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MATERIALS AND METHODS

Setting and Sample. This study was part of a larger US national patient safety study in which health care-associated infections in the ICU was an important end point. Therefore, hospitals were invited to participate through the Association for Professionals in Infection Control and Healthcare Epidemiology (APIC) listserve and through the National Nosocomial Infection Surveillance (NNIS) system. Efforts were made to have a nationally representative sample of hospitals based on bed size and region by tailoring invitations to eligible target hospitals as needed. Because it is known that smaller, nonurban hospitals are underrepresented in the NNIS system, personalized invitations were sent to these institutions with the goal of increasing the representativeness of the hospitals (7). Hospitals were invited to enroll ICUs that provided intensive observation, diagnosis, and therapeutic procedures …