Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals
To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT)...
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| Veröffentlicht in: | Infection control and hospital epidemiology 2020-04, Vol.41 (4), p.404-410 |
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| creator | Polage, Christopher R Quan, Kathleen A Madey, Keith Myers, Frank E Wightman, Debbra A Krishna, Sneha Grein, Jonathan D Gibbs, Laurel Yokoe, Deborah Mabalot, Shannon C Chinn, Raymond Hallmark, Amy Rubin, Zachary Fontenot, Michael Cohen, Stuart Birnbaum, David Huang, Susan S Torriani, Francesca J |
| description | To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15-1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, -25%; IQR, -20% to -29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%-105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, -15%; IQR, -14% to -21%) and decreased the SIR at all hospitals (median, -8%; IQR, -4% to -11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR. |
| doi_str_mv | 10.1017/ice.2020.4 |
| format | Article |
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Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15-1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, -25%; IQR, -20% to -29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%-105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, -15%; IQR, -14% to -21%) and decreased the SIR at all hospitals (median, -8%; IQR, -4% to -11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.</description><identifier>ISSN: 0899-823X</identifier><identifier>EISSN: 1559-6834</identifier><identifier>DOI: 10.1017/ice.2020.4</identifier><identifier>PMID: 32052726</identifier><language>eng</language><publisher>United States: Cambridge University Press</publisher><subject>Academic Medical Centers ; California - epidemiology ; Clostridioides difficile ; Clostridium Infections - epidemiology ; Clostridium Infections - prevention & control ; Cross Infection - epidemiology ; Cross Infection - microbiology ; Cross Infection - prevention & control ; Emergency medical care ; Health care ; Health Facilities ; Hematopoietic Stem Cell Transplantation - adverse effects ; Hematopoietic Stem Cells ; Hospitals ; Hospitals, General ; Humans ; Infections ; Intensive care ; Intensive Care Units - statistics & numerical data ; Laboratories ; Nursing ; Oncology ; Oncology Service, Hospital - statistics & numerical data ; Patient safety ; Reimbursement ; Retrospective Studies ; Risk Adjustment ; Safety ; Stem cell transplantation ; Surveillance ; Tertiary Care Centers ; Transplants</subject><ispartof>Infection control and hospital epidemiology, 2020-04, Vol.41 (4), p.404-410</ispartof><rights>2020 by The Society for Healthcare Epidemiology of America. All rights reserved</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c351t-b7b06f8fa0a84ea2f39f87d26e1dde31358e298dc24ad825b8a95938445980cb3</citedby><cites>FETCH-LOGICAL-c351t-b7b06f8fa0a84ea2f39f87d26e1dde31358e298dc24ad825b8a95938445980cb3</cites><orcidid>0000-0003-1433-6886</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2798282291/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$H</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2798282291?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>314,776,780,21367,27901,27902,33721,33722,43781,74045</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32052726$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Polage, Christopher R</creatorcontrib><creatorcontrib>Quan, Kathleen A</creatorcontrib><creatorcontrib>Madey, Keith</creatorcontrib><creatorcontrib>Myers, Frank E</creatorcontrib><creatorcontrib>Wightman, Debbra A</creatorcontrib><creatorcontrib>Krishna, Sneha</creatorcontrib><creatorcontrib>Grein, Jonathan D</creatorcontrib><creatorcontrib>Gibbs, Laurel</creatorcontrib><creatorcontrib>Yokoe, Deborah</creatorcontrib><creatorcontrib>Mabalot, Shannon C</creatorcontrib><creatorcontrib>Chinn, Raymond</creatorcontrib><creatorcontrib>Hallmark, Amy</creatorcontrib><creatorcontrib>Rubin, Zachary</creatorcontrib><creatorcontrib>Fontenot, Michael</creatorcontrib><creatorcontrib>Cohen, Stuart</creatorcontrib><creatorcontrib>Birnbaum, David</creatorcontrib><creatorcontrib>Huang, Susan S</creatorcontrib><creatorcontrib>Torriani, Francesca J</creatorcontrib><title>Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals</title><title>Infection control and hospital epidemiology</title><addtitle>Infect Control Hosp Epidemiol</addtitle><description>To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15-1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, -25%; IQR, -20% to -29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%-105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, -15%; IQR, -14% to -21%) and decreased the SIR at all hospitals (median, -8%; IQR, -4% to -11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.</description><subject>Academic Medical Centers</subject><subject>California - epidemiology</subject><subject>Clostridioides difficile</subject><subject>Clostridium Infections - epidemiology</subject><subject>Clostridium Infections - prevention & control</subject><subject>Cross Infection - epidemiology</subject><subject>Cross Infection - microbiology</subject><subject>Cross Infection - prevention & control</subject><subject>Emergency medical care</subject><subject>Health care</subject><subject>Health Facilities</subject><subject>Hematopoietic Stem Cell Transplantation - adverse effects</subject><subject>Hematopoietic Stem Cells</subject><subject>Hospitals</subject><subject>Hospitals, General</subject><subject>Humans</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Intensive Care Units - statistics & numerical data</subject><subject>Laboratories</subject><subject>Nursing</subject><subject>Oncology</subject><subject>Oncology Service, Hospital - statistics & numerical data</subject><subject>Patient safety</subject><subject>Reimbursement</subject><subject>Retrospective Studies</subject><subject>Risk Adjustment</subject><subject>Safety</subject><subject>Stem cell transplantation</subject><subject>Surveillance</subject><subject>Tertiary Care Centers</subject><subject>Transplants</subject><issn>0899-823X</issn><issn>1559-6834</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNpdklFrFDEQx1dR2rP64geQgC8i3TOb7N4mj3JUK5T6oIJvy2wy6eW6m1yTbOX66Zu91iJCYAj88ssM8y-KtxVdVrRqP1mFS0YZXdbPi0XVNLJcCV6_KBZUSFkKxn8fF69i3FJKWymro-KYM9qwlq0Wz47ObmGYIFnviDckbZBcHm4wkHOEIW0UBCQ_wGDak0tMf3y4JjGB0xC0vUNNrDOoDoIwvyTBxmsCejvFNKJLxPhANk-q0oCyg0370ruIiawHH1Ow2nqrMRJtjbEZwH-0dj4JXbS3SGbHKfFO-cFf7U9JbiTbR0h-5y0mq4jCYSApgIu7AfL_k7MpzpIrdBjyXKCmhOVhro2PO5tgiK-LlyYXfPNYT4pfX85-rs_Li-9fv60_X5SKN1Uq-7anKyMMUBA1AjNcGtFqtsJKa-QVbwQyKbRiNWjBml6AbCQXdd1IQVXPT4oPD95d8DcTxtSNNs4dg0M_xY7xpm552zY0o-__Q7d-CnkxmWqlYIIxWWXq4wOlgo8xoOl2wY4Q9l1FuzkeXY5HN8ejqzP87lE59SPqJ_RvHvg9xR29JA</recordid><startdate>202004</startdate><enddate>202004</enddate><creator>Polage, Christopher R</creator><creator>Quan, Kathleen A</creator><creator>Madey, Keith</creator><creator>Myers, Frank E</creator><creator>Wightman, Debbra A</creator><creator>Krishna, Sneha</creator><creator>Grein, Jonathan D</creator><creator>Gibbs, Laurel</creator><creator>Yokoe, Deborah</creator><creator>Mabalot, Shannon C</creator><creator>Chinn, Raymond</creator><creator>Hallmark, Amy</creator><creator>Rubin, Zachary</creator><creator>Fontenot, Michael</creator><creator>Cohen, Stuart</creator><creator>Birnbaum, David</creator><creator>Huang, Susan S</creator><creator>Torriani, Francesca J</creator><general>Cambridge University Press</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88C</scope><scope>88E</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AEUYN</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M0T</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>S0X</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-1433-6886</orcidid></search><sort><creationdate>202004</creationdate><title>Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals</title><author>Polage, Christopher R ; Quan, Kathleen A ; Madey, Keith ; Myers, Frank E ; Wightman, Debbra A ; Krishna, Sneha ; Grein, Jonathan D ; Gibbs, Laurel ; Yokoe, Deborah ; Mabalot, Shannon C ; Chinn, Raymond ; Hallmark, Amy ; Rubin, Zachary ; Fontenot, Michael ; Cohen, Stuart ; Birnbaum, David ; Huang, Susan S ; Torriani, Francesca J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c351t-b7b06f8fa0a84ea2f39f87d26e1dde31358e298dc24ad825b8a95938445980cb3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Academic Medical Centers</topic><topic>California - epidemiology</topic><topic>Clostridioides difficile</topic><topic>Clostridium Infections - epidemiology</topic><topic>Clostridium Infections - prevention & control</topic><topic>Cross Infection - epidemiology</topic><topic>Cross Infection - microbiology</topic><topic>Cross Infection - prevention & control</topic><topic>Emergency medical care</topic><topic>Health care</topic><topic>Health Facilities</topic><topic>Hematopoietic Stem Cell Transplantation - adverse effects</topic><topic>Hematopoietic Stem Cells</topic><topic>Hospitals</topic><topic>Hospitals, General</topic><topic>Humans</topic><topic>Infections</topic><topic>Intensive care</topic><topic>Intensive Care Units - statistics & numerical data</topic><topic>Laboratories</topic><topic>Nursing</topic><topic>Oncology</topic><topic>Oncology Service, Hospital - statistics & numerical data</topic><topic>Patient safety</topic><topic>Reimbursement</topic><topic>Retrospective Studies</topic><topic>Risk Adjustment</topic><topic>Safety</topic><topic>Stem cell transplantation</topic><topic>Surveillance</topic><topic>Tertiary Care Centers</topic><topic>Transplants</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Polage, Christopher R</creatorcontrib><creatorcontrib>Quan, Kathleen A</creatorcontrib><creatorcontrib>Madey, Keith</creatorcontrib><creatorcontrib>Myers, Frank E</creatorcontrib><creatorcontrib>Wightman, Debbra A</creatorcontrib><creatorcontrib>Krishna, Sneha</creatorcontrib><creatorcontrib>Grein, Jonathan D</creatorcontrib><creatorcontrib>Gibbs, Laurel</creatorcontrib><creatorcontrib>Yokoe, Deborah</creatorcontrib><creatorcontrib>Mabalot, Shannon C</creatorcontrib><creatorcontrib>Chinn, Raymond</creatorcontrib><creatorcontrib>Hallmark, Amy</creatorcontrib><creatorcontrib>Rubin, Zachary</creatorcontrib><creatorcontrib>Fontenot, Michael</creatorcontrib><creatorcontrib>Cohen, Stuart</creatorcontrib><creatorcontrib>Birnbaum, David</creatorcontrib><creatorcontrib>Huang, Susan S</creatorcontrib><creatorcontrib>Torriani, Francesca J</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Healthcare Administration Database (Alumni)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest One Sustainability</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Consumer Health Database</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Healthcare Administration Database</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>SIRS Editorial</collection><collection>MEDLINE - Academic</collection><jtitle>Infection control and hospital epidemiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Polage, Christopher R</au><au>Quan, Kathleen A</au><au>Madey, Keith</au><au>Myers, Frank E</au><au>Wightman, Debbra A</au><au>Krishna, Sneha</au><au>Grein, Jonathan D</au><au>Gibbs, Laurel</au><au>Yokoe, Deborah</au><au>Mabalot, Shannon C</au><au>Chinn, Raymond</au><au>Hallmark, Amy</au><au>Rubin, Zachary</au><au>Fontenot, Michael</au><au>Cohen, Stuart</au><au>Birnbaum, David</au><au>Huang, Susan S</au><au>Torriani, Francesca J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals</atitle><jtitle>Infection control and hospital epidemiology</jtitle><addtitle>Infect Control Hosp Epidemiol</addtitle><date>2020-04</date><risdate>2020</risdate><volume>41</volume><issue>4</issue><spage>404</spage><epage>410</epage><pages>404-410</pages><issn>0899-823X</issn><eissn>1559-6834</eissn><abstract>To evaluate the National Health Safety Network (NHSN) hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratio (SIR) risk adjustment for general acute-care hospitals with large numbers of intensive care unit (ICU), oncology unit, and hematopoietic cell transplant (HCT) patients.
Retrospective cohort study.
Eight tertiary-care referral general hospitals in California.
We used FY 2016 data and the published 2015 rebaseline NHSN HO-CDI SIR. We compared facility-wide inpatient HO-CDI events and SIRs, with and without ICU data, oncology and/or HCT unit data, and ICU bed adjustment.
For these hospitals, the median unmodified HO-CDI SIR was 1.24 (interquartile range [IQR], 1.15-1.34); 7 hospitals qualified for the highest ICU bed adjustment; 1 hospital received the second highest ICU bed adjustment; and all had oncology-HCT units with no additional adjustment per the NHSN. Removal of ICU data and the ICU bed adjustment decreased HO-CDI events (median, -25%; IQR, -20% to -29%) but increased the SIR at all hospitals (median, 104%; IQR, 90%-105%). Removal of oncology-HCT unit data decreased HO-CDI events (median, -15%; IQR, -14% to -21%) and decreased the SIR at all hospitals (median, -8%; IQR, -4% to -11%).
For tertiary-care referral hospitals with specialized ICUs and a large number of ICU beds, the ICU bed adjustor functions as a global adjustment in the SIR calculation, accounting for the increased complexity of patients in ICUs and non-ICUs at these facilities. However, the SIR decrease with removal of oncology and HCT unit data, even with the ICU bed adjustment, suggests that an additional adjustment should be considered for oncology and HCT units within general hospitals, perhaps similar to what is done for ICU beds in the current SIR.</abstract><cop>United States</cop><pub>Cambridge University Press</pub><pmid>32052726</pmid><doi>10.1017/ice.2020.4</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0003-1433-6886</orcidid><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0899-823X |
| ispartof | Infection control and hospital epidemiology, 2020-04, Vol.41 (4), p.404-410 |
| issn | 0899-823X 1559-6834 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_2354737750 |
| source | MEDLINE; ProQuest Central; Cambridge University Press Journals Complete |
| subjects | Academic Medical Centers California - epidemiology Clostridioides difficile Clostridium Infections - epidemiology Clostridium Infections - prevention & control Cross Infection - epidemiology Cross Infection - microbiology Cross Infection - prevention & control Emergency medical care Health care Health Facilities Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic Stem Cells Hospitals Hospitals, General Humans Infections Intensive care Intensive Care Units - statistics & numerical data Laboratories Nursing Oncology Oncology Service, Hospital - statistics & numerical data Patient safety Reimbursement Retrospective Studies Risk Adjustment Safety Stem cell transplantation Surveillance Tertiary Care Centers Transplants |
| title | Evaluation of the National Healthcare Safety Network standardized infection ratio risk adjustment for healthcare-facility-onset Clostridioides difficile infection in intensive care, oncology, and hematopoietic cell transplant units in general acute-care hospitals |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-12T18%3A01%3A45IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Evaluation%20of%20the%20National%20Healthcare%20Safety%20Network%20standardized%20infection%20ratio%20risk%20adjustment%20for%20healthcare-facility-onset%20Clostridioides%20difficile%20infection%20in%20intensive%20care,%20oncology,%20and%20hematopoietic%20cell%20transplant%20units%20in%20general%20acute-care%20hospitals&rft.jtitle=Infection%20control%20and%20hospital%20epidemiology&rft.au=Polage,%20Christopher%20R&rft.date=2020-04&rft.volume=41&rft.issue=4&rft.spage=404&rft.epage=410&rft.pages=404-410&rft.issn=0899-823X&rft.eissn=1559-6834&rft_id=info:doi/10.1017/ice.2020.4&rft_dat=%3Cproquest_cross%3E2798282291%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2798282291&rft_id=info:pmid/32052726&rfr_iscdi=true |