The impact of health care restructuring: PATIENTS AND METHODS

18 Jan

Hospital volume and acuity: To assess trends in hospital pa­tient care volume, the number of hospital inpatient beds, an­nual admissions and patient days were obtained comparing 1993 and 1994 (1993/94) 1996 and 1997 (1996/97). To assess changes in the hospital population, the proportion of inpatient beds designated as intensive care unit (ICU) beds and the dis­tribution of patient days by medical service were determined. To assess changes in the prevalence of risk factors for blood stream infection, hospital wide days of use of total parenteral nutrition (TPN) supplied by the hospital pharmacy, number of hemodialysis runs performed annually by the he- modialysis unit and central venous catheter (CVC) daysof use by ICUs were determined. Assessment of the extent of mechanical ventilation use (ventilator days) was not avail­able, nor were CVC days of use outside of the ICU.

Nosocomial blood stream infections and rates: Nosocomial blood stream infections were identified through the prospec­tive monitoring of clinical microbiology laboratory reports by the hospital’s infection control staff, as previously described. Centers for Disease Control and Prevention definitions of infection were used to distinguish nosocomial infections from community-acquired infections or blood culture contami­nants. Infection rates were calculated using patient days and patient admission denominators supplied by the hospi­tal’s information systems department. ICU CVC-associated blood stream infection rates were calculated using CVC day de­nominators supplied by the ICU staff. Episodes of pri­mary bacteremia occurring in outpatients undergoing chronic hemodialysis in the hospital hemodialysis unit were included in the numerator. Episodes of hemodialysis-related bactere- mia occurring in ICU patients were attributed to the ICU, and included under the category primary blood stream infection. Infections and infection rates occurring in the two years before restructuring (1993 and 1994) were compared with infections and infection rates occurring during the two years after re­structuring (1996 and 1997). Statistical comparisons of rates were performed by EPI INFO, version 6.04b (Centers for Disease Control and Prevention, Atlanta, Georgia) and by the statistical program of Automated Infection Control Expert (Infection Con­trol and Prevention Analysts Inc, Austin, Texas).
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