Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012

Hyok Jeon Min; Hyong Kim Tae; Ran Kim Sung; Kyung Chun Hee; Ha Han Su; Hwan Bang Ji; Suk Park Eun; Young Jeong Sun; Sik Eom Joong; Keun Kim Young; Yeon Lee Kil; Jung Choi Hee; Youl Kim Hyo; Mi Kim Kyung; Sung Joohon; Uh Young; Bin Kim Hong; Chung Heoung-Soo; Kwon Jun-Wook; Hee Woo Jun

doi:10.14192/kjnic.2014.19.2.52

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Min, Tae, Sung, Hee, Su, Ji, Eun, Sun, Joong, Young, Kil, Hee, Hyo, Kyung, Joohon, Young, Hong, Heoung-Soo, Jun-Wook, and Jun: Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012

Original Article

J Nosocomial Infect Control 2013;19(2):52-63.

Published online: 3 May 2013

DOI: https://doi.org/10.14192/kjnic.2014.19.2.52

Korean Nosocomial Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2011 through June 2012

Hyok Jeon Min, Hyong Kim Tae, Ran Kim Sung, Kyung Chun Hee, Ha Han Su, Hwan Bang Ji, Suk Park Eun, Young Jeong Sun, Sik Eom Joong, Keun Kim Young, Yeon Lee Kil, Jung Choi Hee, Youl Kim Hyo, Mi Kim Kyung, Sung Joohon, Uh Young, Bin Kim Hong, Chung Heoung-Soo, Kwon Jun-Wook, Hee Woo Jun

Division of Infectious Diseases, Soonchunhyang University College of Medicine, Cheonan Hospital, Cheonan, Korea

Division of Infectious Diseases, Soonchunhyang University College of Medicine, Seouf, Korea

Infection Control Office, Korea University Guro Hospital, Seoul, Korea

Infection Control Department, Kyung Hee University Medical Center, Seoul, Korea

Infection Prevention and Control Team, Soonchunhyang University Bucheon Hospital, Bucheon, Korea

Division of Infectious Diseases, Seoul Metropolitan Boramae Hospital, Seoul, Korea

Department of Infection Control, Severance Hospital, Seoul, Korea

Department of Nursing, Konyang University College of Nursing, Daejeon, Korea

Division of Infectious Diseases, Hallym University College of Medicine Kangdong Sacred Heart Hospital, Seoul, Korea

Division of Infectious Diseases, Yonsei University Wonju College of Medicine, Wonju Sevrans Christian Hospital, Wonju, Korea

Department of General Surgery, Kyung Hee University School of Medicine, Kyung Hee Hospital, Seoul, Korea

Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea

Department of Nursing, Semyung University, Jecheon, Korea

Seoul National University School of Public Health and Institution of Health and Environment, Seoul, Korea

Department of Laboratory Medicine, Yonsei University Wonju College of Medicine, Wonju Sevrans Christian Hospital, Wonju, Korea

Division of Infectious Diseases, Seoul National University College of Medicine, Bundang Hospital, Seongnam, Korea

Korea Centers for Disease Control and Prevention, Cheongju, Korea

Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea

Address reprint requests to Tae Hyong Kim, Division of Infections Diseases, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 140-743, Korea Tel: 02-709-9194, Fax: 02-709-9083 E-mail: geuncom@schmc.ac.kr

Received 2 July 2014 Accepted 25 November 2014

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

This article reports annual data of intensive care units (ICU) module of the Korean Nosocomial Infections Surveillance (KONIS) system from July 2011 through June 2012.

Methods

We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 143 ICUs in 81 hospitals using the KONIS system. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient days or device days. Asymptomatic bacteriuria was excluded on or after October 1, 2011.

Results

A total of 3,374 NIs were found during the study period: 1,356 UTIs (1,336 cases were urinary catheter-associated), 1,253 BSIs (1,091 were central line-associated), and 765 PNEUs (481 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 2.26 cases per 1,000 device-days (95% confidence interval, 2.14-2.39) and urinary catheter utilization ratio was 0.85 (0.849-0.851). The rate of central line-associated BSIs was 3.01 (2.84-3.19) and the utilization ratio was 0.52 (0.519-0.521). The rate of ventilator-associated PNEUs (VAPs) was 1.70 (1.56-1.86) and the utilization ratio was 0.40 (0.399-0.401). Ventilator and urinary catheter utilization ratios were lower in the ICUs of hospitals with 400-699 beds than those in hospitals with 700-899 beds or more than 900 beds. Nevertheless, VAPs and CAUTIs were more common in hospitals with 400-699 beds.

Conclusion

Nosocomial infection rates were similar to the findings of those of the previous period, July 2010-July 2011. Implementation of proven infection-control strategies are needed, especially in the hospitals having fewer than 700 beds.

Keywords: Intensive care unit, KONIS, Korean Nosocomial Infections Surveillance System, Nosocomial infection

References

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Table 1.

Characteristics of hospitals and intensive care units participated in KONIS from July 2011 through June 2012

Variables	Number (%)
Characteristics of hospitals
Total No. of hospitals	81
No. of university-affiliated hospitals	59 (72.8)
No. of major teaching hospitals	63 (77.8)
No. of private hospitals	65 (80.2)
Beds size
≥900	21 (25.9)
700-899	26 (32.1)
400-699	34 (42.0)
Area
Seoul	26 (32.1)
Kangwon/Gyeonggi/Incheon	24 (29.6)
Central/South	31 (38.3)
Hospitals with special ward
Hemato-oncology	43 (53.1)
Bone marrow transplantation	32 (39.5)
Solid organ transplantation	17 (20.9)
Hemodialysis	79 (97.5)
Composition ICUs
Total No. of ICUs	143
Medical ICU	60 (42.0)
Medical combined ICU	28 (19.6)
Surgical combined ICU	12 (8.4)
Surgical ICU	20 (14.0)
Neurosurgical ICU	23 (16.0)
Duration of Surveillance
3 months	10 (7.0)
6 months	24 (16.8)
9 months	5 (3.5)
12 months	104 (72.7)

Abbreviations: No., number; ICU, intensive care unit.

Table 2.

Pooled means of nosocomial infection rates, by number of hospital beds, July 2011 through June 2012

Nosocomial infection rate	No. of hospital beds
Nosocomial infection rate	≥900	700-899	400-699	All
No. of units	40	49	54	143
Patient-days	193,650	254,558	250,387	698,595
Infection rate*
No. of infections	926	1,279	1,169	3,374
Pooled mean	4.78	5.02	4.67	4.83
95% CI	4.48-5.10	4.76-5.31	4.41-4.94	4.67-5.00
UTI rate^†
No. of UTI	301	520	535	1,356
Pooled mean	1.55	2.04	2.14	1.94
95% CI	1.39-1.74	1.87-2.23	1.96-2.33	1.84-2.05
BSI rate^‡
No. of BSI	426	461	366	1,253
Pooled mean	2.20	1.81	1.46	1.79
95% CI	2.00-2.42	1.65-1.98	1.32-1.62	1.70-1.90
PNEU rate^§
No. of PNEU	199	298	268	765
Pooled mean	1.03	1.17	1.07	1.10
95% CI	0.89-1.18	1.05-1.31	0.95-1.21	1.02-1.18

*(No. of UTIs, BSIs, or PNEUs/No. of patient-days)×1,000; ^†(No. of UTIs/No. of patient-days)×1,000; ^‡(No. of BSIs/No. of patient-days)×1,000; ^§(No. of PNEUs/No. of patient-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 3.

Pooled means and percentiles of the distribution of device- associated infection rates, by number of hospital beds, July 2011 through June 2012

Urinary catheter-associated UTI rate*
No. of hospital beds	No. of units	No. of UTI	Urinary catheter-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	298	170,599	1.75	1.56-1.96	0	0	0.89	2.55	5.16
700-899	49	516	217,707	2.37	2.17-2.58	0	0	1.49	3.48	5.79
400-699	54	522	202,487	2.58	2.37-2.81	0	0.57	1.72	3.86	6.20
All	143	1,336	590,793	2.26	2.14-2.39	0	0	1.45	3.39	5.61
Central line-associated BSI rate^†
No. of hospital beds	No. of units	No. of BSI	Central line-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	395	122,967	3.21	2.91-3.55	0	0	2.07	3.83	7.32
700-899	49	396	135,151	2.93	2.66-3.23	0	1.15	2.42	4.04	6.53
400-699	54	300	104,458	2.87	2.56-3.22	0	0	1.96	4.03	6.64
All	143	1,091	362,576	3.01	2.84-3.19	0	0	2.17	4.01	6.64
Ventilator-associated PNEU rate^‡
No. of hospital beds	No. of units	No. of PNEU	Ventilator-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	129	93,359	1.38	1.16-1.64	0	0	0.70	2.41	4.70
700-899	49	175	102,007	1.72	1.48-1.99	0	0	0.81	2.64	5.74
400-699	54	177	87,106	2.03	1.75-2.35	0	0	0	3.45	7.19
All	143	481	282,472	1.70	1.56-1.86	0	0	0.59	2.87	5.96

*(No. of urinary catheter-associated UTIs/No. of urinary catheter-days)×1,000; ^†(No. of central line-associated BSIs/No. of central line-days)×1,000; ^‡(No. of ventilator-associated PNEUs/No. of ventilator-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 4.

Pooled means and percentiles of the distribution of device- utilization ratios, by number of hospital beds, July 2011 through June 2012

Urinary catheter utilization ratio*
No. of hospital beds	No. of units	Urinary catheter-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	170,599	193,650	0.88	0.879-0.881	0.79	0.84	0.89	0.94	0.97
700-899	49	217,707	254,558	0.86	0.859-0.861	0.73	0.79	0.87	0.94	0.98
400-699	54	202,487	250,387	0.81	0.808-0.812	0.66	0.74	0.83	0.90	0.96
All	143	590,793	698,595	0.85	0.849-0.851	0.71	0.78	0.86	0.93	0.97
Central line utilization ratio^†
No. of hospital beds	No. of units	Central line-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	122,967	193,650	0.63	0.628-0.632	0.42	0.50	0.64	0.79	0.90
700-899	49	135,151	254,558	0.53	0.528-0.532	0.33	0.43	0.54	0.66	0.75
400-699	54	104,458	250,387	0.42	0.418-0.422	0.23	0.31	0.42	0.52	0.60
All	143	362,576	698,595	0.52	0.519-0.521	0.30	0.40	0.51	0.65	0.79
Ventilator utilization ratio^‡
No. of hospital beds	No. of units	Ventilator-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
≥900	40	93,359	193,650	0.48	0.478-0.482	0.24	0.32	0.48	0.63	0.74
700-899	49	102,007	254,558	0.40	0.398-0.402	0.24	0.30	0.37	0.49	0.65
400-699	54	87,106	250,387	0.35	0.348-0.352	0.14	0.23	0.33	0.43	0.54
All	143	282,472	698,595	0.40	0.399-0.401	0.20	0.28	0.38	0.51	0.65

*No. of urinary catheter-days/No. of patient-days; ^†No. of central line-days/No. of patient-days; ^‡No. of ventilator-days/No. of patient-days.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 5.

Pooled means and percentiles of the distribution of device- associated infection rates, by type of ICU, July 2011 through June 2012

Urinary catheter-associated UTI rate*
Type of ICU	No. of units	No. of UTI	Urinary catheter-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	507	251,633	2.01	1.85-2.20	0	0	1.11	2.87	5.18
MCICU	28	264	121,860	2.17	1.92-2.44	0	0.68	1.53	2.99	5.29
SCICU	12	130	57,205	2.27	1.91-2.70	0	0.83	1.68	3.20	5.44
SICU	20	197	78,901	2.50	2.17-2.87	0	0	1.22	3.35	7.16
NSICU	23	238	81,194	2.93	2.58-3.33	0	0.74	2.47	5.04	6.00
Central line-associated BSI rate^†
Type of ICU	No. of units	No. of BSI	Central line-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	488	162,087	3.01	2.76-3.29	0	0.15	2.12	4.08	6.70
MCICU	28	224	72,617	3.08	2.71-3.52	0	0	2.44	4.24	6.50
SCICU	12	85	33,705	2.52	2.04-3.12	0	0	2.34	3.50	6.49
SICU	20	179	52,462	3.41	2.95-3.95	0	0	2.08	3.53	6.20
NSICU	23	115	41,705	2.76	2.30-3.31	0	0	1.84	3.74	7.64
Ventilator-associated PNEU rate^‡
Type of ICU	No. of units	No. of PNEU	Ventilator-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	136	144,082	0.94	0.80-1.12	0	0	0	1.54	3.13
MCICU	28	109	54,249	2.01	1.67-2.42	0	0	1.20	3.61	6.14
SCICU	12	75	22,018	3.41	2.72-4.27	0	0	2.64	6.06	8.89
SICU	20	66	35,110	1.88	1.48-2.39	0	0	0	2.70	6.50
NSICU	23	95	27,013	3.52	2.88-4.30	0	0	2.63	4.90	10.63

Abbreviations: ICU, intensive care unit; MICU, medical ICU; MCICU, medical combined ICU; SCICU, surgical combined ICU; SICU, surgical ICU; NSICU, neurosurgical ICU; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 6.

Pooled means and percentiles of the distribution of device- utilization ratios, by type of ICU, July 2011 through June 2012

Urinary catheter utilization ratio*
Type of ICU	No. of units	Urinary catheter-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	251,633	305,525	0.82	0.819-0.821	0.67	0.75	0.84	0.89	0.95
MCICU	28	121,860	145,560	0.84	0.838-0.842	0.72	0.77	0.85	0.92	0.95
SCICU	12	57,205	63,884	0.90	0.898-0.902	0.75	0.86	0.93	0.95	0.98
SICU	20	78,901	92,047	0.86	0.858-0.862	0.65	0.81	0.89	0.95	0.98
NSICU	23	81,194	91,579	0.89	0.888-0.892	0.78	0.83	0.91	0.98	0.99
Central line utilization ratio^†
Type of ICU	No. of units	Central line-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	162,087	305,525	0.53	0.528-0.532	0.31	0.41	0.51	0.68	0.78
MCICU	28	72,617	145,560	0.50	0.497-0.503	0.30	0.38	0.45	0.62	0.83
SCICU	12	33,705	63,884	0.53	0.526-0.534	0.28	0.45	0.56	0.64	0.67
SICU	20	52,462	92,047	0.57	0.567-0.573	0.30	0.42	0.57	0.79	0.90
NSICU	23	41,705	91,579	0.46	0.457-0.463	0.27	0.33	0.48	0.58	0.65
Ventilator utilization ratio^‡
Type of ICU	No. of units	Ventilator-days	Patient-days	Pooled mean	95% CI	10‰	25‰	50‰	75‰	90‰
MICU	60	144,082	305,525	0.47	0.468-0.472	0.26	0.38	0.46	0.59	0.69
MCICU	28	54,249	145,560	0.37	0.368-0.372	0.19	0.26	0.36	0.46	0.60
SCICU	12	22,018	63,884	0.34	0.336-0.344	0.22	0.28	0.34	0.38	0.53
SICU	20	35,110	92,047	0.38	0.377-0.383	0.12	0.23	0.32	0.51	0.67
NSICU	23	27,013	91,579	0.29	0.287-0.293	0.18	0.23	0.28	0.34	0.42

*No. of urinary catheter-days/No. of patient-days; ^†No. of central line-days/No. of patient-days; ^‡No. of ventilator-days/No. of patient-days.

Table 7.

Number (%) of microorganisms isolated from clinical specimens of patients with nosocomial infections

Organism	No. of isolates
Organism	SUTI	ASB	UTI	BSI	PNU3	PNU2	PNU1	PNEU	All
Gram-positive cocci (%)	251	64	315	702	1	24	213	238	1255
	(23.9)	(17.4)	(22.2)	(52.9)	(20.0)	(29.3)	(33.6)	(33.0)	(36.2)
Staphylococcus aureus	45	9	54	231	1	15	200	216	501
Coagulase-negative staphylococci	32	6	38	199	0	3	3	6	243
Streptococcus pneumoniae	0	0	0	4	0	0	0	0	4
Streptococcus species	2	3	5	11	0	0	4	4	20
Enterococcus faecalis	77	24	101	77	0	2	2	4	182
Enterococcus faecium	93	22	115	177	0	3	4	7	299
Enterococcus species	0	0	0	1	0	1	0	1	2
Others	2	0	2	2	0	0	0	0	4
Gram-positive bacilli (%)	4	3	7	11	0	1	1	2	20
	(0.4)	(0.8)	(0.5)	(0.8)	(0)	(1.2)	(0.2)	(0.3)	(0.6)
Corynebacterium species	3	3	6	3	0	1	1	2	11
Others	1	0	1	8	0	0	0	0	9
Gram-negative bacilli (%)	408	118	526	408	3	53	415	471	1405
	(38.9)	(32.2)	(37.1)	(30.8)	(60.0)	(64.6)	(65.4)	(65.3)	(40.6)
Escherichia coli	126	37	163	27	0	2	9	11	201
Klebsiella pneumoniae	59	21	80	53	0	6	69	75	208
Klebsiella species	3	0	3	4	0	0	1	1	8
Enterobacter cloacae	14	7	21	19	0	1	17	18	58
Enterobacter aerogenes	7	5	12	6	0	1	16	17	35
Enterobacter species	4	1	5	6	0	0	0	0	11
Serratia marcescens	16	5	21	22	0	0	6	6	49
Proteus mirabilis	17	1	18	2	0	1	2	3	23
Proteus vulgaris	2	0	2	0	0	0	0	0	2
Citrobacter freundii	4	1	5	4	0	0	0	0	9
Citrobacter species	2	2	4	3	0	0	1	1	8
Morganella morganii	3	1	4	1	0	1	1	2	7
Providencia species	0	0	0	0	0	0	0	0	0
Pseudomonas aeruginosa	97	22	119	40	0	9	70	79	238
Pseudomonas species	2	1	3	13	0	2	1	3	19
Acinetobacter baumannii	42	9	51	166	2	27	204	233	450
Acinetobacter species	0	3	3	5	0	0	0	0	8
Burkholderia cepacia	0	0	0	0	0	0	0	0	0
Stenotrophomonas maltophilia	1	0	1	23	1	3	12	16	40
Others	9	2	11	14	0	0	6	6	31
Anaerobes (%)	3	0	3	10	0	0	0	0	13
	(0.3)	(0)	(0.2)	(0.7)	(0)	(0)	(0)	(0)	(0.4)
Fungi (%)	383	182	565	196	1	4	5	10	771
	(36.5)	(49.6)	(40.0)	(14.8)	(20.0)	(4.9)	(0.8)	(1.4)	(22.2)
Candida albicans	147	59	206	82	0	1	4	5	293
Candida tropicalis	76	39	115	40	0	0	0	0	155
Candida glabrata	39	12	51	14	0	0	0	0	65
Candida parapsilosis	11	5	16	35	0	0	0	0	51
Candida species	67	28	95	14	0	1	0	1	110
Cryptococcus species	1	0	1	3	0	0	0	0	4
Trichosporon asahii	12	13	25	0	0	1	0	1	26
Yeast	27	24	51	6	0	0	1	1	58
Others	3	2	5	2	1	1	0	2	9
Total	1049	367	1416	1327	5	82	634	721	3464

Table 8.

Susceptibilities of major pathogens isolated from patients with nosocomial infections

Organism	No. of resistant/total isolates (%)
Methicillin-resistant Staphylococcus aureus	443/497 (89.1)
Vancomycin-resistant Enterococcus faecalis	4/179 (2.2)
Vancomycin-resistant Enterococcus faecium	151/296 (51.0)
Cefotaxime-resistant Escherichia coli	95/193 (49.2)
Cefotaxime-resistant Klebsiella pneumoniae	115/194 (59.3)
Ciprofloxacin-resistant Escherichia coli	46/87 (52.9)
Ciprofloxacin-resistant Klebsiella pneumoniae	48/98 (49.0)
Imipenem-resistant Pseudomonas aeruginosa	86/236 (36.4)
Imipenem-resistant Acinetobacter baumannii	377/434 (86.9)

Table 9.

Comparison of the device utilization ratios and the rates of device-associated infections from 2007 through 2012

Parameter	July 2007-June 2008	July 2008-June 2009	July 2009-June 2010	July 2010-June 2011	July 2011-June 2012
No. of hospitals	56	57	63	72	81
No. of units	96	101	116	130	143
Patient-days	367,352	435,035	518,620	585,325	698,595
Device-days
Urinary catheter-days	308,279	369,476	446,612	503,365	590,793
Central line-days	199,169	243,882	289,380	309,500	362,576
Ventilator-days	143,475	179,803	209,858	233,640	282,472
No. of infections
Urinary catheter-associated UTI	1,365	1,772	2,119	1,949	1,366
Central line-associated BSI	563	797	948	932	1,091
Ventilator-associated PNEU	357	335	410	410	481
Device utilization ratio (95% CI) [range*]
Urinary catheter	0.84	0.85	0.86	0.86	0.85
	(0.839-0.841)	(0.849-0.851)	(0.859-0.861)	(0.859-0.861)	(0.849-0.851)
	[0.70-0.96]	[0.71-0.96]	[0.73-0.96]	[0.73-0.97]	[0.71-0.97]
Central line	0.54	0.56	0.56	0.53	0.52
	(0.538-0.542)	(0.559-0.561)	(0.559-0.561)	(0.529-0.531)	(0.519-0.521)
	[0.33-0.85]	[0.35-0.83]	[0.35-0.82]	[0.31-0.81]	[0.30-0.79]
Ventilator	0.39	0.41	0.41	0.40	0.40
	(0.388-0.392)	(0.409-0.411)	(0.409-0.411)	(0.399-0.401)	(0.399-0.401)
	[0.21-0.63]	[0.21-0.64]	[0.19-0.62]	[0.19-0.61]	[0.20-0.65]
Rate per 1,000 device-days (95% CI) [range*]
Urinary catheter-associated UTI	4.43	4.80	4.75	3.87	2.26
	(4.20-4.67)	(4.58-5.03)	(4.55-4.95)	(3.70-4.05)	(2.14-2.39)
	[1.10-7.49]	[1.08-8.13]	[1.14-8.40]	[0-8.80]	[0-5.61]
Central line-associated BSI	2.83	3.27	3.28	3.01	3.01
	(2.61-3.07)	(3.05-3.51)	(3.07-3.49)	(2.82-3.21)	(2.84-3.19)
	[0-6.34]	[0.73-5.84]	[0.68-5.61]	[0-6.92]	[0-6.64]
Ventilator-associated PNEU	2.49	1.86	1.95	1.75	1.70
	(2.25-2.76)	(1.67-2.07)	1.77-2.15	1.59-1.93	1.56-1.86
	[0-10.31]	[0-4.75]	[0-6.33]	[0-5.88]	[0-5.96]

Abbreviations: ICU, intensive care unit; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

*10th to 90th percentile range.

Table 10.

Comparison of the results of validation studies of Korean Nosocomial Infections Surveillance System (KONIS) with those of National Healthcare Safety Network (NHSN)

Nosocomial infection	Sensitivity(%)	Specificity(%)	PPV(%)	NPV(%)
UTI
KONIS 2008	93	100
KONIS 2010	88.4	97.7	88.5	97.7
BSI
NHSN	85.0	98.3	87.0
KONIS 2008	87.0	100
KONIS 2010	90.6	98.6	87.9	98.9
PNEU
NHSN	68.0	98.0	89.0
KONIS 2008	71.4	98.6	78.9	97.9
KONIS 2010	55.6	99.3	71.4	98.7
KONIS 2012	91.7	100	100	97.7

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; PPV, positive predictive value; NPV, negative predictive value.

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