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Background: Information regarding the incidence of antibiotic-resistant infection in residents of skilled nursing facilities is lacking., Methods: The incidence and predictors of antibiotic-resistant infection were investigated in 56,182 long-term residents of 3314 skilled nursing facilities in California, Florida, Michigan, New York, and Texas., Results: The annual incidence was 12.7 cases per 1000 long-term residents overall, which varied by state (highest incidence, New York) and type of admitting facility (highest incidence, rehabilitation hospital). The incidence was greater in younger residents, males, and residents with paraplegia, quadriplegia, peripheral vascular disease, or diabetes mellitus. Dialysis, urinary catheterization, feeding tubes, tracheostomy, and use of intravenous medications were associated with elevated risk. Adjusted odds ratios (ORs) were greatest in residents with paraplegia (OR = 2.86; 95% confidence interval [CI] = 1.67 to 4.89) and those receiving dialysis (OR = 2.84; 95% CI = 1.84 to 4.37)., Conclusion: There is significant variation in the risk of antibiotic-resistant infection by admitting diagnosis, device use, and facility characteristics.

Background: Patients who are hospitalized and infected with multidrug-resistant bacteria are usually placed in contact isolation, which requires hospital personnel to gown and glove before patient examination. Contact isolation with active culture surveillance appears beneficial in preventing the spread of drug-resistant infections; however, contact isolation may impede the ability to examine patients as a result of the additional effort required to gown and glove. We assessed whether patients who are hospitalized and placed under contact precautions are examined less often by second- and third-year medical residents (ie, senior medical residents), and attending physicians during morning rounds., Method: We conducted a prospective cohort study on the inpatient medical services at 2 university-affiliated medical centers. We directly observed senior medical residents and attending physicians during morning rounds, and recorded the contact precaution status of the patient and whether they were examined by either physician., Results: Of a total of 139 patients, 31 (22%) were in contact isolation. Senior medical residents examined 26 of 31 patients (84%) in contact isolation versus 94 of 108 patients (87%) not in contact isolation (relative risk, 0.96; 95% confidence interval, 0.81-1.14; P =.58). In comparison, attending physicians examined 11 of 31 patients (35%) in contact isolation versus 79 of 108 patients (73%) not in contact isolation (relative risk, 0.49; 95% confidence interval, 0.30-0.79; P <.001)., Discussion: Attending physicians are about half as likely to examine patients in contact isolation compared with patients not in contact isolation.

Given the rise in health care-related expenditures, decision-makers are increasingly relying on both clinical effectiveness and economic efficiency when making health care decisions. The field of infection control is not immune to this rise in cost-consciousness among health care managers. This article clarifies the role of economic evaluation within infection control for both the user and producer of economic evaluations in this field. The strengths and drawbacks of the several different types of economic analysis--cost minimization, cost-effectiveness, cost-benefit, and cost utility analysis--will be discussed. Additionally, the important features of two specific methods used for economic evaluation-decision analytic modeling and economic analysis alongside a clinical trial-will be outlined. Finally, the criteria by which economic analyses should be judged will be provided. As economic evaluation and health services research continue to play an increasingly important role in health care, it will be vital for infection control advocates to partner with individuals from diverse fields to give decision-makers the type of information they need to make choices.

Background: At the University of Michigan Hospitals and Health Centers, there is increasing use of an electronic medical record. Because orthopedic surgeons dictate all outpatient visits to the patient's electronic record, total knee arthroplasties were chosen to determine whether the use of electronic medical records increased case finding., Methods: All patients who underwent a total knee arthroplasty during the study period (1996-1999) were followed prospectively with the use of the National Nosocomial Infection Surveillance System definitions. Traditional surveillance methods were used to ascertain infections. In addition, each patient's postdischarge outpatient clinic chart was reviewed electronically for 1 year after operation., Results: From 1996 to 1999, 555 procedures were performed. Overall, 25 infections were identified after operation. Seven infections were identified through traditional surveillance methods, which resulted in an average surgical site infection rate of 1.3%. The use of electronic chart review surveillance after discharge revealed a rate of 4.5%, which was significantly higher than traditional surveillance (P <.01). Eighteen of 25 infections (72%) would not have been identified with the use of traditional surveillance methods., Conclusion: Postdischarge electronic chart review enhanced case finding significantly, which resulted in a more accurate infection rate. Awareness should be given to the institutions' surveillance methods and intensity when comparing to published rates.

Background: Proper staffing of infection control departments has long been a topic of interest. The most complete report on the subject, the Study on the Efficacy of Nosocomial Infection Control, was published in 1985. To provide current benchmarking comparison data for expected staff reductions at the University of Michigan Health System, a survey of University HealthSystem Consortium members was performed., Methods: A survey tool was developed to obtain general demographic, staffing, and case-mix information. An infection control professional at each institution was contacted to obtain most of the information. Additional information was obtained from standard references., Results: Responses were obtained from 45 University HealthSystem Consortium members (67%). Full-time equivalent ratios were based on the following parameters and compared for the institutions: number of occupied beds (according to occupancy rate, median 137 occupied beds/full-time equivalent), number of intensive care unit beds (median 28 beds/full-time equivalent), number of admissions or discharges (median 6686 admissions/full-time equivalent), number of ambulatory care visits (median 104,426 visits/full-time equivalent), and case-mix index (median 1.75)., Conclusions: Many institutions are using benchmarking comparison data to make decisions regarding staff reductions. This survey provides preliminary data for determining the "best practice" in staffing for infection control departments. More information may be needed to evaluate other factors that affect infection control professionals' workload.

Background: Endometritis is a possible complication of delivery among patients undergoing cesarean section, resulting in increased costs and patient morbidity. However, traditional case-finding methods for endometritis may not identify most cases. We compared various case-finding methods with a reference method to determine a simple and accurate method for collecting data on endometritis after cesarean section., Methods: We reviewed charts of all patients undergoing cesarean section (N = 167) during March 1 through July 31, 1991. These data were compared with study case-finding methods that used microbiology data, infection report forms from nursing, and computerized reports linking patients undergoing cesarean section with intravenous antibiotic use data and admission and discharge diagnoses., Results: Each case-finding method was compared separately with the reference method ("gold standard"), which was designed to capture all cases among the patients in the study population (N = 145). This review yielded nine cases of endometritis (infection rate of 5.4/100 procedures). The computerized report method linking patients who underwent cesarean section with antibiotic use had a positive predictive value of 0.53. Methods that used microbiology data and nursing report forms had lower positive predictive values of 0.18 and 0.20, respectively., Conclusions: In our institution, case finding for postcesarean endometritis by means of a computerized report linking patients undergoing cesarean section with i.v. antibiotic use data and admission and discharge diagnoses is the most effective method of detecting postcesarean endometritis. It also represents the most efficient use of the infection control department's resources.