The application of statistical process control charts to the detection and monitoring of hospital-acquired infections

J Qual Clin Pract. 2001 Dec;21(4):112-7. doi: 10.1046/j.1440-1762.2001.00423.x.


The monitoring of infection control indicators including hospital-acquired infections is an established part of quality maintenance programmes in many health-care facilities. However, surveillance data use can be frustrated by the infrequent nature of many infections. Traditional methods of analysis often provide delayed identification of increasing infection occurrence, placing patients at preventable risk. The application of Shewhart, Cumulative Sum (CUSUM) and Exponentially Weighted Moving Average (EWMA) statistical process control charts to the monitoring of indicator infections allows continuous real-time assessment. The Shewhart chart will detect large changes, while CUSUM and EWMA methods are more suited to recognition of small to moderate sustained change. When used together, Shewhart and EWMA methods are ideal for monitoring bacteraemia and multiresistant organism rates. Shewhart and CUSUM charts are suitable for surgical infection surveillance.

MeSH terms

  • Australia / epidemiology
  • Bacteremia / epidemiology
  • Bacteremia / prevention & control
  • Cross Infection / epidemiology*
  • Cross Infection / prevention & control
  • Data Interpretation, Statistical*
  • Forms and Records Control
  • Hospital Administration / standards*
  • Hospital Records*
  • Humans
  • Infection Control / methods
  • Infection Control / statistics & numerical data*
  • Monitoring, Physiologic
  • Poisson Distribution
  • Population Surveillance / methods
  • Quality Indicators, Health Care
  • Surgical Wound Infection / epidemiology
  • Surgical Wound Infection / prevention & control