Reduction of nosocomial infections by an infection control quality management concept for surgical patients. 2. Report: No significant reduction whenstarting from a lower level of infection

In the framework of a prospective controlled study in surgical and intensiv e care units of four study and four control hospitals it was tried to set u p an infection control quality management concept for reduction of nosocomi al infections in hospital D. With an incidence density of 5.4 nosocomial in fections per 1000 patient days the most favorable situation among the four study hospitals was found initially in this hospital. However, after a smal l decrease of infection rate during the first study year, no benefit of int ervention was achieved in this hospital at the end of the study (6.4 nosoco mial infections per 1000 patient days). Possible explanations may be a very small potential for reduction at the beginning, a change of patient mix du e to a new head of the department and the phenomenon of the "regression to the mean". Distinct improvements of the situation were achieved on the leve l of process quality. Meanwhile surveillance of nosocomial infections becam e an integral part of quality management in this hospital. The quality circ le method was not well accepted for the longterm. But the concept of link n urses was introduced successfully.