National Healthcare Quality and Disparities Report
Latest available findings on quality of and access to health care
Data
- Data Infographics
- Data Visualizations
- Data Tools
- Data Innovations
- All-Payer Claims Database
- Healthcare Cost and Utilization Project (HCUP)
- Medical Expenditure Panel Survey (MEPS)
- AHRQ Quality Indicator Tools for Data Analytics
- State Snapshots
- United States Health Information Knowledgebase (USHIK)
- Data Sources Available from AHRQ
Search All Research Studies
AHRQ Research Studies Date
Topics
- Adverse Events (7)
- Ambulatory Care and Surgery (2)
- Antibiotics (9)
- Antimicrobial Stewardship (6)
- Blood Clots (1)
- Burnout (1)
- Care Management (1)
- Catheter-Associated Urinary Tract Infection (CAUTI) (4)
- Central Line-Associated Bloodstream Infections (CLABSI) (8)
- Children/Adolescents (3)
- Clinical Decision Support (CDS) (1)
- Clostridium difficile Infections (9)
- Community-Acquired Infections (2)
- Comparative Effectiveness (2)
- COVID-19 (2)
- Critical Care (3)
- Diagnostic Safety and Quality (1)
- Elderly (5)
- Electronic Health Records (EHRs) (1)
- Evidence-Based Practice (5)
- Guidelines (2)
- (-) Healthcare-Associated Infections (HAIs) (65)
- Healthcare Costs (3)
- Healthcare Delivery (1)
- Health Information Technology (HIT) (1)
- Home Healthcare (2)
- Hospitalization (3)
- Hospital Readmissions (1)
- Hospitals (20)
- Implementation (3)
- (-) Infectious Diseases (65)
- Influenza (1)
- Injuries and Wounds (1)
- Inpatient Care (2)
- Intensive Care Unit (ICU) (6)
- Long-Term Care (5)
- Medication (9)
- Methicillin-Resistant Staphylococcus aureus (MRSA) (11)
- Neonatal Intensive Care Unit (NICU) (1)
- Newborns/Infants (4)
- Nursing Homes (6)
- Outcomes (1)
- Patient-Centered Healthcare (1)
- Patient-Centered Outcomes Research (1)
- Patient Safety (33)
- Payment (2)
- Pneumonia (2)
- Policy (2)
- Practice Patterns (2)
- Prevention (27)
- Primary Care (1)
- Provider (2)
- Provider: Health Personnel (1)
- Provider: Nurse (1)
- Provider Performance (2)
- Public Health (8)
- Public Reporting (1)
- Quality Improvement (6)
- Quality Measures (1)
- Quality of Care (6)
- Registries (1)
- Respiratory Conditions (1)
- Risk (2)
- Sepsis (1)
- Shared Decision Making (1)
- Surgery (9)
- Treatments (1)
- Urinary Tract Infection (UTI) (4)
AHRQ Research Studies
Sign up: AHRQ Research Studies Email updates
Research Studies is a compilation of published research articles funded by AHRQ or authored by AHRQ researchers.
Results
1 to 25 of 65 Research Studies DisplayedPatel P, Deshpande A, Yu PC
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
The purpose of this study was to explore the relationships between the antibiotic regimens of empiric therapy with a respiratory fluoroquinolone or cephalosporin plus macrolide combination and the development of hospital-onset Clostridioides difficile infection (CDI). The researchers used data from 638 United States hospitals and included adults admitted with pneumonia and discharged from July 2010 through June 2015 with a pneumonia diagnosis code who received 3 or more days of either antibiotic regimen. The study sample included 58,060 patients treated with either cephalosporin plus macrolide (36,796 patients) or a fluoroquinolone alone (21,264 patients). 0.35% of patients who received cephalosporin plus macrolide and 0.31% who received a fluoroquinolone developed CDI, making CDI risks similar for fluoroquinolones versus cephalosporin plus macrolide.
AHRQ-funded; HS024277.
Citation: Patel P, Deshpande A, Yu PC .
Association of fluoroquinolones or cephalosporin plus macrolide with Clostridioides difficile infection (CDI) after treatment for community-acquired pneumonia.
Infect Control Hosp Epidemiol 2023 Jan; 44(1):47-54. doi: 10.1017/ice.2022.60..
Keywords: Pneumonia, Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Medication, Infectious Diseases, Community-Acquired Infections
Crnich CJ
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
This paper provides an overview of nursing home (NH) infection and control, reviews the 2016 CMS changes to federal regulations, and proposes recommendations to sustain improvements. COVID-19 put further pressure on nursing homes who were already strained by rising numbers of infections from C. difficile and multidrug-resistant organisms. The author puts out a call for reimagining infection prevention and control using the Systems Engineering Initiative for Patient Safety framework. Additional recommendations are made to enhance NH infection prevention and control programs in the areas of people, tasks, tools, organization, built environment, and external environment.
AHRQ-funded; HS022465.
Citation: Crnich CJ .
Reimagining infection control in U.S. nursing homes in the era of COVID-19.
J Am Med Dir Assoc 2022 Dec;23(12):1909-15. doi: 10.1016/j.jamda.2022.10.022..
Keywords: Elderly, COVID-19, Public Health, Infectious Diseases, Nursing Homes, Healthcare-Associated Infections (HAIs), Prevention
Krauss DM, Molefe A, Hung L
AHRQ Author: Henderson S, Miller M
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic.
In this study, researchers summarized themes for maintaining infection prevention activities learned from the implementation of a quality improvement (QI) program during the COVID-19 pandemic. They concluded that future shocks such as the pandemic must be anticipated, and the healthcare system must be resilient to the resulting disruptions to healthcare-associated infection prevention activities. Their study encountered four themes for successful maintenance of infection prevention activities during the current pandemic: the value of a pre-existing infection prevention infrastructure; a flexibility in approach; broad buy-in for maintaining QI programs; and the facilitation of idea-sharing.
AHRQ-authored; AHRQ-funded; 233201500016I.
Citation: Krauss DM, Molefe A, Hung L .
Emergent themes from a quality improvement programme for CLABSI/CAUTI prevention in ICUs amid the COVID-19 pandemic.
BMJ Open Qual 2022 Nov;11(4):e001926. doi: 10.1136/bmjoq-2022-001926..
Keywords: COVID-19, Central Line-Associated Bloodstream Infections (CLABSI), Catheter-Associated Urinary Tract Infection (CAUTI), Healthcare-Associated Infections (HAIs), Quality Improvement, Quality of Care, Critical Care, Intensive Care Unit (ICU), Prevention, Urinary Tract Infection (UTI), Infectious Diseases
Bartsch SM, Wong KF, Mueller LE
Modeling interventions to reduce the spread of multidrug-resistant organisms between health care facilities in a region.
The objective of this study was to identify a group of target facilities and to assess which multidrug-resistant organism (MDRO) intervention would be best to implement in the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, a large regional public health collaborative in Orange County, California. Findings suggested that decolonization would be the best strategy for the Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County.
AHRQ-funded; HS023317; HS028165.
Citation: Bartsch SM, Wong KF, Mueller LE .
Modeling interventions to reduce the spread of multidrug-resistant organisms between health care facilities in a region.
JAMA Netw Open 2021 Aug 2;4(8):e2119212. doi: 10.1001/jamanetworkopen.2021.19212..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Public Health
Harris AD, Morgan DJ, Pineles L
Acquisition of antibiotic-resistant gram-negative bacteria in the Benefits of Universal Glove and Gown (BUGG) cluster randomized trial.
This study is a secondary analysis of a randomized trial in 20 hospital intensive units called Benefits of Universal Glove and Gown (BUGG) to see if intervention decreases the acquisition of antibiotic-resistant gram-negative bacteria. The primary outcome included 40,492 admission and discharge perianal swabs from 20,246 individual patient admissions. A non-statistically significant decrease in acquisition of antibiotic-resistant gram-negative bacteria was associated with universal glove and gown use.
AHRQ-funded; HS024045.
Citation: Harris AD, Morgan DJ, Pineles L .
Acquisition of antibiotic-resistant gram-negative bacteria in the Benefits of Universal Glove and Gown (BUGG) cluster randomized trial.
Clin Infect Dis 2021 Feb 1;72(3):431-37. doi: 10.1093/cid/ciaa071..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Patient Safety
Lee BY, Bartsch SM, Lin MY
How long-term acute care hospitals can play an important role in controlling carbapenem-resistant Enterobacteriaceae in a region: a simulation modeling study.
Researchers investigated how implementing control measures in long-term acute care hospitals (LTACHs) can impact carbapenem-resistant Enterobacteriaceae (CRE) spread regionwide. They used their own Chicago metropolitan region agent-based model to simulate CRE spread and control. They found that a prevention bundle in only LTACHs decreased prevalence and averted new carriers, infections, and deaths over 3 years compared with no CRE control measures. When LTACHs and intensive care units intervened, prevalence decreased further. They concluded that LTACHs may be more important than other acute care settings for controlling CRE, and regional efforts to control drug-resistant organisms should start with LTACHs as a centerpiece.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Lin MY .
How long-term acute care hospitals can play an important role in controlling carbapenem-resistant Enterobacteriaceae in a region: a simulation modeling study.
Am J Epidemiol 2021 Feb 1;190(3):448-58. doi: 10.1093/aje/kwaa247..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Hospitals, Patient Safety, Implementation
Lee BY, Bartsch SM, Hayden MK
How to choose target facilities in a region to implement carbapenem-resistant Enterobacteriaceae control measures.
The authors investigated how best to choose the highest-yield facilities to target for interventions when trying to control regional spread of antibiotic-resistant pathogens such as carbapenem-resistant Enterobacteriaceae (CRE). They used their own Regional Healthcare Ecosystem Analyst-generated agent-based model of Chicago metropolitan area inpatient facilities to simulate the spread of CRE and to choose facilities to apply prevention bundles. They found that, while choosing target facilities based on single metrics (including most inpatient beds, most connections to other facilities) achieved better control than randomly choosing facilities, more effective targeting occurred when considering how these and other factors (including patient length of stay, care for higher-risk patients) interacted as a system.
AHRQ-funded; HS023317.
Citation: Lee BY, Bartsch SM, Hayden MK .
How to choose target facilities in a region to implement carbapenem-resistant Enterobacteriaceae control measures.
Clin Infect Dis 2021 Feb 1;72(3):438-47. doi: 10.1093/cid/ciaa072..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Implementation, Prevention, Patient Safety
Vsevolozhskaya OA, Manz KC, Zephyr PM
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
Since October 2014, the Centers for Medicare and Medicaid Services has penalized 25% of U.S. hospitals with the highest rates of hospital-acquired conditions under the Hospital Acquired Conditions Reduction Program (HACRP). While early evaluations of the HACRP program reported cumulative reductions in hospital-acquired conditions, more recent studies have not found a clear association between receipt of the HACRP penalty and hospital quality of care. In this article, the authors posit that some of this disconnect may be driven by frequent scoring updates.
AHRQ-funded; HS025148.
Citation: Vsevolozhskaya OA, Manz KC, Zephyr PM .
Measurement matters: changing penalty calculations under the Hospital Acquired Condition Reduction Program (HACRP) cost hospitals millions.
BMC Health Serv Res 2021 Feb 10;21(1):131. doi: 10.1186/s12913-021-06108-w..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Policy, Quality Improvement, Quality of Care, Patient Safety
Aasen DM, Bronsert Rozeboom, PD
Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database.
This study looked at the relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned hospital readmissions after surgery. Data from the American College of Surgeons National Surgical Quality Improvement database from 2012 to 2017 across nine surgical specialties was used to analyze 30-day postoperative infectious complications including sepsis, surgical site infections, pneumonia, and urinary tract infections. Postoperative infectious complications were identified in 5.2% of cases, of which 59.8% were postdischarge. The specific postdischarge complications identified were 73.4% of surgical site infections, 34.9% of sepsis cases, 26.5% of pneumonia cases, and 53.2% of urinary tract infections. These postoperative infections were associated with an increased risk of readmission. Most infections were diagnosed postdischarge. The trend towards shorter length of stays postoperation also contribute to the increase in infections detected after discharge and the rate of unplanned related postoperative readmissions.
AHRQ-funded; HS026019.
Citation: Aasen DM, Bronsert Rozeboom, PD .
Relationships between predischarge and postdischarge infectious complications, length of stay, and unplanned readmissions in the ACS NSQIP database.
Surgery 2021 Feb;169(2):325-32. doi: 10.1016/j.surg.2020.08.009..
Keywords: Hospital Readmissions, Adverse Events, Healthcare-Associated Infections (HAIs), Infectious Diseases, Quality Improvement, Quality of Care, Surgery
Nelson RE, Lautenbach E, Chang N
Attributable cost of healthcare-associated methicillin-resistant Staphylococcus aureus infection in a long-term care center.
The purpose of this study was to estimate the attributable cost of methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections in long-term care centers (LTCCs) within the Department of Veterans Affairs. Findings showed a significant increase in the odds of being transferred to an acute care facility and in acute care costs. These findings of high cost and increased risk of transfer from LTCC to acute care are important because they highlight the substantial clinical and economic impact of MRSA infections in this population.
AHRQ-funded; HS023794.
Citation: Nelson RE, Lautenbach E, Chang N .
Attributable cost of healthcare-associated methicillin-resistant Staphylococcus aureus infection in a long-term care center.
Clin Infect Dis 2021 Jan 29;72(Suppl 1):S27-s33. doi: 10.1093/cid/ciaa1582..
Keywords: Methicillin-Resistant Staphylococcus aureus (MRSA), Healthcare-Associated Infections (HAIs), Infectious Diseases, Healthcare Costs, Long-Term Care
Gaughan AA, Walker DM, DePuccio MJ
Rewarding and recognizing frontline staff for success in infection prevention.
This article discusses how managers can use reward and recognition programs as motivational tools to sustain frontline healthcare-associated infection (HAI) prevention. Data from interviews with hospital managers and frontline staff at 18 US hospitals were used to identify these tools.
AHRQ-funded; HS024958.
Citation: Gaughan AA, Walker DM, DePuccio MJ .
Rewarding and recognizing frontline staff for success in infection prevention.
Am J Infect Control 2021 Jan;49(1):123-25. doi: 10.1016/j.ajic.2020.06.208..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Quality Improvement, Quality of Care
Kim JJ, Johnson JK, Stucke EM
Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves.
Transmission of Staphylococcus aureus (S. aureus) to health care workers (HCWs) on gowns and gloves has been an issue in nursing homes. This study evaluated the effect of the burden in 13 community-based nursing homes in Maryland and Michigan. Residents were cultured for S. aureus at the perianal skin and the anterior nares areas. A total of 403 residents were enrolled, with 169 colonized with methicillin-resistant S. aureus (MRSA) or methicillin-sensitive S. aureus (MSSA). Transmission to HCW gowns and gloves was greater from those colonized with greater quantities of S. aureus on the perianal skin. These findings inform future infection control practices for both MRSA and MSSA in nursing homes.
AHRQ-funded; HS019979; HS025451.
Citation: Kim JJ, Johnson JK, Stucke EM .
Burden of perianal Staphylococcus aureus colonization in nursing home residents increases transmission to healthcare worker gowns and gloves.
Infect Control Hosp Epidemiol 2020 Dec;41(12):1396-401. doi: 10.1017/ice.2020.336..
Keywords: Elderly, Nursing Homes, Long-Term Care, Healthcare-Associated Infections (HAIs), Infectious Diseases, Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention
Anderson DJ, Ilieş I, Foy K
Early recognition and response to increases in surgical site infections using optimized statistical process control charts-the Early 2RIS Trial: a multicenter cluster randomized controlled trial with stepped wedge design.
This paper discusses the study protocol that was used to conduct the Early 2RIS Trial, which was a multicenter cluster randomized controlled trial from 2016 to 2020 to reduce surgical site infection (SSI) rates. The trial was performed in 29 hospitals in the Duke Infection Control Outreach Network (DICON) and 105 clusters over 4 years. All patients who underwent one of 13 targeted procedures at study hospitals were included. Six clusters were identified: cardiac, orthopedic, gastrointestinal, OB-GYN, vascular, and spinal. Clusters were randomized to intervention, and also underwent surveillance and feedback using optimized SPC charts. Surveillance data feedback was provided to all clusters, regardless of allocation or type of surveillance. The goal was to lower SSI through SPC intervention compared to traditional surveillance and feedback alone.
AHRQ-funded; HS023821.
Citation: Anderson DJ, Ilieş I, Foy K .
Early recognition and response to increases in surgical site infections using optimized statistical process control charts-the Early 2RIS Trial: a multicenter cluster randomized controlled trial with stepped wedge design.
Trials 2020 Oct 28;21(1):894. doi: 10.1186/s13063-020-04802-4..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety
Vaughn VM, O'Malley M, Flanders SA
Association of infectious disease physician approval of peripherally inserted central catheter with appropriateness and complications.
The purpose of this study was to evaluate whether infectious disease physician approval prior to PICC placement for intravenous antimicrobials was associated with more appropriate device use and fewer complications. The authors concluded that this cohort study suggested that, when PICCs were placed for intravenous antimicrobial therapy, infectious disease physician approval of PICC insertion was associated with more appropriate device use and fewer complications.
AHRQ-funded; HS026530; HS025891.
Citation: Vaughn VM, O'Malley M, Flanders SA .
Association of infectious disease physician approval of peripherally inserted central catheter with appropriateness and complications.
JAMA Netw Open 2020 Oct;3(10):e2017659. doi: 10.1001/jamanetworkopen.2020.17659..
Keywords: Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases, Adverse Events
Gall E, Long A, Hall KK
Chlorhexidine bathing strategies for multidrug-resistant organisms: a summary of recent evidence.
This systematic literature review investigated the latest evidence for patient bathing with a 2%-4% chlorhexidine gluconate solution to reduce multidrug-resistant organism (MDRO) transmission and infection. Three databases were searched for articles from 2008 through 2018, as well as any key articles published after 2018. Findings focused on health care-associated infections (HAIs) and 3 categories of MDROs: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and carbapenem-resistant Enterobacteriaceae (CRE). Chlorhexidine reduced MRSA acquisition and carriage, but no studies found significant reductions in infections. Several studies found that chlorhexidine bathing reduced VRE acquisition and carriage. Two very large studies found bathing significantly reduced HAIs, but these reductions may be smaller when HAIs are already controlled with other anti-infection measures.
AHRQ-funded; HHSP233201500013I.
Citation: Gall E, Long A, Hall KK .
Chlorhexidine bathing strategies for multidrug-resistant organisms: a summary of recent evidence.
J Patient Saf 2020 Sep;16(3S Suppl 1):S16-s22. doi: 10.1097/pts.0000000000000743..
Keywords: Healthcare-Associated Infections (HAIs), Methicillin-Resistant Staphylococcus aureus (MRSA), Prevention, Patient Safety, Infectious Diseases
Schoyer E, Hall K
Environmental cleaning and decontamination to prevent clostridioides difficile infection in health care settings: a systematic review.
The aim of this systematic review was to examine the most effective and feasible methods for environmental cleaning and decontamination to prevent Clostridioides difficile infection (CDI) in health care settings. The investigators concluded that the studied practices for environmental cleaning and decontamination were associated with significant decreases in facility-level CDI rates in most of the reviewed studies; however, study quality was low.
AHRQ-funded; 233201500013I.
Citation: Schoyer E, Hall K .
Environmental cleaning and decontamination to prevent clostridioides difficile infection in health care settings: a systematic review.
J Patient Saf 2020 Sep;16(3S Suppl 1):S12-s15. doi: 10.1097/pts.0000000000000749..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Prevention, Patient Safety
Chatterjee P, Williams MD, Coppin JD
Effectiveness of copper-impregnated solid surfaces on lowering microbial bio-burden levels in an acute care hospital.
This study examined whether using novel coper-impregnated solid materials on high-touch surfaces in patient rooms lowered bacterial contamination which may lead to health care-associated infections in acute care hospitals. Sixteen rooms were installed with copper-impregnated surfaces and were compared to standard noncopper laminate surfaces in 16 rooms over a 3-day period. Samples were taken 3 times per day. A lower level of microbial contamination was found in copper-impregnated solid surfaces as compared to standard surfaces.
AHRQ-funded; HS025598.
Citation: Chatterjee P, Williams MD, Coppin JD .
Effectiveness of copper-impregnated solid surfaces on lowering microbial bio-burden levels in an acute care hospital.
Open Forum Infect Dis 2020 Aug;7(8). doi: 10.1093/ofid/ofaa238..
Keywords: Patient Safety, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Comparative Effectiveness, Prevention, Evidence-Based Practice
Sheetz KH, Ryan A
Accuracy of quality measurement for the hospital acquired conditions reduction program.
Accuracy of quality measurement for the hospital acquired conditions reduction program.
AHRQ-funded; HS026244; HS000053.
Citation: Sheetz KH, Ryan A .
Accuracy of quality measurement for the hospital acquired conditions reduction program.
BMJ Qual Saf 2020 Jul;29(7):605-07. doi: 10.1136/bmjqs-2019-009747..
Keywords: Healthcare-Associated Infections (HAIs), Hospitals, Quality Measures, Quality Improvement, Quality of Care, Surgery, Infectious Diseases
Luzum M, Sebolt J, Chopra V
Catheter-associated urinary tract infection, Clostridioides difficile colitis, central line-associated bloodstream infection, and methicillin-resistant Staphylococcus aureus.
This article provides summaries of the background, epidemiology, diagnosis, and treatment of central line-associated bloodstream infection, catheter-associated urinary tract infection, Clostridioides difficile, and methicillin-resistant Staphylococcus aureus colonization and infections. Additional prevention strategies, including those related to recent national interventions, are also reviewed.
AHRQ-funded; HS022835.
Citation: Luzum M, Sebolt J, Chopra V .
Catheter-associated urinary tract infection, Clostridioides difficile colitis, central line-associated bloodstream infection, and methicillin-resistant Staphylococcus aureus.
Med Clin North Am 2020 Jul;104(4):663-79. doi: 10.1016/j.mcna.2020.02.004..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Urinary Tract Infection (UTI), Clostridium difficile Infections, Methicillin-Resistant Staphylococcus aureus (MRSA), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases
Ilieş I, Anderson DJ, Salem J
Large-scale empirical optimisation of statistical control charts to detect clinically relevant increases in surgical site infection rates.
Researchers sought to determine which statistical process control chart types and design parameters maximized the detection of clinically relevant surgical site infection (SSI) rate increases while minimizing false alarms. Statistically significant SSI rate increases (signals) at individual hospitals were identified using 50 different statistical process control chart variations; blinded epidemiologists evaluated the clinical significance of 2709 representative signals of potential outbreaks and rated them as requiring action or no action. The researchers concluded that an optimized combination of two moving average charts had the best performance for identifying clinically relevant small but sustained above-network SSI rates and large short-term individual hospital increases.
AHRQ-funded; HS023821.
Citation: Ilieş I, Anderson DJ, Salem J .
Large-scale empirical optimisation of statistical control charts to detect clinically relevant increases in surgical site infection rates.
BMJ Qual Saf 2020 Jun;29(6):472-81. doi: 10.1136/bmjqs-2018-008976..
Keywords: Surgery, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Patient Safety
Baker AW, Nehls N, Ilies I
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
This study analyzed the use of optimized dual statistical process control (SPC) charts to predict surgical site infection (SSI) outbreaks. The researchers retrospectively applied an optimized pair of moving average (MA) SPC charts to all 30 SSI outbreaks previously identified and investigated from 2007 to 2015 in the Duke Infection Control Outreach Network (DICON), which is a network of more than 50 community hospitals. The dual MA SPC chart approach detected all 30 outbreaks at a median of 16 months prior to traditional surveillance detection.
AHRQ-funded; HS23821.
Citation: Baker AW, Nehls N, Ilies I .
Use of optimised dual statistical process control charts for early detection of surgical site infection outbreaks.
BMJ Qual Saf 2020 Jun;29(6):517-20. doi: 10.1136/bmjqs-2019-010586..
Keywords: Healthcare-Associated Infections (HAIs), Surgery, Patient Safety, Hospitals, Public Health, Infectious Diseases
Bartsch SM, Wong KF, Stokes-Cawley OJ
Knowing more of the iceberg: how detecting a greater proportion of carbapenem-resistant Enterobacteriaceae carriers influences transmission.
This study examined the impact of detecting a greater proportion of carbapenem-resistant Enterobacteriaceae (CRE) carriers in the hospital inpatient population. The researchers used the Regional Healthcare Ecosystem Analyst-generated agent-based model of adult inpatient healthcare facilities in Orange County, California. They found that only if the detection level is increased to 1 in 5 carriers does it garner large reductions in the number of new CRE carriers. At the present time the detection level is 1 in 9 carriers.
AHRQ-funded; HS023317.
Citation: Bartsch SM, Wong KF, Stokes-Cawley OJ .
Knowing more of the iceberg: how detecting a greater proportion of carbapenem-resistant Enterobacteriaceae carriers influences transmission.
J Infect Dis 2020 May 11;221(11):1782-94. doi: 10.1093/infdis/jiz288..
Keywords: Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Patient Safety, Prevention
Meddings J, Greene MT, Ratz D
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
AHRQ’s Safety Program for ICUs aimed to reduce central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) in intensive care units with elevated rates. Included hospitals had at least one adult intensive care unit with elevated CLABSI or CAUTI rates. The investigators targeted intensive care units with elevated catheter infection rates but yielded no statistically significant reduction in CLABSI, CAUTI or catheter utilization in the first two of six planned cohorts. Improvements in the interventions based on lessons learned from these initial cohorts are being applied to subsequent cohorts.
AHRQ-funded; 233201500016I.
Citation: Meddings J, Greene MT, Ratz D .
Multistate programme to reduce catheter-associated infections in intensive care units with elevated infection rates.
BMJ Qual Saf 2020 May;29(5):418-29. doi: 10.1136/bmjqs-2019-009330..
Keywords: Catheter-Associated Urinary Tract Infection (CAUTI), Central Line-Associated Bloodstream Infections (CLABSI), Healthcare-Associated Infections (HAIs), Infectious Diseases, Patient Safety, Urinary Tract Infection (UTI), Intensive Care Unit (ICU), Hospitals, Evidence-Based Practice, Patient-Centered Outcomes Research, Inpatient Care, Critical Care
McHaney-Lindstrom M, Hebert C, Miller H
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
This paper explores how social network analysis (SNA) software can be used to analyze intra-hospital networks of individuals with a healthcare associated infection (HAI) for further analysis in a GIS environment. The SNA analysis compared cases to controls which highlighted significant differences in the overall structure of the networks.
AHRQ-funded; HS024379.
Citation: McHaney-Lindstrom M, Hebert C, Miller H .
Network analysis of intra-hospital transfers and hospital onset Clostridium difficile infection.
Health Info Libr J 2020 Mar;37(1):26-34. doi: 10.1111/hir.12274..
Keywords: Clostridium difficile Infections, Healthcare-Associated Infections (HAIs), Infectious Diseases, Hospitals, Public Health
Adams C, Young D, Gastanaduy PA
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
Norovirus transmissibility is poorly understood and the goal of this study was to examine transmission via vomiting, diarrhea, and patient exposures. Six nursing home outbreaks in South Carolina were examined from 2014 to 2016. Vomiting infected 2.12 times the number of individuals as non-vomiters, diarrhea 1.39 times, and resident cases infected 1.53 times the number of individuals as staff cases. This finding is important for not just nursing homes, but other sites of norovirus outbreaks such as cruise ships.
AHRQ-funded; HS025987.
Citation: Adams C, Young D, Gastanaduy PA .
Quantifying the roles of vomiting, diarrhea, and residents vs. staff in norovirus transmission in U.S. nursing home outbreaks.
PLoS Comput Biol 2020 Mar;16(3):e1007271. doi: 10.1371/journal.pcbi.1007271..
Keywords: Elderly, Nursing Homes, Long-Term Care, Infectious Diseases, Healthcare-Associated Infections (HAIs), Prevention, Public Health