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Identifying possible deaths associated with nosocomial infection in a hospital by data mining

  • Alexis Hautemanière
    Correspondence
    Address correspondence to A. Hautemanière, MD, PhD, Environmental Department and Public Health, Medicine University of Nancy, 9 Avenue de la Forêt de Haye, BP 184, 54505 Vandoeuvre-les-Nancy, France.
    Affiliations
    Infection Prevention and Control, University Hospital of Nancy, Nancy, France

    Environmental Department and Public Health, and RHEM 4369 Relations Environments Micro-Organisms, Medicine University of Nancy, Nancy, France
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  • Arnaurd Florentin
    Affiliations
    Infection Prevention and Control, University Hospital of Nancy, Nancy, France
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  • Philippe Hartemann
    Affiliations
    Infection Prevention and Control, University Hospital of Nancy, Nancy, France

    Environmental Department and Public Health, and RHEM 4369 Relations Environments Micro-Organisms, Medicine University of Nancy, Nancy, France
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  • Paul R. Hunter
    Affiliations
    Environmental Department and Public Health, and RHEM 4369 Relations Environments Micro-Organisms, Medicine University of Nancy, Nancy, France

    University of East Anglia School of Medicine, Health Policy and Practice, Norwich, UK
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Published:October 04, 2010DOI:https://doi.org/10.1016/j.ajic.2010.04.216

      Background

      Nosocomial infection (NI) is a cause of patient morbidity and mortality. Conducting an audit of deaths due to NI is a potentially useful approach to improving professional standards. In France, these deaths are required to be reported, but the reporting is left to clinicians, who often do not comply. The aim of the present study was to assess whether linking the microbiological database with the hospital mortality database might be a suitable surveillance approach for identifying patients who died with an NI.

      Methods

      A total of 1,726 deaths were recorded in the mortality database of a French university hospital between September 1, 2006, and September 16, 2007. During this same period, 6,290 potential NIs (PNIs) were identified by bacteriological examination. These PNIs were generated using a computer algorithm specific to the bacteriology database. PNI information request forms were sent to the senior doctor of the unit where the samples had been obtained to determine whether the PNI was an NI, colonization, or a non-nosocomial infection. A total of 364 cases were common to both databases; from these, a sample of 135 cases was selected for further analysis. To establish the strength of evidence for NI as the cause of death, the 135 cases were analyzed using the patient record by an investigator from the hospital hygiene team.

      Results

      During the study period, no deaths associated with NI were reported spontaneously. Of the 135 cases analyzed, NI was considered the main cause of death in 6 (4.4%) and a contributory factor in 51 (37.8%). Thus, NI was estimated to be the main cause of death in 0.9% of all patients who died in the hospital during the study period and a contributory cause in another 8.0% of these patients.

      Conclusion

      Linking databases from bacteriology with those containing hospital mortality records is a simple, reproducible tool for identifying the number of deaths attributable to NI. This may provide a powerful approach to help reduce the burden of disease due to NI through the auditing of such identified deaths.

      Key Words

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      References

        • Kirkland K.B.
        • Briggs J.P.
        • Trivette S.L.
        • Wilkinson W.E.
        • Sexton D.J.
        The impact of surgical-site infections in the 1990s: attributable mortality, excess length of hospitalization, and extra costs.
        Infect Control Hosp Epidemiol. 1999; 20: 725-730
        • Digiovine B.
        • Chenoweth C.
        • Watts C.
        • Higgins M.
        The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit.
        Am J Respir Crit Care Med. 1999; 160: 976-981
        • Pittet D.
        • Tarara D.
        • Wenzel R.P.
        Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs, and attributable mortality.
        JAMA. 1994; 271: 1598-1601
        • World Health Organization
        Report of the Technical Discussion at the 21st World Health Assembly on National and Global Surveillance of Communicable Disease.
        World Health Organization, Geneva1968
        • Haley R.W.
        • Culver D.H.
        • White J.W.
        • Morgan W.M.
        • Emori T.G.
        • Munn V.P.
        • et al.
        The efficacy of infection surveillance and control programs in preventing nosocomial infection in US hospitals.
        Am J Epidemiol. 1985; 121: 182-205
        • Hysong S.J.
        Meta-analysis audit and feedback features impact effectiveness on care quality.
        Med Care. 2009; 47: 356-363
        • Gastmeier P.
        European perspective on surveillance.
        J Hosp Infect. 2007; 65: 159-164
        • Penel N.
        • Fournier C.
        • Roussel-Delvallez M.
        • Deberles M.-F.
        • Buisset E.
        • Cazin J.-L.
        • et al.
        Analysis of the factors influencing the internal reporting of nosocomial infections: a review of 108 notifications.
        Presse Med. 2003; 32: 1797-1801
        • Fabbro-Peray P.
        • Sotto A.
        • Defez C.
        • Cazaban M.
        • Molinari L.
        • Lossouarn M.
        • et al.
        Mortality attributable to nosocomial infection: an exposed/nonexposed cohort of patients in a French university hospital.
        Infect Control Hosp Epidemiol. 2007; 28: 265-272
        • Kaoutar B.
        • Joly C.
        • L’Hériteau F.
        • Barbut F.
        • Robert J.
        • Denis M.
        • et al.
        Nosocomial infections and hospital mortality: a multicentrique epidemiological study.
        J Hosp Infect. 2004; 58: 268-275
        • Gross P.A.
        • Van Antwerpen C.
        Nosocomial infections and hospital deaths: a case-control study.
        Am J Med. 1983; 75: 658-662
        • Gross P.A.
        • Neu H.A.
        • Aswapokee P.
        • Van Antwerpen C.
        • Aswapokee N.
        Deaths from nosocomial infections: experience in a unviversity hospital and community hospital.
        Am J Med. 1980; 68: 219-223
        • Fagon J.Y.
        • Chastre J.
        • Hance A.J.
        • Montravers P.
        • Novara A.
        • Gibert C.
        Nosocomial pneumonia in ventilated patients: a cohort study evaluating attributable mortality and hospital stay.
        Am J Med. 1993; 94: 281-288
        • Pittet D.
        • Wenzel R.P.
        Nosocomial bloodstream infections: secular trends in rates, mortality, and contribution to total hospital deaths.
        Arch Intern Med. 1995; 155: 1177-1184
        • Moine P.
        • Timsit J.F.
        • De Lassence A.
        • Troche G.
        • Fosse J.P.
        • Alberti C.
        • et al.
        Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study.
        Intensive Care Med. 2002; 28: 154-163
        • Bueno-Cavanillas A.
        • Delgado-Rodriguez M.
        • Lopez-Luque A.
        • Schaffino-Cano S.
        • Galvez-Vargas R.
        Influence of nosocomial infection on mortality rate in an intensive care unit.
        Crit Care Med. 1994; 22: 55-60
        • Craven D.E.
        • Kunches L.M.
        • Lichtenberg D.A.
        • Kollisch N.R.
        • Barry M.A.
        • Heeren T.C.
        • et al.
        Nosocomial infection and fatality in medical and surgical intensive care unit patients.
        Arch Intern Med. 1988; 148: 1161-1168
        • Lyons G.
        Saving mothers’ lives: Confidential Enquiry into Maternal and Child Health.
        Int J Obstet Anesth. 2003; 17: 103-105
        • Weindling A.M.
        The Confidential Enquiry into Maternal and Child Health (CEMACH).
        Arch Dis Child. 2003; 88: 1034-1037
        • Bailly P.
        • Haore H.G.
        • Crenn D.
        • Talon D.
        Hospital deaths attributable to nosocomial infections: surveillance in a university hospital.
        Méd Mal Inf. 2004; 34: 76-82
      1. Technical committee of the nosocomiales infections and the infections related to the care, definition of the infections associated with the care. Ministry for health, youth and the sports, DGS/DHOS, CTINILS. May 2007, (In French).

        • Mertens R.
        • Van Den Berg J.M.
        • Fabry J.
        • Jepsen O.B.
        HELICS: a European project to standardise the surveillance of hospital-acquired infection, 1994–1995.
        Eur Surveill. 1996; 1: 28-30
        • Emori T.G.
        • Culver D.H.
        • Horan T.C.
        • Jarvis W.R.
        • White J.W.
        • Olson D.R.
        • et al.
        National Nosocomial Infection Surveillance System (NNIS): description of surveillance methods.
        Am J Infect Control. 1991; 19: 19-35
        • MacCabe W.R.
        • Jackson G.G.
        Gram-negative bacteremia.
        Arch Intern Med. 1962; 110: 847-864
        • Haslam R.A.
        • Hide S.A.
        • Gibb A.G.F.
        • Gyi D.E.
        • Pavitt T.
        • Atkinson S.
        • et al.
        Contributing factors in construction accidents.
        Appl Ergon. 2005; 36: 401-415
        • Poulsen K.B.
        • Wachmann C.H.
        • Bremmelgaard A.
        • Sorensen A.I.
        • Raahave D.
        • Petersen J.V.
        Survival of patients with surgical wound infection: a case-control study of common surgical interventions.
        Br J Surg. 1995; 82: 208-209
        • Chalfine A.
        • Cauet D.
        • Lin W.C.
        • Gonot J.
        • Calvo-Verjat N.
        • Dazza F.E.
        • et al.
        Highly sensitive and efficient computer-assisted system for routine surveillance for surgical site infection.
        Infect Control Hosp Epidemiol. 2006; 27: 794-801