National Healthcare Quality and Disparities Report
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AHRQ Research Studies
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Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
351 to 375 of 420 Research Studies DisplayedCurtis JR, Xie F, Yun H
Risk of hospitalized infection among rheumatoid arthritis patients concurrently treated with a biologic agent and denosumab.
The researchers evaluated rates of hospitalized infection among patients treated with biologic agents for RA who subsequently initiated denosumab in order to assess whether rates of infection were increased with concurrent biologic agent use for RA. They found that the rate of hospitalized infection among RA patients receiving denosumab concurrently with biologic agents for RA was not increased compared to those receiving zoledronate.
AHRQ-funded; HS018517
Citation: Curtis JR, Xie F, Yun H .
Risk of hospitalized infection among rheumatoid arthritis patients concurrently treated with a biologic agent and denosumab.
Arthritis Rheumatol. 2015 Jun;67(6):1456-64. doi: 10.1002/art.39075..
Keywords: Arthritis, Healthcare-Associated Infections (HAIs), Risk, Patient Safety, Comparative Effectiveness
Meddings J, Saint S, Fowler KE
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
A 15-member multidisciplinary panel used the RAND/UCLA Appropriateness Method to assess the appropriateness of using Foley catheters, intermittent straight catheters, and external condom catheters for hospitalized adults on medical services in 299 scenarios, including urinary retention, incontinence, and wounds. The panel concluded that these new appropriateness criteria can inform large-scale collaborative and bedside efforts to reduce inappropriate urinary catheter use.
AHRQ-funded; 290201000025I; HS019767
Citation: Meddings J, Saint S, Fowler KE .
The Ann Arbor criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND/UCLA Appropriateness Method.
Ann Intern Med. 2015 May 5;162(9 Suppl):S1-34. doi: 10.7326/m14-1304..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Decision Making, Guidelines, Healthcare-Associated Infections (HAIs), Inpatient Care, Patient Safety
Rothberg MB, Zilberberg MD, Pekow PS
Association of guideline-based antimicrobial therapy and outcomes in healthcare-associated pneumonia.
The study objective was to examine the association between guideline-based therapy (GBT) and outcomes for patients with healthcare associated pneumonia (HCAP). It found that among patients who met HCAP criteria, GBT was not associated with lower adjusted mortality, length of stay or costs in any analyses.
AHRQ-funded; HS018723.
Citation: Rothberg MB, Zilberberg MD, Pekow PS .
Association of guideline-based antimicrobial therapy and outcomes in healthcare-associated pneumonia.
J Antimicrob Chemother 2015 May;70(5):1573-9. doi: 10.1093/jac/dku533..
Keywords: Patient-Centered Outcomes Research, Healthcare-Associated Infections (HAIs), Antimicrobial Stewardship, Comparative Effectiveness
Finnell SM, Rosenman MB, Christenson JC
Decolonization of children after incision and drainage for MRSA abscess: a retrospective cohort study.
The researchers sought to determine whether decolonization following incision and drainage (I&D) for methicillin-resistant Staphylococcus aureus (MRSA) abscess decreases repeat I&D and MRSA-positive cultures in children. They found that no statistically significant association between referral to the Pediatric Infectious Disease Service for decolonization and the outcomes.
AHRQ-funded; HS020014.
Citation: Finnell SM, Rosenman MB, Christenson JC .
Decolonization of children after incision and drainage for MRSA abscess: a retrospective cohort study.
Clin Pediatr 2015 May;54(5):445-50. doi: 10.1177/0009922814556059..
Keywords: Children/Adolescents, Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Treatments
Patel PA, Robicsek A, Grayes A
Evaluation of multiple real-time PCR tests on nasal samples in a large MRSA surveillance program.
The researchers evaluated the LightCycler MRSA Advanced Test (Roche Molecular Diagnostics, Pleasanton, CA), the BD MAX MRSA assay (Becton Dickinson, Franklin Lakes, NJ), and the Xpert MRSA assay (Cepheid, Sunnyvale, CA) on nasal samples using the same population. Their results suggest that the performance of the three commercial assays is similar.
AHRQ-funded; HS019968.
Citation: Patel PA, Robicsek A, Grayes A .
Evaluation of multiple real-time PCR tests on nasal samples in a large MRSA surveillance program.
Am J Clin Pathol 2015 May;143(5):652-8. doi: 10.1309/ajcpmdy32ztdxpfc..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Patient Safety, Diagnostic Safety and Quality, Genetics
Scheck McAlearney A, Hefner J, Robbins J
AHRQ Author: Harrison MI
Preventing central line-associated bloodstream infections: a qualitative study of management practices.
This study identified factors that may explain hospital-level differences in outcomes of programs to prevent central line–associated bloodstream infections. A main theme that differentiated higher- from lower-performing hospitals was a distinctive framing of the goal of “getting to zero” infections. Five additional management practices were nearly exclusively present in the higher-performing hospitals: (1) top-level commitment, (2) physician-nurse alignment, (3) systematic education, (4) meaningful use of data, and (5) rewards and recognition.
AHRQ-authored; AHRQ-funded; 290200600022.
Citation: Scheck McAlearney A, Hefner J, Robbins J .
Preventing central line-associated bloodstream infections: a qualitative study of management practices.
Infect Control Hosp Epidemiol 2015 May;36(5):557-63. doi: 10.1017/ice.2015.27..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Comprehensive Unit-based Safety Program (CUSP), Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Prevention
Lewis SS, Dicks KV, Chen LF
Delay in diagnosis of invasive surgical site infections following knee arthroplasty versus hip arthroplasty.
The researchers compared time to diagnosis of invasive surgical site infection (SSI) following hip vs knee arthroplasty. They found that time to diagnosis of invasive SSI remained significantly shorter for hip than for knee arthroplasties after adjusting for age, pathogen virulence, and hospital surgical volume. They hypothesized that differences in symptom manifestation and disparities in access to care may contribute to the observed differential timing of diagnosis.
AHRQ-funded; HS023866.
Citation: Lewis SS, Dicks KV, Chen LF .
Delay in diagnosis of invasive surgical site infections following knee arthroplasty versus hip arthroplasty.
Clin Infect Dis 2015 Apr 1;60(7):990-6. doi: 10.1093/cid/ciu975.
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Keywords: Diagnostic Safety and Quality, Healthcare-Associated Infections (HAIs), Orthopedics, Surgery, Injuries and Wounds, Adverse Events
Vogel JA, Haukoos JS, Erickson CL
Is long-axis view superior to short-axis view in ultrasound-guided central venous catheterization?
The authors evaluated whether using long-axis or short-axis view during ultrasound-guided internal jugular and subclavian central venous catheterization results in fewer skin breaks, decreased time to cannulation, and fewer posterior wall penetrations. They found the long-axis view for the internal jugular more efficient than the short-axis view with fewer redirections; the long-axis view for subclavian central venous catheterization more efficient with decreased time to cannulation and fewer redirections; the long-axis approach to subclavian central venous catheterization associated with fewer posterior wall penetrations; and the long-axis view for subclavian central venous catheterization and avoiding posterior wall penetrations resulting in fewer central venous catheter-related complications.
AHRQ-funded; HS017526.
Citation: Vogel JA, Haukoos JS, Erickson CL .
Is long-axis view superior to short-axis view in ultrasound-guided central venous catheterization?
Crit Care Med 2015 Apr;43(4):832-9. doi: 10.1097/ccm.0000000000000823.
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Keywords: Adverse Events, Comparative Effectiveness, Evidence-Based Practice, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research
Pepin CS, Thom KA, Sorkin JD
Risk factors for central-line-associated bloodstream infections: a focus on comorbid conditions.
This cohort study explored risk factors for CLABSI using 2 comorbidity classification schemes, the Charlson Comorbidity Index (CCI) and the Chronic Disease Score (CDS). It found that individual comorbid conditions obtained electronically by ICD-9 codes and admission medications can be used to identify factors for increased risk for CLABSI. The composite CDS and CCI scores were not risk factors.
AHRQ-funded; HS022291.
Citation: Pepin CS, Thom KA, Sorkin JD .
Risk factors for central-line-associated bloodstream infections: a focus on comorbid conditions.
Infect Control Hosp Epidemiol 2015 Apr;36(4):479-81. doi: 10.1017/ice.2014.81..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Patient Safety, Risk
Harris AD, Fleming B, Bromberg JS
Surgical site infection after renal transplantation.
The researchers sought to identify factors associated with the development of surgical site infection (SSI) among adult patients undergoing renal transplantation. They found that BMI was a risk factor for the development of SSI following renal transplantation. Somewhat surprisingly, they did not find other biologically plausible or transplant-specific risk factors such as presence of comorbid conditions or receipt of appropriate (type and dose) antibiotic prophylaxis.
AHRQ-funded; HS022291.
Citation: Harris AD, Fleming B, Bromberg JS .
Surgical site infection after renal transplantation.
Infect Control Hosp Epidemiol 2015 Apr;36(4):417-23. doi: 10.1017/ice.2014.77..
Keywords: Transplantation, Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Risk, Adverse Events
Dicks KV, Baker AW, Durkin MJ
The potential impact of excluding funguria from the surveillance definition of catheter-associated urinary tract infection.
The authors examined surveillance data from a network of community hospitals as well as a tertiary-care medical center to describe the potential impact of excluding yeast as a urinary pathogen from the catheter-associated urinary tract infection (CAUTI) definition on CAUTI rates. They found that excluding yeast from the CAUTI surveillance definition reduced CAUTI rates by nearly 25% in the studied medical centers.
AHRQ-funded; HS023866.
Citation: Dicks KV, Baker AW, Durkin MJ .
The potential impact of excluding funguria from the surveillance definition of catheter-associated urinary tract infection.
Infect Control Hosp Epidemiol 2015 Apr;36(4):467-9. doi: 10.1017/ice.2014.72.
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Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Patient Safety, Urinary Tract Infection (UTI)
Friedant AJ, Gouse BM, Boehme AK
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
The authors sought to develop a simple scoring system for any hospital-acquired infection (HAI). Ranging from 0 to 7, the overall infection score consists of age 70 years or more, history of diabetes, and National Institutes of Health Stroke Scale score. Patients with an infection score of 4 or more were at 5 times greater odds of developing an infection. They concluded that, if validated in other populations, this score could assist providers in predicting infections after ischemic stroke.
AHRQ-funded; HS013852.
Citation: Friedant AJ, Gouse BM, Boehme AK .
A simple prediction score for developing a hospital-acquired infection after acute ischemic stroke.
J Stroke Cerebrovasc Dis 2015 Mar;24(3):680-6. doi: 10.1016/j.jstrokecerebrovasdis.2014.11.014.
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Keywords: Decision Making, Healthcare-Associated Infections (HAIs), Patient-Centered Outcomes Research, Risk, Stroke
Waters TM, Daniels MJ, Bazzoli GJ
Effect of Medicare's nonpayment for hospital-acquired conditions: lessons for future policy.
This study measured the association between Medicare’s nonpayment policy and 4 outcomes addressed by the Hospital-Acquired Conditions Initiative and found improvements in both the rates of central-line associated bloodstream infections and catheter-related urinary tract infections but no improvements for either hospital acquired pressure ulcers or injurious patient falls.
AHRQ-funded; HS020627
Citation: Waters TM, Daniels MJ, Bazzoli GJ .
Effect of Medicare's nonpayment for hospital-acquired conditions: lessons for future policy.
JAMA Intern Med. 2015 Mar;175(3):347-54. doi: 10.1001/jamainternmed.2014.5486..
Keywords: Quality of Care, Healthcare-Associated Infections (HAIs), Medicare, Patient Safety
Jump RL, Heath B, Crnich CJ
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
The reseasrchers conducted an anonymous survey of providers who care for older adults from 10 Veterans Affairs long-term-care facilities to assess their knowledge, beliefs, and confidence toward treating infections and antimicrobial stewardship. They found that the average score on 5 questions assessing knowledge was 3.6 out of 5.0, thus supporting a need for education regarding the care of older adults with infections.
AHRQ-funded; HS023866.
Citation: Jump RL, Heath B, Crnich CJ .
Knowledge, beliefs, and confidence regarding infections and antimicrobial stewardship: a survey of Veterans Affairs providers who care for older adults.
Am J Infect Control 2015 Mar;43(3):298-300. doi: 10.1016/j.ajic.2014.11.017.
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Keywords: Antimicrobial Stewardship, Healthcare-Associated Infections (HAIs), Long-Term Care, Medication
Olsen MA, Nickel KB, Wallace AE
Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair.
The researchers investigated whether operative factors are associated with risk of surgical site infection (SSI) after hernia repair. After analyzing a total of 119,973 hernia repair procedures, they found that the incidence of SSI was highest after open procedures, incisional/ventral repairs, and hernia repairs with bowel obstruction necrosis.
AHRQ-funded; HS019713.
Citation: Olsen MA, Nickel KB, Wallace AE .
Stratification of surgical site infection by operative factors and comparison of infection rates after hernia repair.
Infect Control Hosp Epidemiol 2015 Mar;36(3):329-35. doi: 10.1017/ice.2014.44..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Risk, Patient Safety
Hogan PG, Burnham CA, Singh LN
Evaluation of environmental sampling methods for detection of Staphylococcus aureus on fomites.
The researchers sought to determine effective and efficient methods to recover S. aureus from porous and non-porous surfaces in addition to multiple brands of bar soap while also considering the practicality of use and cost of sampling. They concluded that both contact plates and swabs provided adequate S. aureus recovery from porous and non-porous environmental surfaces, while MRSA was infrequently recovered from bar soap.
AHRQ-funded; HS021736.
Citation: Hogan PG, Burnham CA, Singh LN .
Evaluation of environmental sampling methods for detection of Staphylococcus aureus on fomites.
Ann Public Health Res 2015 Jan 29;2(1):pii: 1013..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Healthcare-Associated Infections (HAIs), Quality of Care
Olsen MA, Nickel KB, Margenthaler JA
Increased risk of surgical site infection among breast-conserving surgery re-excisions.
The aim of this study was to determine the risk of surgical site infection (SSI) after primary breast-conserving surgery (BCS) versus re-excision among women with carcinoma in situ or invasive breast cancer. It found that the risk of SSI after re-excision remained significantly higher after accounting for multiple procedures within a woman.
AHRQ-funded; HS019713.
Citation: Olsen MA, Nickel KB, Margenthaler JA .
Increased risk of surgical site infection among breast-conserving surgery re-excisions.
Ann Surg Oncol 2015;22(6):2003-9. doi: 10.1245/s10434-014-4200-x..
Keywords: Surgery, Risk, Cancer: Breast Cancer, Cancer, Healthcare-Associated Infections (HAIs), Injuries and Wounds, Adverse Events, Patient Safety, Women
Abdelsattar ZM, Krapohl G, Alrahmani L
Postoperative burden of hospital-acquired Clostridium difficile infection.
The researchers studied clostridium dificile infection (CDI) across diverse surgical settings. They found that incidence of postoperative CDI varied by surgical procedure and was associated with higher rates of extended length of stay, emergency room presentations, and readmissions, placing a potentially preventable burden on hospital resources.
AHRQ-funded; HS000053.
Citation: Abdelsattar ZM, Krapohl G, Alrahmani L .
Postoperative burden of hospital-acquired Clostridium difficile infection.
Infect Control Hosp Epidemiol 2015 Jan;36(1):40-6. doi: 10.1017/ice.2014.8.
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Keywords: Surgery, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Adverse Events, Hospitals
Lee CS, Montalmont B, O'Hara JA
Screening for methicillin-resistant Staphylococcus aureus colonization using sponges.
The researchers investigated whether the additional use of a sponge to collect skin culture samples would significantly improve the sensitivity of MRSA detection. They found that the sensitivity of nasal swab culture for screening MRSA carriage is low, but it can be improved significantly by adding a second method, either sampling the skin or the pharynx.
AHRQ-funded; HS021521.
Citation: Lee CS, Montalmont B, O'Hara JA .
Screening for methicillin-resistant Staphylococcus aureus colonization using sponges.
Infect Control Hosp Epidemiol 2015 Jan;36(1):28-33. doi: 10.1017/ice.2014.4..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Patient Safety, Quality of Care, Screening
Rangachari P, Madaio M, Rethemeyer RK
The evolution of knowledge exchanges enabling successful practice change in two intensive care units.
There are gaps in understanding the mechanisms by which top-down communications enable practice change. The authors sought to address these gaps in order to help identify evidence-based management strategies for successful practice change at the unit level. They found that both intensive care units studied experienced substantially improved outcomes and indicated a statistically significant increase in proactive communications. Early in the study, champions emerged within each unit to initiate process improvements. The authors concluded that the study helped to identify evidence-based management strategies for successful practice change at the unit level.
AHRQ-funded; HS019785.
Citation: Rangachari P, Madaio M, Rethemeyer RK .
The evolution of knowledge exchanges enabling successful practice change in two intensive care units.
Health Care Manage Rev 2015 Jan-Mar;40(1):65-78. doi: 10.1097/hmr.0000000000000001.
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Keywords: Intensive Care Unit (ICU), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Critical Care, Communication, Evidence-Based Practice, Organizational Change, Prevention, Patient Safety
Bundy DG, Gaur AH, Billett AL
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
This study assessed the feasibility of a multicenter effort to standardize central line (CL) care and central line-associated bloodstream infection (CLABSI) tracking and to quantify the impact of standardizing these processes on CLABSI rates. It found a reduction of 28 percent in the mean CLABSI rate from 2.85 to 2.04 per 1,000 CL days over almost 3 years.
AHRQ-funded; HS019590
Citation: Bundy DG, Gaur AH, Billett AL .
Preventing CLABSIs among pediatric hematology/oncology inpatients: national collaborative results.
Pediatrics. 2014 Dec;134(6):e1678-85. doi: 10.1542/peds.2014-0582..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Quality of Care, Children/Adolescents
Sanger P, Hartzler A, Lober WB
Design considerations for post-acute care mHealth: patient perspectives.
The authors are developing an mHealth platform to engage patients in wound tracking to identify and manage surgical site infections (SSI) after hospital discharge. Their key design qualities include: meeting basic accessibility, usability and security needs; encouraging patient-centeredness; facilitating better, more predictable communication; and supporting personalized management by providers. In this article, they illustrated their application of these guiding design considerations and proposed a new framework for mHealth design based on illness duration and intensity.
AHRQ-funded; HS019482.
Citation: Sanger P, Hartzler A, Lober WB .
Design considerations for post-acute care mHealth: patient perspectives.
AMIA Annu Symp Proc 2014 Nov 14;2014:1920-9.
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Keywords: Telehealth, Patient Self-Management, Surgery, Injuries and Wounds, Healthcare-Associated Infections (HAIs), Hospital Discharge, Patient-Centered Healthcare, Patient-Centered Outcomes Research, Adverse Events
Segal CG, Waller DK, Tilley B
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
The authors developed four independent, multivariate, predictive models to assess the unique associations between risk factors and each surgical site infection (SSI) group: superficial, deep, organ space, and an aggregate of all 3 types of SSIs. They found that unique risks for superficial SSIs include diabetes, chronic obstructive pulmonary disease, and dyspnea; deep SSIs had the greatest magnitude of association with BMI and the greatest incidence of wound disruption; and organ space SSIs were often owing to anastomotic leaks and were uniquely associated with disseminated cancer, preoperative dialysis, preoperative radiation treatment, and a bleeding disorder. They concluded that more effective prevention strategies may be developed by reporting and examining each type of SSI separately.
AHRQ-funded; HS021857.
Citation: Segal CG, Waller DK, Tilley B .
An evaluation of differences in risk factors for individual types of surgical site infections after colon surgery.
Surgery 2014 Nov;156(5):1253-60. doi: 10.1016/j.surg.2014.05.010.
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Keywords: Risk, Healthcare-Associated Infections (HAIs), Adverse Events, Surgery, Patient Safety
Fritz SA, Hogan PG, Singh LN
Contamination of environmental surfaces with Staphylococcus aureus in households with children infected with methicillin-resistant S aureus.
This study of the households of 50 children with active or recent culture-positive community-associated methicillin-resistant staphylococcus aureus (MRSA) infection found MRSA-contaminated surfaces in 23 of the 50 households, most frequently form the bed linens (18 percent), television remote control (16 percent), and bathroom hand towel (15 percent).
AHRQ-funded; HS021736
Citation: Fritz SA, Hogan PG, Singh LN .
Contamination of environmental surfaces with Staphylococcus aureus in households with children infected with methicillin-resistant S aureus.
JAMA Pediatr. 2014 Nov;168(11):1030-8. doi: 10.1001/jamapediatrics.2014.1218..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Children/Adolescents, Racial and Ethnic Minorities
Bish EK, El-Amine H, Steighner LA
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
The researchers sought to identify the risk factors associated with surgical site infections (SSIs) resulting from procedures performed at ambulatory surgery centers (ASCs) and to design an intervention to mitigate the likelihood of SSIs for the most common risk factors that were identified by the socio-technical probabilistic risk assessment (ST-PRA) tool for a particular surgical procedure. They found that failure to protect the patient effectively accounted for 51.9% of SSIs in the ambulatory care setting. Critical components of this event included skin preparation, antibiotic administration, staff training, proper response to glove punctures during surgery, and adherence to surgical preparation rules related to the wearing of jewelry, watches, and artificial nails. They determined that, assuming a 75% reduction in noncompliance on any combination of 2 of these 5 components, the risk for an SSI decreased.
AHRQ-funded; 290200600019I.
Citation: Bish EK, El-Amine H, Steighner LA .
A socio-technical, probabilistic risk assessment model for surgical site infections in ambulatory surgery centers.
Infect Control Hosp Epidemiol 2014 Oct;35 Suppl 3:S133-41. doi: 10.1086/677824.
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Keywords: Ambulatory Care and Surgery, Risk, Surgery, Healthcare-Associated Infections (HAIs), Patient Safety, Injuries and Wounds, Adverse Events