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Summary The University of Iowa Hospitals and Clinics is located in the center of the United States in Eastern Iowa, has 1,000 hospital beds, and is the largest university owned teaching hospital in the country. Over 35,000 patients are admitted each year. The infection control efforts began in 1969 and were broadened in 1976 with the establishment and implementation of the Program of Epidemiology directed byW.J. Hierholzer, Jr., M.D., hospital epidemiologist. Hospital-wide surveillance is routinely performed by three and a half full-time equivalent LPN practitioners who assess problems and evaluate data essential to realistic identification of nosocomial infection rates, implementation of controls and evaluation of control measures. Nosocomial infection surveillance, utilizing modified CDC criteria, has been performed since July 1976. Ward rounds are made by staff, utilizing nursing care and medication Kardex's, microbiology, hematology and X-ray reports. Importantly, the surveillance system is being validated by concurrent prospective surveys to determine the sensitivity and specificity of reporting data. Outbreaks/epidemics of infections, such asLegionella pneumonia, diarrhea of unknown species, and wounds, as well as burns from manufactured changes in cautery grounds, have been identified and controlled before they have become major epidemics. Surveillance has identified one epidemic per 10,000 patients admitted. Relying on microbiology reports would have identified some of these problems, but we know that: 1) not all infection sites are cultured or appropriate serologies performed, and 2) not every culture is appropriately taken or quickly delivered, resting in faulty data. One of the most sophisticated hospital computer systems in the country is available to link patient data to ongoing infection surveillance. Data are reported monthly by site and organism to nursing units and clinical services and yearly surgical wound data are reported to the individual surgeon by procedure, as well as by wound classification.R. P. Wenzel, M.D., hospital epidemiologist was appointed to the program in 1986 and also directs a training program for physicians in the new Division of Clinical Epidemiology in the Department of Internal Medicine. Our team will utilize all data to assist in more indepth evaluation and control of endemic pneumonias, bacteremias and antibiotic use evaluation, and continue epidemic controls. Purchase of sophisticated printers and computer packages will allow more extensive use of graphics in the future. |
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