A Case Study in Monitoring

Hospital-Associated Infections
with Count Control Charts
Shreyas S. Limaye
1
,
Christina M. Mastrangelo
1
,
Danielle M. Zerr
2
1
Industrial Engineering,
University of Washington,
Seattle, Washington
2
Childrens Hospital, Seattle,
Washington
ABSTRACT Hospital-associated infections are a major concern in the
medical community due to the potential loss of life and high costs. Monitor-
ing the incidences of infections is an established part of quality maintenance
programs in hospitals. However, traditional methods of analysis are often
inadequate since the incidences of infections are infrequent. In order to
address this issue, techniques such as the cumulative sum (CUSUM) chart
for counted data and the g-type control chart have been suggested. This
article demonstrates how these charts may be applied to infection control
surveillance data from Childrens Hospital and makes recommendations
for a control chart most suitable for monitoring hospital-associated infec-
tions.
KEYWORDS g-type control charts, hospital-associated infections, Poisson
control charts, SPC, statistical process control, surveillance
INTRODUCTION
Hospital-associated (HA) infections are any infections that are acquired or
spread as a direct result of a patients hospital stay. The Centers for Disease
Control and Prevention (CDC) estimates that about 2 million people acquire
HA infections each year and that about 90,000 of these patients die as a
result of their infections. Vulnerable populations such as children or ICU
patients are even more susceptible (Health Protection Agency, 2003).
The most common HA infections are central lineassociated blood stream
infections (BSI), ventilator-associated pneumonia (VAP), and catheter-
associated urinary tract infections (UTI). Approximately 80,000 BSIs occur
in ICUs each year in the United States, and these infections may prolong a
hospital stay by 7 to 21 days (Champion and Mabee, 2000). Some of the pro-
spective studies indicate up to a 35% increase in mortality due to these
infections. The attributable cost per infection is estimated to be
$34,000$56,000, and the annual cost of caring for patients with BSIs ranges
from $296 million to $2.3 billion. The incidence of VAP varies greatly,
ranging from 6 to 52% of intubated patients depending on patient risk
factors (AHRQ, 2001). The cumulative incidence is approximately 13%
Address correspondence to Shreyas S.
Limaye, 5505 15th Ave. NE, Apt. 306,
Seattle, WA 98105. E-mail:
shreyas@u.washington.edu
Quality Engineering, 20:404413, 2008
Copyright # Taylor & Francis Group, LLC
ISSN: 0898-2112 print=1532-4222 online
DOI: 10.1080/08982110802334120
404
per day of intubation. Overall, VAP is associated with
an attributable mortality of up to 30%. The average
cost per episode of VAP is estimated at $3000 to
$6000, and the additional length of stay for patients
who develop VAP is estimated at 13 days (Warren
et al., 2003). Urinary tract infections (UTIs) account
for about 40% of the total number of HA infections
in some reports and affect an estimated 600,000
patients per year (MMWR, 2002). The average cost
of one hospital-associated UTI is estimated to be
between $680 and $1,875 per patient infection, and
additional hospital days per patient due to UTIs
range between 1 to 4 days.
The problem of HA infections is quite significant
in terms of affecting patient lives, adding to the econ-
omic cost of the healthcare, and putting additional
strain on the hospital resources. Effective monitoring
of infection rates can alert clinicians to a change of
infection rates, prompt the quality improvement
teams to identify causes behind the abnormal
increase, and stimulate efforts to look for effective
interventions to reduce them. A control chart is an
effective tool for this.
The control chart is a running record of behavior
over time (Carey, 2002) and usually has one of three
goals: (1) reduce variation, that is, process improve-
ment; (2) signal the need for a process adjustment;
and (3) demonstrate stability. Control charts can
directly address goals 2 and 3. In order to accomplish
goal 1, they can provide useful pointers if used
appropriately. The use of control charts is increas-
ingly being suggested for a variety of applications
in healthcare in an effort to improve the quality of
healthcare delivery. Components of variability exhib-
ited by healthcare data make them attractive candi-
dates to apply control charting techniques (Matthes
et al., 2007). Woodall (2006) gives an excellent sum-
mary of various types of control charts in healthcare
monitoring and in public health surveillance, as well
as discussing the issues related to these charts.
The use of control charts is also widely used for
monitoring infections in an effort to improve patient
safety. Benneyan (1998) reasons that the use of SPC
in other fields that is, understanding current process
performance, achieving a consistent level of process
quality, monitoring for process deterioration and
reducing process variation, is very much applicable
to the case of monitoring infections as well. In order
to address some of the concerns of traditional control
charts in this setting, alternate charts have been
suggested. Gustafson (2000) suggests the use of
risk-adjusted control charts based on a standardized
infection ratio calculated by dividing the observed
number of infections by the expected number of
infections during a particular period. Benneyan
(2001a) develops the g-type and h-type control
charts based on inverse sampling from geometric
and negative binomial distributions for evaluating
number of cases or number of days between
HA infections as they can exhibit greater detection
power over conventional binomial-based approa-
ches. Morton et al. (2001) demonstrate use of
counted-data EWMA and CUSUM charts for effective
monitoring of hospital-associated infections.
This article compares different control charting
techniques for monitoring hospital-associated infec-
tions. It demonstrates a u-chart, a CUSUM chart for
low count data, and g-type control chart. The next
section describes the data, the application of control
charts to the data, and the merits of these charts. The
following section concludes by providing recom-
mendations regarding use of a suitable control chart-
ing technique for monitoring hospital-associated
infections based on this case study.
DATA DESCRIPTION
Five years of infection surveillance data (from
2002 to 2006) from the pediatric ICU of the Childrens
Hospital, Seattle, is used. The data represents the
total number of HA infections as well as patient
days, which is the total number of days patients
spent in the ICU that quarter. Quarterly data on three
of the main infection types, that is, catheter-related
blood stream infections (BSI), urinary tract infections
(UTI) and ventilator-associated pneumonia (VAP), of
infections is also available. In addition, the data
contain each infection incidence. The data are shown
in the Appendix.
The current practice is to use a control chart for
individuals on a quarterly basis to monitor the rate
of infections per unit, where the unit is 1000:1000
patient days, 1000 central line days, 1000 ventilator
days, or 1000 catheter days. In the infectious disease
field, it is common practice to collect data in this
manner and is how it is reported to the CDC. As
such, this data is readily available, and the methods
described here may easily be used in other infection
405 Monitoring Hospital-Associated Infections
monitoring applications (as shown by Benneyan,
1998, 2006; Smyth and Emmerson, 2000).
Figure 1 plots the total number of infections from
2002 to 2006. The data show an increase in the num-
ber of infections after 2002, followed by an upward
trend in 20042005 and a decreasing trend in 2005
2006. In 2002, Childrens performed about 50 cardiac
surgeries; in the following years, between 200 and
250 cardiac surgeries were performed. In 2006, an
intensive hospital-wide initiative to reduce blood-
stream infections began. The yearly variation in the
data is not unsurprising since hospitals continuously
strive to improve the quality of their services with
new interventions and procedures to reduce the
possibility of infection transmission. Given this con-
dition of 24 subgroups and non-constant infection
rates, determining an appropriate control chart is a
challenge and is the goal of this article. Since it is
clear from Figure 1 that there is a difference in infec-
tion rates between 2002 and the subsequent years,
the control charts in this article will exclude 2002.
MONITORING INFECTION RATES
There are two distinct phases of control chart
practice (Alt, 2006; Woodall, 2000): Phase I uses
the charts for retrospectively testing whether or not
the process has been in statistical control, and phase
II uses the control charts to detect any departure of
the process from the standard values. Rather than
determining the control limits for one type of control
chart based on stable retrospective data, this case
study explores the type of control chart that is most
suitable for infection control data, which is typically
collected in terms of number of infections and
number of patient days or line days over a certain
period of time (quarter or month). In order to
achieve this, a u-chart, a CUSUM chart for low count
data, and g-type control chart are applied to the
infections data and their applications are discussed.
Figure 2 shows the method currently used for
monitoring infection rates. A control chart for indivi-
duals is used, and the control limits are recalculated
at the end of the year using the preceding two years
of data. The challenge with the current method is
that the process is actually producing attributes data
that follows a Poisson distribution.
The U Chart
Figure 3 illustrates a u-chart for the quarterly num-
ber of infections per 1000 days patient days in the
ICU. This presentation is consistent with the National
Nosocomial Infections Surveillance system (NNIS
Report, 2004). The u-chart is used here because each
patient day is an area of opportunity in which one
or more infections could occur. If the data had been
FIGURE 1 Plot of total infections per quarter.
FIGURE 2 Current method: control chart for individuals moni-
toring total quarterly infections per 1000 patients.
FIGURE 3 U-chart for number of infections per quarter per 1000
patient days.
S. S. Limaye et al. 406
recorded as the number of patient days with one or
more infections, a p-chart would be more appropriate.
P-charts also work best if the rate of non-conforming
is greater than 0.05% (Montgomery, 2005). The HA
infection rates are typically smaller than that (.009
per day). In addition, even if the data were collected
in that manner, it follows that other charts that
handle low-count attribute data would be more
appropriate.
In this application, the number of infections per
quarter represents the number of nonconformities
and the number of patient days in the ICU per quar-
ter represents the sample size. To account for the dif-
ference in opportunity for initiation of infections, the
ratio of number of infections to total number of line
days per quarter is calculated (Carey, 2002). The cen-
ter line remains constant, whereas the control limits
shift for every observation to account for the differ-
ence in the number of ICU days.
It should be noted that more than 20 subgroups
are generally recommended for starting a control
chart. A monthly based control chart may be more
appropriate in that a sufficient number of samples
would be available as well as increased opportunities
to detect significant increases (or decreases) in infec-
tion rates. While the data contains the date of each
infection, the number of patient days per month is
not available. Figure 4 shows the u-chart for the
monthly number of infections per 1000 patient days
assuming that the patient days are equal in each
month of the quarter. The monthly based u-chart
may be more effective in pointing out some of the
sharp increases in the infection rate when compared
to the quarterly one.
Counted Data CUSUM Chart
The cumulative sum chart may also used to moni-
tor adverse events in health care (Morton et al., 2001;
Woodall, 2006). The CUSUM chart plots the cumulat-
ive sum deviations from the mean and places empha-
sis on keeping the process on aim rather than
allowing it to drift between the upper and lower con-
trol limits (Lucas, 1985). As a result, an out-of-control
signal indicates that action should be taken to pre-
vent the adverse events from exceeding the target.
The CUSUM charts in health care are typically one
sided, with the part corresponding to a decrease in
the number of hospital-acquired infections not
included. However, we use a two-sided CUSUM.
The upper CUSUM is designed to detect worsening
performance, and the lower CUSUM is designed to
detect improvement in performance (Woodall,
2006). By including both an upper and lower
CUSUM one will not only be able to determine what
is causing an increase in infection rates but also be
able to determine factors that will decrease the infec-
tion rate.
Figure 5 shows a CUSUM chart for count data that
follows the Poisson distribution for the number of
monthly hospital associated infections in the pedi-
atric ICU. While creating a CUSUM chart, one needs
to choose the reference value (k) and the decision
interval value (h). The parameter k is chosen to be
between the acceptable process mean (l
a
) and the
mean that the CUSUM aims to detect quickly (l
d
).
Lucas (1985) recommends the approach given in
Table 1.
The average number of infections per month is
5.2, a target of 5 (l
a
) infections per month is reason-
able, and the CUSUM aims to detect the shift to 7 (l
d
)
FIGURE 4 U-chart for the number of infections per month per
1000 patient days. FIGURE 5 CUSUM control charts for monthly infections.
407 Monitoring Hospital-Associated Infections
infections per month. For this shift, using the above
formula, k 6. Once k is chosen, the value of h is
chosen. It should give an appropriately large ARL
when the counts are at the acceptable level and an
appropriately small ARL value when the process is
running at the count level that should be detected
quickly. For a k value of 6, an h value of 5 is chosen
(see Lucas, 1985). For detecting an increase in the
infection rate, a positive head start of 4 is used
whereas a head-start is not used for detecting
decrease in the infection rate. The corresponding
ARL
1
s for the counted data CUSUM are 9.5 and
1.32, respectively.
Each bar in Figure 5 represents the cumulative
sum deviation from the target mean. In addition,
the individual observations for each period on the
CUSUM status chart are also plotted as the solid dots.
The primary advantages of the CUSUM chart are
its ability to detect small shifts in the process and
its ability to provide early warning. In addition, the
CUSUM is particularly helpful in determining when
the assignable cause has occurred by just counting
backward from the out-of-control signal to the time
period when the CUSUM lifted above zero. The
CUSUM chart does provide an early warning regard-
ing increasing infection rates in January 2003 when
the CUSUM crosses center line after being below it
during 2002 and again in early 2005 after higher
infection rates are observed.
G-Type Control Chart
The g-type control chart provides an alternate way
to look at infection data. The g-type (geometric) con-
trol charts track the number of cases or amount of
time between events. These charts are particularly
useful when the data are low-count (Benneyan,
2001a).
Benneyan (2001a) observes that events between
infections do not follow the typical Poisson,
binomial, or normal distributions. Instead, these data
follow that of a geometric random variable. Figure 6
shows the actual days between infections and the
theoretical geometric distribution for p .2 and
how the data closely follow the geometric distri-
bution. However, in this application, p is unknown,
so xx will be used and the control parameters esti-
mated using the equations in Table 2. Note that
n1 and when the lower limit is negative, it is
rounded up to zero.
Figure 7 shows a g-type chart for the days
between infections. It is important to note that the
g-chart operates differently from a typical control
chart. It does not follow the standard intuition, which
is if a point is above the upper control limit an
assignable cause is present. In this case, a point
above the upper control limit signals an above aver-
age number of days between infections, which is a
desired goal (Benneyan, 2001b). While the lower
control limit is typically zero, it may be beneficial
to set the lower control limit slightly above zero so
in the rare case of an infection outbreak it would
be more readily detected.
The g-chart indicates an increase in the frequency
of infections. The annotations in Figure 7 point to
the two quarters (4th quarter of 2003 and 2nd quarter
of 2005) that had the highest infections rates (see
Figure 1). In addition, one can also note that even
though the number of infections in 20032004 and
TABLE 1 Calculation of k
Formula l
a
l
d
k
k
l
d
l
a

lnl
d
lnl
a

5 7
75
ln7ln5
6
FIGURE 6 The actual number of days between infections and
the values of the geometric distribution.
TABLE 2 Control Limits for the G-type Control Chart
Chart type UCL CL LCL
G-type chart (infection
rate known)
1p
p
k

1p
p
2
q
1p
p
1p
p
k

1p
p
2
q
G-type chart (infection
rate estimated)
xx k

xx xx 1
p
xx xx k

xx xx 1
p
where xx the average number of days between infections, p the
rate of infection (if known), and k the number of standard deviations
used in the control limits.
S. S. Limaye et al. 408
20052006 are approximately the same, infections
occur at more regular time intervals after December
2004 (as evidenced by the lower number of spikes).
A g-type control chart has an advantage in that
each data point can be plotted immediately, and the
overall effects can be seen quickly as well. Figure 8
shows g-type charts for BSI, UTI, VAP, and total
infections from 2003 to 2006. The plots indicate a
slight decrease in the number of BSIs in 2006 and
an increase in the days between infections. For
2006, UTIs and VAPs show a decrease in frequency
and increased days between occurrences.
CONCLUSIONS
This case study illustrates how control charting is
used currently in the pediatric ICU at the Childrens
Hospital and then demonstrates the use of different
techniques for the infection surveillance data. The
u-chart monitors the number of infections per 1000
FIGURE 7 G-type control chart for number of days between HA-infection incidences.
FIGURE 8 G-type control charts for overall infections, BSI, UTI, and VAP infections.
409 Monitoring Hospital-Associated Infections
patient days. The counted data CUSUM chart does
not use denominators and monitors the number of
infections per month directly. The g-type control
chart monitors the number of days between interven-
tions. Each chart has a set of advantages and
disadvantages.
The u-chart is simple to construct, capable of hand-
ling low-count data, and easy to interpret. It also takes
into account the change in the sample size which in
case is the varying number of patient days, line days
or ventilator days. In Figure 9, the quarterly based
u-chart did not detect a change in infection rates as
would be expected since the control chart was
developed from the data being monitored. A u-chart
for monthly data may provide more information.
However as Figure 10 shows, such a chart for rare
infections like UTI or VAP would not be very useful
since many months would have infection rates of 0.
The counted data CUSUM chart does provide an
early warning and can track small changes effec-
tively. However, it is slightly more complicated to
build, understand, and explain. Moreover, it is very
sensitive to the selection of k and h parameter values,
which affects the usability of this chart. Also, as one
can see in Figure 5, the CUSUM chart shows out-of-
control signals only in February and April 2006 while
actually the months preceding February 2006 have
higher infection rates. This is counterintuitive to the
user and not the preferred option.
The g-type control chart is simple to construct; it
can quickly point out the years in which the number
of infections is low; and it can quickly indicate long
periods having no infection occurrences. However,
the g-charts are not very helpful in detecting
increased rates of infection.
Childrens Hospital can certainly improve their
infection monitoring practices. The simplest and
effective way to achieve that would be the use of
u-chart as it would take into account the changing
number of patient, line, and ventilator days. For
FIGURE 9 U-type control charts for quarterly rates of BSI, UTI, and VAP infections.
S. S. Limaye et al. 410
monitoring overall infection rates and BSI, a u-chart
based on monthly infection rates would be more
effective, whereas for UTI and VAP, a u-chart based
on quarterly infection rates would be more suitable.
One of the disadvantages for the control charts
discussed is that they do not account for the differ-
ences between patients. Patients differ on their sever-
ity of illness, so it is expected that this variability
affects a patients likelihood of contracting a hospi-
tal-acquired infection. Risk-adjusted control charts
aim to address this issue by accounting for the vul-
nerability of a patient to infections (Alemi and Oliver,
2001). The vulnerability is established by key clinical
findings, diagnosis codes, or by consensus among
clinicians. The expected rate of infection is calcu-
lated using logistic regression to determine the
expected probability of an infection for each individ-
ual patient and then averaging these to calculate the
expected rate of infection for the period. The control
chart monitors the observed rate of infections versus
their expected rate.
In practice, an index to account for patient con-
dition is difficult to determine because the existing
methods are subjective. Unless a credible system to
compute the vulnerability of a patient for the specific
infection is developed, it may not be practical to use
risk-adjusted control charts. The data used in this
article do not provide information regarding the
vulnerability of each patient for different type of
infection so it is not possible to include this chart
in this case study or use it in most healthcare applica-
tions either.
ABOUT THE AUTHORS
Shreyas S. Limaye is a doctoral candidate at the
University of Washington, Seattle, and Advanced
Process Control Engineer at the Hitachi Global
Storage Technology, San Jose, CA. His professional
and research interests include applications of com-
plex system modeling, statistical analysis and process
control in healthcare, semiconductor manufacturing
FIGURE 10 U-type control charts for monthly rates of BSI, UTI, and VAP infections.
411 Monitoring Hospital-Associated Infections
and transportation logistics. He is a member of
INFORMS and IIE.
Dr. Christina M. Mastrangelo is an Associate
Professor of industrial engineering at the University
of Washington. She holds a BS, MS and PhD
degrees in Industrial Engineering from Arizona State
University. Prior to joining UW in 2002, she was an
Associate Professor of systems and information
engineering at the University of Virginia.
Dr. Danielle M. Zerr is an Associate Professor of
pediatric infectious diseases at the University of
Washington and the Medical Director of infection
control at Seattle Childrens Hospital.
REFERENCES
AHRQ. (2001). Making Health Care Safer: A Critical Analysis of Patient
Safety Practices. Rockville, MD: Agency for Healthcare Research and
Quality. Evidence Report=Technology Assessment: Number 43, AHRQ
Publication No. 01-E058. Available at http://www.ahrq.gov/clinic/
ptsafety/, accessed August 2008.
Alemi, F., Oliver, D. W. (2001). Tutorial on risk-adjusted P-charts. Quality
Management in Health Care, 10:19.
Alt, F. (2006). Multivariate Quality Control. Encyclopedia of Statistical
Sciences, 112. Available at http://www.mrw.interscience.wiley.com/
emrw/9780471667193/ess/titles?filter M, accessed August 2008.
Benneyan, J. (1998). Statistical quality control methods in infection con-
trol and hospital epidemiology, part I: Introduction and basic theory.
Infection Control and Hospital Epidemiology, 19(3):194214.
Benneyan, J. (2001a). Number-between g-type statistical control charts
for monitoring adverse events. Health Care Management Science,
4:305318.
Benneyan, J. (2001b). Performance of number-between g-type statistical
control charts for monitoring adverse events. Health Care Manage-
ment Science, 4:319336.
Benneyan, J. (2001c). Design, use, and performance of statistical control
charts for clinical process improvement. Available at http://www1.coe.
neu.edu/~benneyan/papers/intro_spc.pdf, accessed August 2008.
Carey, R. G. (2002). How do you know that your care is improving? Part II:
Using control charts to learn from your data. Journal of Ambulatory
Care Management, 25:7888.
Champion, H., Mabee, M. (2000). The coalition for American trauma care.
Washington Report, 2(6):23. Available at http://www.traumacoalition.
org/Washingtonreport.pdf, accessed May 2006.
Gustafson, T. L. (2000). Practical risk-adjusted quality control charts for
infection control. American Journal of Infection Control, 28(6):406414.
Health Protection Agency. (2003). General informationHealthcare-
associated infections. Available at http://www.camr.org.uk/webw/
HRAweb/HPAweb/&HPAwebStandard/HPAweb_C/1195733802872?p
1191942126527, accessed August 2008.
Lucas, J. (1985). Counted data CUSUMs. Technometrics, 27(2):
129144.
Matthes, M., Ogunbo, S., Pennington, G., Wood, N., Hart, M., Hart, R.
(2007). Statistical process control for hospitals: Methodology, user
education, and challenges. Quality Management in Health Care,
16(3):205214.
Montgomery, D. (2005). Introduction to Statistical Quality Control.
New York: Wiley.
Morbidity and Mortality Weekly Report. (2002). Guideline for prevention
of catheter-associated urinary tract infections, Centers for Disease
Control and Prevention. Available at http://www.cdc.gov/ncidod/
dhqplgl_catheter_assoc.html, accessed August 2008.
Morton, A., Whitby, M., McLaws, M., Dobson, A., McElwain, S., Looke, D.,
Stockelroth, J., Sartor, A., (2001). The application of statistical process
control charts to detection and monitoring of hospital-acquired infec-
tions. Journal of Quality in Clinical Practise, 21(4): 112117.
National Nosocomial Infections Surveillance Systems Report. (2004). http:
//www.cdc.gov/ncidod/dhqp/pdf/nnis/2004NNISreport.pdf, accessed
August 2008.
Smyth, E. T. M., Emmerson, A. M. (2000). Surgical site infection surveil-
lance. Journal of Hospital Infection, 45:173184.
Warren, D. K., Shukla, S. J., Olsen, M. A., Kollef, M. H., Hollenbeak, C. S.,
Cox, M. J., Cohen, M. M., Fraser, V. J. (2003). Outcome and attribu-
table cost of ventilator associated pneumonia among intensive care
unit patients in a suburban medical center. Critical Care Medicine,
31(5):13121317.
Woodall, W. (2000). Controversies and contradictions in statistical pro-
cess control. Journal of Quality Technology, 32(4):341350.
Woodall, W. (2006). The use of control charts in health-care and public-
health surveillance. Journal of Quality Technology, 38(2):89104.
APPENDIX
TABLE A1 Total Number of Infections and ICU Patient Days
Quarter
# of
Infections
Patient
days
Infections per 1000
patient days Quarter
# of
Infections
Patient
days
Infections per 1000
patient days
Q1 2002 8 1451 5.51 Q3 2004 17 1526 11.14
Q2 2002 4 1207 3.31 Q4 2004 18 1543 11.67
Q3 2002 10 1372 7.29 Q1 2005 20 1629 12.28
Q4 2002 6 1413 4.25 Q2 2005 24 1453 16.52
Q1 2003 21 1481 14.18 Q3 2005 20 1552 12.89
Q2 2003 12 1256 9.55 Q4 2005 20 1519 13.17
Q3 2003 17 1275 13.33 Q1 2006 19 1934 9.82
Q4 2003 22 1348 16.32 Q2 2006 18 1950 9.23
Q1 2004 13 1432 9.08 Q3 2006 16 2066 7.74
Q2 2004 16 1596 10.03 Q4 2006 15 1857 8.08
S. S. Limaye et al. 412
TABLE A3 Total Number of UTI and ICU Foley Catheter Days
Quarter # of UTI
Foley
catheter days
UTI per 1000
Foley catheter days Quarter # of UTI
Foley
catheter days
UTI per 1000
Foley catheter days
Q1 2002 1 778 1.28 Q3 2004 1 718 1.39
Q2 2002 1 471 2.12 Q4 2004 3 848 3.53
Q3 2002 3 625 4.80 Q1 2005 2 921 2.17
Q4 2002 1 657 1.52 Q2 2005 4 844 4.73
Q1 2003 5 801 6.24 Q3 2005 6 873 6.87
Q2 2003 2 659 3.03 Q4 2005 4 768 5.20
Q3 2003 2 689 2.90 Q1 2006 1 752 1.32
Q4 2003 5 757 6.60 Q2 2006 3 624 4.80
Q1 2004 2 599 3.33 Q3 2006 1 808 1.23
Q2 2004 2 708 2.82 Q4 2006 0 512 0
TABLE A4 Total Number of VAP and ICU Ventilator Days
Quarter # of VAP
Ventilator
days
VAP per 1000
ventilator days Quarter # of VAP
Ventilator
days
VAP per 1000
ventilator days
Q1 2002 0 586 0 Q3 2004 2 713 2.80
Q2 2002 0 405 0 Q4 2004 1 766 1.30
Q3 2002 1 692 1.44 Q1 2005 0 1023 0
Q4 2002 0 594 0 Q2 2005 0 807 0
Q1 2003 1 840 1.19 Q3 2005 0 913 0
Q2 2003 0 480 0 Q4 2005 0 739 0
Q3 2003 1 602 1.66 Q1 2006 1 749 1.33
Q4 2003 2 703 2.84 Q2 2006 0 987 0
Q1 2004 1 571 1.75 Q3 2006 1 973 1.02
Q2 2004 3 724 4.14 Q4 2006 2 722 2.77
TABLE A2 Total Number of BSI and ICU Central Line Days
Quarter # of BSI
Central
line days
BSI per 1000
central line days Quarter # of BSI
Central
line days BSI per 1000 central line days
Q1 2002 4 821 4.87 Q3 2004 3 875 3.43
Q2 2002 3 510 5.88 Q4 2004 10 1160 8.62
Q3 2002 3 775 3.87 Q1 2005 9 1250 7.20
Q4 2002 2 801 2.50 Q2 2005 8 1121 7.14
Q1 2003 3 950 3.16 Q3 2005 7 1388 5.04
Q2 2003 5 768 6.51 Q4 2005 9 1054 8.54
Q3 2003 6 835 7.19 Q1 2006 10 1147 8.72
Q4 2003 6 897 6.69 Q2 2006 6 1055 5.69
Q1 2004 7 855 8.19 Q3 2006 8 1104 7.25
Q2 2004 4 892 4.48 Q4 2006 5 882 5.67
413 Monitoring Hospital-Associated Infections