LL McKinley, Philadelphia VA Medical Center; HJ Moriarity, Philadelphia VA Medical Center; TH Short, Villanova University; CC Johnson, Philadelphia VA Medical Center

Objectives: The purpose of this study was to: 1) provide network hospitals with a systematized data management system for ICU surveillance and 2) to compare ICU nosocomial infection rates in hospitals that receive comparative data feedback to those that do not receive the comparative data.

Methods: Infection control surveillance is not performed using standardized methodology within the Department of Veterans Affairs (VA) health system; therefore, interhospital comparisons are of limited value. In addition, many smaller VA hospitals do not meet entry criteria and do not have the resources to participate in national surveillance projects, such as the CDC National Nosocomial Surveillance System (NNIS). To facilitate standardization of surveillance within a VA hospital network, a study was designed to use one central coordination site to collect and analyze data for other network hospitals. VISN 4 is a VA health care network of ten hospitals in the midatlantic region of the United States. Among VISN 4 hospitals, only the Philadelphia VA Medical Center (PVAMC) has been a NNIS participant. In this study, PVAMC serves as the central coordination site where surveillance data are analyzed according to NNIS criteria and reported back to the sites. The eight participating hospitals in the study were randomized into one of two groups. The experimental group (N=4 hospitals) receives risk adjusted infection rates with national comparative data and the control group (N=4 hospitals) receives only the risk adjusted infection rates without the comparative data.

Results: In 1999, the device-associated infection rates were higher that the national comparative NNIS data in both the control and experimental groups. After one year of data collection, both the central line-associated bloodstream infection rate and the ventilator-associated pneumonia rate were significantly higher in the control group when compared to the experimental group, 13.9 vs. 5.5 (p = 0.0063) and 25.0 vs. 13.4 (p = 0.012), respectively.

Conclusions: In general, risk-adjusted infection rates were higher in the VA hospitals studied when compared to national data. Preliminary results of this study suggest that infection rate outcomes may be reduced when national comparative data are provided.

Impact: The study may serve as an infection control surveillance model for VA hospital networks.

Funded by the VISN4 Competitive Pilot Project Fund