A Quality Management Project in 8 Selected Hospitals to Reduce Nosocomial Infections: A Prospective, Controlled Study

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Abstract
Objective: : To reduce the number of nosocomial infections (NIs) in surgical patients by a quality management approach.Design: : Prospective, controlled study in 8 medium-sized hospitals during a 26-month period.Setting: : Four study hospitals and 4 control hospitals.Methods: : In two 10-month intervention periods, 4 external physicians introduced quality circles and ongoing surveillance in the 4 study hospitals. There were three 8-week observation periods in all 8 hospitals with the same physicians before, during, and after the intervention periods.Results: : During the first observation period, almost identical overall incidence densities were found for the study hospitals and the control hospitals. During the course of the study, the overall incidence density decreased significantly in the study hospitals (risk ratio [RR], 0.74; 95% confidence interval [CI95], 0.59 to 0.94) and nonsignificantly in the control hospitals (RR, 0.90; CI95 0.70 to 1.16). With the use of a Cox regression model to evaluate the impact of the intervention periods while taking into account the distribution of risk factors for NI in both groups, a significant risk reduction (RR, 0.75; CI95, 0.58 to 0.97) was observed after the first intervention period when comparing study and control hospitals. At the end of the study (ie, after the second intervention period), the difference between the study hospitals and the control hospitals was not significant (RR, 0.78; CI95, 0.60 to 1.01). This was due to no further improvement at the end of the study in the study hospitals and a decrease in the control hospitals.Conclusion: : This study demonstrates that NI rates can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous intense efforts are necessary to maintain these improvements.