title: A toolkit for monitoring hospital-acquired bloodstream infection in neonatal intensive care.
abstract: OBJECTIVE
  In neonatal intensive care units (NICUs), monitoring hospital-acquired bloodstream infection (BSI) is critical to alert clinicians to variations in the incidence of infection between units and over time. We demonstrate a toolkit of monitoring techniques that account for case mix and could be implemented using routinely available clinical data. This toolkit could enable quality of care comparisons between hospitals to facilitate the sharing of improved practices.
  
  
  METHODS
  Prospective study over 4 years.
  
  
  METHODS
  Babies admitted to 2 tertiary London NICUs.
  
  
  METHODS
  We derived expected numbers of BSI episodes using a Poisson regression risk model adjusting for variations in birth weight, transfers to the NICU from other hospitals, postnatal age, and days spent at each National Health Service level of care. We compared observed and expected numbers of BSI episodes using 2 monitoring techniques: standardized infection ratios (SIRs) and the sequential probability ratio test (SPRT).
  
  
  RESULTS
  Using the SIR method, observed BSI incidence increased over expected incidence in 2002 at both NICUs, but this increase did not reach statistical significance at the 1% level. Using the SPRT method, neither unit showed a clinically important increase or decrease, defined as a 30% deviation from expected incidence.
  
  
  CONCLUSIONS
  Risk-adjusted BSI monitoring can be performed using routine hospital data. NICUs could use SIRs for an annual look back at infection incidence and SPRTs for prospective, quarterly monitoring. The SIR and the SPRT methods have different strengths, and both could help clinicians improve infection control and patient care in NICUs.
authors: Medical Research Council Centre of Epidemiology for Child Health, University College London Institute of Child Health, London, United Kingdom. ph.leighton@gmail.com
authors: Pamela
authors: P
authors: Leighton
authors: Mario
authors: M
authors: Cortina-Borja
authors: Michael
authors: M
authors: Millar
authors: Stephen
authors: S
authors: Kempley
authors: Ruth
authors: R
authors: Gilbert
mesh_terms: D016470:Bacteremia / Q000453:epidemiology*; D003428:Cross Infection / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D016012:Poisson Distribution; D011159:Population Surveillance / Q000379:methods*; D011336:Probability; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*