© 1998 Oxford University Press
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Multivariate time series analysis in nosocomial infection surveillance: a case study
aServicio de Medicina Preventiva Hospital Universitario San Carlos C/ Martin Lagos s/n, 28040 Madrid (Spain)
bDepartment of Statistics and Operations Research, Universidad Complutense Madrid, Spain
cUniversity Center for Public Health, Universidad Autonoma Madrid, Spain
BACKGROUND: The present study describes the use of time series analysis in the evaluation of the incidence of nosocomial infection. The main hypothesis analysed was that monthly occurrence of nosocomial infection in a hospital may be related to work-related factors such as the control and training of personnel imposed by a surveillance system, strikes supported by medical personnel and movement of personnel. Time series analysis was used to quantify, model and statistically evaluate these interventions.
METHODS: The data employed (March 1982-December 1990) were supplied by the nosocomial infection surveillance system of a primary-care general hospital. The monthly time series incidence of nosocomial infections (measured as percentage cumulative incidence) was analysed by curve fitting, autoregressive, integrated and moving average (ARLMA) modelling (Box-Jenkins) and intervention and dynamic regression analysis.
RESULTS: The imposed control and training of personnel by the surveillance system was associated with a 3.63% decrease in the accumulated monthly incidence of nosocomial infection from 7.82% to a baseline level of 4.19%. There was a strong indication that an increase of infection incidence of 4.34% corresponded to a medical strike. This increase was maintained over the following months raising the baseline level to 4.84%. An increase of 0.18% was associated with each new nursing contract. Evidence was obtained for the possible relationship between incidence of nosocomial infection and vacation periods.
CONCLUSIONS: The results suggest the need for strict control of the activities of hospital personnel and for the adoption of certain preventative measures during vacation periods to avoid an undesirable increase in the incidence of nosocomial infections.
Keywords Intervention studies, nosocomial infection, surveillance, time series, ARIMA models, quality control
Accepted 28 July 1997
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