M.
        • O'Connor M.
        • Schwartz M.L.
        Surgical wound infections: a 5-year prospective study of 20,193 wounds at the Minneapolis VA Medical Center.
        Ann Surg. 1984; 199: 253-259
        • Cruse P.J.E.
        • Foord R.
        A five-year prospective study of 23,649 surgical wounds.
        Arch Surg. 1973; 107: 206-210
        • American Hospital Association
        Prevention and control of staphylococcus infections in hospitals.
        in: U.S. Public Health Service-Communicable Disease Center and National Academy of Sciences-National Research Council: Proceedings of the National Conference on Hospital-Acquired Staphylococcal Disease, Atlanta Communicable Disease Center, September 1958: XXII, XXVI
      2. Joint Commission on Accreditation of Hospitals, Accreditation Manual for Hospitals 1976. Joint Commission on Accreditation of Hospitals, Chicago1976
        • Health Care Financing Administration
        42CFR 482.42 Condition of participation: infection control.
        Federal Register. 1986; 51: 316
      3. Joint Commission on Accreditation of Hospitals, Standards for Hospital Accreditation. Joint Commission on Accreditation of Hospitals, ChicagoJanuary 1964
        • Kislak J.W.
        • Eickhoff T.C.
        • Finland M.
        Hospital-acquired infections and antibiotic usage in the Boston City Hospital-January, 1964.
        N Engl J Med. 1964; 271: 834-835
        • Thoburn R.
        • Fekety R.
        • Cluff L.E.
        • Melvin V.B.
        Infections acquired by hospitalized patients.
        Arch Intern Med. 1968; 121: 1-10
        • Caswell H.T.
        • Groschel D.
        • Rogers F.B.
        • Learner N.
        • Schreck K.M.
        • Shuman C.R.
        A ten-year study of staphylococcal disease: surveillance, control, and prevention of hospital infections, 1956 to 1965.
        Arch Environ Health. 1968; 17: 221-224
        • Centers for Disease Control
        Infection surveillance and control programs in U.S. hospitals: an assessment, 1976.
        MMWR. 1978; 27: 139-145
        • Lynch P.
        • Jackson M.M.
        Monitoring: surveillance for nosocomial infections and uses for assessing quality of care.
        Am J Infect Control. 1985; 13: 161-173
        • Hughes J.M.
        Nosocomial infection surveillance in the United States: historical perspective.
        Infect Control. 1987; 8: 450-453
        • Joint Commission on Accreditation of Healthcare Organizations
        Accreditation Manual for Hospitals, 1990. Joint Commission on Accreditation of Healthcare Organizations, ChicagoAugust 1989
        • Haley R.W.
        • Culver D.H.
        • Morgan W.M.
        • White J.W.
        • Emori T.G.
        • Hooton T.M.
        Increased recognition of infectious diseases in U.S. hospitals through increased use of diagnostic tests, 1970–1976.
        Am J Epidemiol. 1985; 121: 168-181
        • Haley R.W.
        Surveillance by objective: a new prioritydirected approach to the control of nosocomial infections.
        Am J Infect Control. 1985; 13: 78-89
        • Larson E.
        A comparison of methods for surveillance of nosocomial infections.
        Infect Control. 1980; 1: 377-380
        • Fuchs P.C.
        Will the real infection rate please stand?.
        Infect Control. 1987; 8: 235-236
        • Larson E.
        • Oram L.F.
        • Hedrick E.
        Nosocomial infection rates as an indicator of quality.
        Med Care. 1988; 26: 676-684
        • Donowitz L.G.
        • Wenzel R.P.
        • Hoyt J.W.
        High risk of hospital-acquired infection in the ICU patient.
        Crit Care Med. 1982; 10: 355-357
        • Wenzel R.
        • Osterman C.A.
        • Donowitz L.
        Identification of procedure-related nosocomial infections in high-risk patients.
        Rev Infect Dis. 1981; 3: 701-707
        • Selva J.
        • Toledo A.
        • Maroney A.
        • Forlenza S.
        The value of participation in the CDC-National Nosocomial Infection Surveillance (NNIS) in a large teaching hospital.
        in: Presented at APIC `89: Sixteenth Annual Educational Conference. May 21–26, 1989 (Reno, Nev.)
        • Hemming V.G.
        • Overall Jr, J.C.
        • Britt M.R.
        Nosocomial infections in a newborn intensive-care unit.
        N Engl J Med. 1976; 294: 1310-1316
        • Goldmann D.A.
        • Durbin W.A.
        • Freeman J.
        Nosocomial infections in a neonatal intensive care unit.
        J Infect Dis. 1981; 144: 449-459
        • Hoogkamp-Korstanje J.A.A.
        • Cats B.
        • Senders R.C.
        • et al.
        Analysis of bacterial infections in a neonatal intensive care unit.
        J Hosp Infect. 1982; 3: 275-284
        • Townsend T.R.
        • Wenzel R.P.
        Nosocomial bloodstream infections in a newborn intensive care unit.
        Am J Epidemiol. 1981; 114: 73-80
        • Kotloff K.L.
        • Blackmon L.R.
        • Tenney J.H.
        • Rennels M.B.
        • Morris J.G.
        Nosocomial sepsis in the neonatal intensive care unit.
        South Med J. 1989; 82: 699-704
        • Haley R.W.
        • Hooton T.M.
        • Culver D.H.
        • et al.
        Nosocomial infections in U.S. hospitals, 1975–1976.
        Am J Med. 1981; 70: 947-959
        • Cruse P.J.E.
        Wound infection surveillance.
        Rev Infect Dis. 1981; 3: 734-737
        • Haley R.W.
        • Culver D.H.
        • Morgan W.M.
        • White J.W.
        • Emori T.G.
        • Hooton T.M.
        Identifying patients at high risk of surgical wound infection.
        Am J Epidemiol. 1985; 121: 206-215
        • Britt M.R.
        • Schleupner C.J.
        • Matsumiya S.
        Severity of underlying disease as a predictor of nosocomial infection.
        JAMA. 1978; 239: 1047-1051
        • Rhame F.S.
        • Sudderth W.D.
        Incidence and prevalence as used in the analysis of the occurrence of nosocomial infections.
        Am J Epidemiol. 1981; 113: 1-18
        • Madison R.
        • Afifi A.A.
        Definition and comparability of nosocomial infection rates.
        Am J Infect Control. 1982; 10: 49-52
        • National Center for Health Statistics
        • U.S. Department of Health and Human Services
        • Public Health Service
        Utilization of short-stay hospitals by diagnosis-related groups, United States, 1980–1984.
        in: (Vital and health statistics. Series B: Data from the National Health Survey, No. 87.) DHHS publications No. (PHS) 86-1748. National Center for Health Statistics, Hyattsville Md1986
        • Burns S.J.
        • Dippe S.E.
        Postoperative wound infections detected during hospitalization and after discharge in a community hospital.
        Am J Infect Control. 1982; 10: 60-65
        • Rosendorf L.L.
        • Octavio J.
        • Estes J.P.
        Effect of methods of postdischarge wound infection surveillance on reported infection rates.
        Am J Infect Control. 1983; 11: 226-229
        • Reimer K.
        • Gleed C.
        • Nicolle L.E.
        The impact of postdischarge infection on surgical wound infection rates.
        Infect Control. 1987; 8: 237-240
        • Joint Commission on Accreditation of Hospitals
        The Joint Commission's “Agenda for Change,”.
        November 1986
        • Fuchs P.C.
        • Gustafson M.E.
        Significance of nosocomial infection rates in the era of DRGs.
        Infect Control. 1986; 7: 506-507
        • Wenzel R.P.
        Nosocomial infections, diagnosis-related groups, and study on the efficacy of nosocomial infection control.
        Am J Med. 1985; 78: 3-7