Device Utilization Ratios Research Articles

Device-Associated Infection Rates, Device Utilization, and Antimicrobial Resistance in Long-Term Acute Care Hospitals Reporting to the National Healthcare Safely Network, 2010

To evaluate national data on healthcare-associated infections (HAIs), device utilization, and antimicrobial resistance in long-term acute care hospitals (LTACHs). Comparison of data from LTACHs and from medical and medical-surgical intensive care units (ICUs) in short-stay acute care hospitals reporting to the National Healthcare Safety Network (NHSN) during 2010. Rates of central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and ventilator-associated pneumonia (VAP) as well as device utilization ratios were calculated. For each HAI, pathogen profiles and antimicrobial resistance prevalence were evaluated. Comparisons were made using Poisson regression and the mood median and χ2 tests. In 2010, 104 LTACHs reported CLABSIs and 57 reported CAUTIs and VAP to the NHSN. Median CLABSI rates in LTACHs (1.25 events per 1,000 device-days reported; range, 0.0-5.96) were comparable to rates in major teaching ICUs and were higher than those in other ICUs. CAUTI rates in LTACHs (median, 2.61; range, 0.0-9.92) were higher and VAP rates (median, 0.0; range, 0.0-3.29) were generally lower than those in ICUs. Central line utilization in LTACHs was higher than that in ICUs, whereas urinary catheter and ventilator utilization was lower. Methicillin resistance among Staphylococcus aureus CLABSIs (83%) and vancomycin resistance among Enterococcus faecalis CAUTIs (44%) were higher in LTACHs than in ICUs. Multidrug resistance among Pseudomonas aeruginosa CAUTIs (25%) was higher in LTACHs than in most ICUs. CLABSIs and CAUTIs associated with multidrug-resistant organisms present a challenge in LTACHs. Continued HAI surveillance with pathogen-level data can guide prevention efforts in LTACHs.

Evaluation of Healthcare-Associated Infection Surveillance in Pennsylvania Hospitals

In Pennsylvania, reporting of healthcare-associated infections (HAIs) was mandated in 2007, and hospitals were encouraged to implement qualified electronic surveillance (QES) systems to assist HAI detection. This study evaluated the usefulness of these systems in reducing HAIs. Online survey and retrospective cohort study. Eligible facilities had a QES or manual system in place for the entire study period and sufficient data in selected hospital units. Surveys were sent to infection preventionists (IPs) in all Pennsylvania hospitals to gather qualitative information about their systems. National Healthcare Safety Network data from Pennsylvania hospitals for July 2008 through June 2010 were used to compare catheter-associated urinary tract infection (CAUTI) rates in facilities with and without a QES system. IPs from 174 facilities responded to the survey. Data from 119 of 234 hospitals were analyzed. IPs in facilities with a QES system reported spending as much time on data management and education as IPs in hospitals with manual surveillance. Significant interaction was observed in CAUTI rates over time between groups of facilities with and without a QES system after controlling for device-utilization ratio, location within hospital, and licensed bed size (P < .01). QES hospitals showed a significant decline in CAUTI rates (P < .01) manual surveillance facilities showed no change in rates (P > .05). Over the 2-year period, a significant decline in CAUTI rates was observed in facilities with a QES system. This suggests that electronic systems may aid in reducing HAI rates. Additional data are needed to see whether these improvements and trends persist.

Device associated infection in medical surgical intensive care unit inpatients of an A level, tertiary class hospital in Beijing

To understand the situation of the device-associated infection (DAI) in the medical-surgical intensive care unit(ICU)inpatients in an A-level tertiary class hospital in Beijing. DAI date were collected through a surveillance on the medical-surgical ICU inpatients in an A-level tertiary class hospital in Beijing from January 2008 to December 2010. In 2279 patients admitted to the medical-surgical ICU (with a 15,332 days total hospitalization stay), 283 were found infected. The incidence for in-hospital infection was 12.42%, and 2.452% for the incidence per patient-day. The device utilization ratios for ventilator, central venous catheter and urinary catheter were 56.76%, 59.01% and 80.07% respectively while the incidence for ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLABSI) and catheter-associated urinary tract infection (CAUTI) were 1.632%, 0.409% and 0.350% respectively. The predominant bacteria species found in these cases were Gram-negatives and the main stay of pathogenic species were A. baumannii, P. aeruginosa, Staphylococcus, E. coli, K. pneumoniae and C. albicans etc. The incidence of DAI in the surveyed hospital is close to other hospitals in China and other developing countries but higher than hospitals in United States. More efforts should be made for its prevention / control by hospital stuff, with the cooperation from the patients.

Reporting Catheter-Associated Urinary Tract Infections: Denominator Matters

To evaluate two different methods of measuring catheter-associated urinary tract infection (CAUTI) rates in the setting of a quality improvement initiative aimed at reducing device utilization. Comparison of CAUTI measurements in the context of a before-after trial of acute care adult admissions to a multicentered healthcare system. CAUTIs were identified with an automated surveillance system, and device-days were measured through an electronic health record. Traditional surveillance measures of CAUTI rates per 1,000 device-days (R1) were compared with CAUTI rates per 10,000 patient-days (R2) before (T1) and after (T2) an intervention aimed at reducing catheter utilization. The device-utilization ratio declined from 0.36 to 0.28 between T1 and T2 (P = .001), while infection rates were significantly lower when measured by R2 (28.2 vs 23.2, P = .02). When measured by R1, however, infection rates trended upward by 6% (7.79 vs. 8.28, P = .47), and at the nursing unit level, reduction in device utilization was significantly associated with increases in infection rate. The widely accepted practice of using device-days as a method of risk adjustment to calculate device-associated infection rates may mask the impact of a successful quality improvement program and reward programs not actively engaged in reducing device usage.

Electronic Algorithmic Prediction of Central Vascular Catheter Use

To develop prediction algorithms for the presence of a central vascular catheter in hospitalized patients with use of data present in an electronic health record. Such algorithms could be used for measurement of device utilization rates and for clinical decision support rules. Criterion standard. John H. Stroger, Jr, Hospital of Cook County, a 464-bed public hospital in Chicago, Illinois. Patients admitted to the medical intensive care unit from May 31, 2005 through June 26, 2006 (derivation data set, May 31, 2005-September 28, 2005; validation data set, September 29, 2005-June 28, 2006). Covariates were collected from the electronic medical record for each patient; the outcome variable was presence of a central vascular device. Multivariate models were developed using the derivation set and the generalized estimating equation. Three models, each with increasing database requirements, were validated using the validation set. Device utilization ratios and performance characteristics were calculated. Although Charlson score and duration of intensive care unit stay were significant predictors in all models, factors that indicated use or presence of a central line were also important. Device utilization rates derived from the algorithmic models were as accurate as those obtained using manual sampling. Automated calculation of central vascular catheter use is both feasible and accurate, providing estimates statistically similar to those obtained using manual surveillance. Prediction modeling of central vascular catheter use may enable automated surveillance of bloodstream infections and enhance important prevention interventions, such as timely removal of unnecessary central lines.

Evaluation of Device Associated Infection Rates in Intensive Care Units of Pamukkale University Hospital

Intensive care units (ICUs) are unfortunately the epicenters of nosocomial infections. The aim of the study was to investigate device associated infection rates in a small Turkish hospital. Device utilization ratios and device associated infection rates were calculated according to definitions of the Centers for Disease Control (CDC). During a period of 24 months 1,387 patients were surveyed in our ICUs. A total of 287 device associated infections were detected. In our study ventilator associated pneumonia was the most frequent nosocomial infection with a rate of 59.7 per 1,000 ventilator days. The most frequent pathogen of device associated infection was Candida spp. High rates of device associated infections in a small Turkish hospital clearly indicate the urgent need of the implementation of infection control guidelines.

Epidemiology of hospital-acquired bloodstream infections in a Tunisian pediatric intensive care unit: A 2-year prospective study

There are few data providing rates of nosocomial bloodstream infections (NBI) in pediatric intensive care patients from developing regions of the world. To describe the epidemiology of NBI in a Tunisian pediatric intensive care unit (PICU). A prospective surveillance study from January 2004 through December 2005 was performed in the PICU of the Children's Hospital of Tunis. All patients who remained in the PICU for more than 48 hours were included. Centers for Disease Control and Prevention criteria were applied for the diagnosis of NBI. Six hundred forty-seven patients aged 0 to 15 years were included. Forty-one NBIs occurred in 38 patients. The NBI rate was 7/1000 patient days (6.3/100 admissions). Twenty-seven NBIs (66%) occurred in patients with central venous catheter (CVC). CVC-associated infection rate was 14.8 per 1000 catheter days. Gram-negative rods were involved in 53.6% of NBIs. The most common organisms causing NBIs were Staphylococcus aureus (26.8%), Klebsiella pneumoniae (19.5%) and Coagulase-negative staphylococci (17%). Staphylococcus aureus was methicillin-resistant in 9.1% of cases. Eighty-seven percent of Klebsiella pneumoniae isolates had extended-spectrum beta-lactamases. The PICU crude mortality rate of infected patients was 42% (versus 5.9% in noninfected patients; P< .001). Multivariate logistic regression analyses demonstrated device utilization ratio greater than 1 (odds ratio [OR]=8.46; 95% confidence interval [CI] 3.11-23; P< .001) and previous colonization with multidrug resistant gram-negative rods (OR=2; 95% CI 1.39-2.89; P< .001) significantly related to NBI. Considering the high incidence of NBI resulted from multiple drug-resistant gram-negative rods in our center, implementation of improved infection control practices is required.

Catheter-associated bloodstream infections in general medical patients outside the intensive care unit: a surveillance study.

To determine the incidence of central venous catheter (CVC)-associated bloodstream infection (CA-BSI) among patients admitted to general medical wards outside the intensive care unit (ICU). Prospective cohort study performed over a 13-month period, from April 1, 2002, through April 30, 2003. Four selected general medical wards at Barnes-Jewish Hospital, a 1,250-bed teaching hospital in Saint Louis, Missouri. PATIENTS; All patients admitted to 4 general medical wards. A total of 7,337 catheter-days were observed during 33,174 patient-days. The device utilization ratio (defined as the number of catheter-days divided by the number of patient-days) was 0.22 overall and was similar among the 4 wards (0.21, 0.25, 0.19, and 0.24). Forty-two episodes of CA-BSI were identified (rate, 5.7 infections per 1,000 catheter-days). Twenty-four (57%) of the 42 cases of CA-BSI were caused by gram-positive bacteria: 10 isolates (24%) were coagulase-negative staphylococci, 10 (24%) were Enterococcus species, and 3 (7%) were Staphylococcus aureus. Gram-negative bacteria caused 7 infections (17%). Five CA-BSIs (12%) were caused by Candida albicans, and 5 infections (12%) had a polymicrobial etiology. Thirty-five patients (83%) with CA-BSI had nontunneled CVCs in place. Non-ICU medical wards in the study hospital had device utilization rates that were considerably lower than those of medical ICUs, but CA-BSI rates were similar to CA-BSI rates in medical ICUs in the United States. Studies of catheter utilization and on CVC insertion and care should be performed on medical wards. CA-BSI prevention strategies that have been used in ICUs should be studied on medical wards.

Device-Associated Nosocomial Infection Rates in Turkish Medical-Surgical Intensive Care Units

To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates. Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions. Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey. All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission. Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter-days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line-days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases). We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.

Nosocomial infections in a Dutch neonatal intensive care unit: surveillance study with definitions for infection specifically adapted for neonates

The incidence of nosocomial infection in neonatal intensive care units (NICUs) is high compared with other wards. However, no definitions for hospital-acquired infection are available for NICUs. The aim of this study was to measure the incidence of such infections and to identify risk factors in the NICU of the VU University Medical Center, which serves as a level III regional NICU. For this purpose, a prospective surveillance was performed in 1998-2000. We designed definitions by adjusting the current definitions of the Centers for Disease Control and Prevention (CDC) for children <1 year of age. Birth weight was stratified into four categories and other baseline risk factors were dichotomized. Analysis of risk factors was performed by Cox regression with time-dependent variables. The relationship between the Clinical Risk Index for Babies (CRIB) and nosocomial infection was investigated. Furthermore, for a random sample of cases, we determined whether bloodstream infection and pneumonia would also have been identified with the CDC definitions. Seven hundred and forty-two neonates were included in the study. One hundred and ninety-one neonates developed 264 infections. Bloodstream infection (N=138, 14.9/1000 patient-days) and pneumonia (N=69, 7.5/1000 patient-days) were the most common infections. Of bloodstream infections, 59% were caused by coagulase-negative staphylococci; in 21% of neonates, blood cultures remained negative. In 25% of pneumonias, Enterobacteriaceae were the causative micro-organisms; 26% of cultures remained negative. Compared with the Nosocomial Infections Surveillance System (NNIS) of the CDC, our device utilization ratios and device-associated nosocomial infection rates were high. The main risk factors for bloodstream infection were birth weight [hazard ratio (HR) 1.79, 95% confidence interval (CI) 1.45-2.17] and parenteral feeding with hospital-pharmacy-produced, all-in-one mixture 'Minimix' (HR 3.69, 95%CI 2.03-6.69); administration of intravenous antibiotics (HR 0.39, 95%CI 0.26-0.56) was a protective risk factor. The main risk factors for pneumonia were low birth weight (HR 1.37, 95%CI 1.01-1.85) and mechanical ventilation (HR 9.69, 95%CI 4.60-20.4); intravenous antibiotics were protective (HR 0.37, 95%CI 0.21-0.64). In a subcohort of 232 very-low-birthweight neonates, the CRIB was not predictive for infection. With the CDC criteria, only 75% (21/28) of bloodstream infections and 87.5% of pneumonias (21/24) would have been identified. In conclusion, our local nosocomial infection rates are high compared with those of NICUs participating in the NNIS. This can be partially explained by: (1) the use of our definitions for nosocomial infection, which are more suitable for this patient category; and (2) the high device utilization ratios.

Épidémiologie des infections liées aux cathéters en réanimation

Catheter-related infections remain an important cause of nosocomial infection in the ICU. They include colonization of the device, exit-site infection and catheter-related bloodstream infection with or without bacteraemia. Data from clinical studies and surveillance networks should be compared cautiously due to important methodological differences and wide variations of device-utilization ratio between units or countries. In France, two regional networks (C-CLIN Paris-Nord and C-CLIN Sud-Est) produced comparable and reproducible results. Colonization represents five–six cases per 1000 catheter-days and bacteraemia represents one case per 1000 catheter-days. Incidence rates from North American studies are usually four to five times higher. Numerous risk factors have been identified. Some of them could be used to stratify patients according to risk of catheter-related infection and to allow more valid comparison between ICU’s performances. Participation of French ICUs to the recent national surveillance networks (REA RAISIN and REACAT RAISIN) should be encouraged.

A Collaborative Practice Model Reduces Indwelling Urinary Catheter Use and Risk for Nosocomial Urinary Tract Infections

ABSTRACT Objectives: (1) Decrease use of indwelling urinary catheters. (2) Limit the number of overall catheter days. Design: Prospective cohort study. Population, Sample, Setting, and Years: Patients requiring indwelling urinary catheters admitted to general medical units at Yale‐New Haven Hospital were included. Patients with chronic catheters were excluded. Data were collected in spring 2002 and repeated in spring 2003. Intervention and Outcome: A physician–nurse protocol was developed to allow physicians to select, via a computerized order‐entry system, one the following options: (1) discontinue catheter, (2) maintain catheter for 48 hours, or (3) maintain chronic device. The protocol permits nurses to independently remove urinary catheters for patients meeting established criteria. Outcome measures included calculated device days (CDD), calculated infection rates (CIR), and device utilization ratio (DUR). Methods: During 53 consecutive days in 2002, all patients (n = 883) were assessed for occurrence, duration, and appropriateness of catheter use. Patients with catheters were assessed for infection. This procedure was repeated 1 year later postintervention (n = 894). Data were analyzed using descriptive and inferential statistics. Findings: Compared to baseline, there was a 51% reduction in catheter use post intervention (164 versus 81) among all four patient units. Although the outcome variables were not statistically significant, they were clinically significant. The CDD declined from 892 to 521 days, a 42% reduction, while the CIR decreased from 36 of 1000 to 19 of 1000 patient days (47% reduction). The DUR (device days/all patient days) fell from 16% to 10%. One unit demonstrated a statistically significant decrease in CIR (p &lt; 0.05). Conclusions: Results of this study demonstrate that use of a collaborative practice model reduces indwelling urinary catheter use and risk for nosocomial urinary tract infections. Implications: This protocol will heighten clinicians' awareness of the appropriate use of catheters and parameters to guide decision‐making regarding their removal.

Pediatric risk of mortality and hospital infection.

We studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.

Medicine Ward Patients in a Large Teaching Hospital: A High-Risk Population for Catheter-Associated Bloodstream Infections?

BACKGROUND: Infection control surveillance for catheter-associated bloodstream infections (CA-BSIs) is often focused in intensive care units (ICUs), where national benchmark data is available. Limited data on CA-BSI rates are available for non-ICU areas. Increasing acuity among non-ICU patients with central venous catheters (CVCs) raised the need to evaluate these areas. OBJECTIVE: To determine the CA-BSI rate in selected non-ICU medical wards over a 13-month period. METHODS: An infection control specialist performed active surveillance for CA-BSIs on four medical wards (A, B, C, D) from April 2002 to April 2003. CA-BSI was defined using NNIS definitions. CVC days were obtained from an electronic report based on nurses' CVC charting. Type of CVC and CA-BSI microbiology was documented. RESULTS: The general medicine wards each average 5–10 admissions/day. Each ward has separate nursing staff. A medical director, nurse manager, and interns/residents are shared between wards A & B and between wards C & D. The mean monthly CVC days for the 13-month period was 141 (range 77-215) per ward. Device utilization ratios for the four wards were 0.21, 0.25, 0.19, 0.24, respectively. Forty-two episodes of CA-BSI were identified. The mean CA-BSI rate in Ward A was 5.3/1000 CVC days (n=9); Ward B: 8.0/1000 CVC days (n=16); Ward C: 4.3/1000 CVC days (n=7); and Ward D: 4.9/1000 CVC days (n=10). CA-BSI organisms were: polymicrobial, 12% (n=5); Enterococcus spp., 24% (n=10); Coagulase-negative staphylococci, 24% (n=10); Staphylococcus aureus, 7% (n=3); other gram-positive, 2% (n=1); Pseudomonas aeruginosa, 2% (n=1); Escherichia coli, 2% (n=1); Proteus mirabilis, 2% (n=1); other gram-negative, 10% (n=4); Candida albicans, 12% (n=5), and other Candida, 2% (n=1). Patients with CA-BSI had the following catheters: tunneled, 5% (n=2); non-tunneled, 83% (n=35); and implanted port, 7% (n=3). Two patients had more than one type of CVC. CONCLUSION: Non-ICU medical wards in our study had device utilization ratios that were considerably lower than medical ICUs, but CA-BSI rates were comparable to medical ICUs nationally. Studies of catheter utilization rates and knowledge of CVC care and insertion on medical wards should be performed. Interventions usually focused on ICU personnel may be indicated to prevent CA-BSI on medical wards.

Incidence of urinary tract and bloodstream infections in Ghotbeddin Burn Center, Shiraz 2000–2001

Though burn wound infections have been extensively studied, other nosocomial infections (NIs) in burn patients have received less attention. Invasive diagnostic procedures (vascular and bladder catheterization) make the burn patients more susceptible to different nosocomial infections. The aim of this study was to determine the rate of bloodstream and urinary tract infections associated with IV line and urinary catheter (UC) in Ghotbeddin Burn Center and also to compare these rates with those of the National Nosocomial Infections Surveillance System (NNIS) in the USA. This study was conducted over 11 months, from 21st December 2000 to 21st November 2001. All the patients who were admitted for more than 48 h and did not have evidence of infection at the time of admission were included in the study. For diagnosis of urinary tract and bloodstream infections, the standard definitions from the Center for Diseases Control (CDC) were used. Of the total 106 qualifying patients, 91 study patients acquired nosocomial infections (85.85%). Urinary catheter-associated urinary tract infection (UC-UTI) rate was 30 per 1000 urinary catheter days and IV line-associated bloodstream infection (IV line-BSI) rate was 17 per 1000 IV line days. Comparison of incidence rates of UC-UTI and IV line-BSI in Ghotbeddin Hospital and NNIS showed that rate of infection to be higher in Ghotbeddin Hospital while device utilization ratio (urinary catheter and central line) was higher in the NNIS hospitals. To reduce the rate of infection at Ghotbeddin Burn Center, education, development of standardized guidelines for the use of invasive devices and introduction of a nosocomial infections surveillance system are necessary.

Risk factors for nosocomial infections in a critically ill pediatric population: a 25-month prospective cohort study.

We studied risk factors for nosocomial infections among 500 critically ill children who were admitted to a pediatric intensive care unit from August 1994 through August 1996 and who were prospectively followed until death, transfer, or discharge. Age, gender, postoperative state, length of stay, device-utilization ratio, pediatric risk of mortality score, and total parenteral nutrition were the risk factors studied. Through multivariate analysis, we identified three independent risk factors for nosocomial infection: device-utilization ratio (odds ratio [OR], 1.6; 95% confidence interval [CI95], 1.10-2.34), total parenteral nutrition (OR, 2.5; CI95, 1.05 5.81) and length of stay (OR, 1.7; CI95, 1.31-2.21).

Device-associated, device-day infection rates in an Israeli adult general intensive care unit

Surveillance is an essential element of hospital infection control programs. Previous studies have shown that interhospital comparison of intensive care unit (ICU) nosocomial infections (NI) may be best made by comparing ICU-type-specific, device-associated infection rates and that these adjusted rates vary by ICU type. The aim of this study was to evaluate whether significant structural improvements introduced in an adult general ICU were associated with changes in the NI rates in this unit. In addition, we compared these rates with those of ICUs reported by the National Nosocomial Infections Surveillance (NNIS) System of the Centers for Diseases Control and Prevention. During a 12-month period 337 patients were surveyed. There were 20 ventilator-associated pneumonias (VAP)/1000 ventilator (VEN)-days, 12 bloodstream infections (BSI)/1000 central vascular catheter (CVC)-days and 14 urinary tract infection (UTI)/1000 indwelling urinary catheter (IUC)-days. Structural changes and reduction in device utilization ratios were not followed by change in NI rates in this unit. VAP and BSI rates were comparable to those reported for neurosurgical and burn ICUs, respectively, in the NNIS System, despite a much higher device utilization ratios. The present study provides specific surveillance data for further interhospital comparison with similar types of ICUs.

Nosocomial infections in an oncology intensive care unit

Introduction: Treatment of cancer has contributed to a growing number of immunocompromised patients with life-threatening nosocomial infections (NI). High mortality with considerable cost is observed when they are admitted to the intensive care unit (ICU). Few studies on infection control and surveillance have been undertaken in this population group. Methods: All patients treated at a six-bed medical-surgical oncology ICU for >48 hours were prospectively observed for the development of an NI and the influence of device utilization on infection rates. The analysis used the standard definitions of the National Nosocomial Infection Surveillance System Intensive Care Unit surveillance component. Results: From September 1993 through November 1995, 370 infections occurred in 623 patients during 4034 patient-days, for an overall rate of 50.0 per 100 patients or 91.7 per 1000 patient-days. Pneumonia (28.9%), urinary tract infections (25.6%), and bloodstream infections (24.1%) were the main types of infection. The most common microorganisms isolated were Enterobacteriaceae (29.7%), fungi (22.2%), and Pseudomonas aeruginosa (13.2%). The median device utilization ratios were 0.63, 0.83, and 0.86 for ventilator, indwelling urinary catheter, and central venous catheter, respectively. The highest median device-specific associated infection rate was 41.7 for ventilator. The median for the average length of stay was 8.8 days, and the average severity of illness score was 4.0. There was a strong positive correlation between the overall NI patient rate and device utilization ( r = 0.56, p < 0.01), average severity of illness score ( r = 0.54, p < 0.01), and average length of stay ( r = 0.67, p < 0.01). No correlations were statistically significant when patient-days were used in the denominator. Among the devices only the number of central venous catheter days was significantly correlated with infections ( r = 0.51, p = 0.01). The NI patient-day rates were progressively higher the longer the patients stayed in the ICU. Conclusions: The high rates reported in this study may reflect a combination of several factors related to the underlying illness, neutrophil count, and exposure to invasive procedures. The adjusted infection rates described here provide specific surveillance data for further interhospital comparisons and also to assess the influence of invasive medical interventions, allowing the implementation of preventable measures to control infections.

Risk factors for nosocomial infection in critically ill children

To identify factors in pediatric intensive care unit (ICU) patients that are associated with an increased risk of nosocomial infections. A prospective, 1-yr cohort study. A 16-bed pediatric ICU in a multidisciplinary, regional referral center. All patients admitted to the pediatric ICU. None. The primary outcome variable was the development of nosocomial infection. Out of 945 consecutive admissions, 75 patients developed 96 nosocomial infections. The most frequent infection sites were the lower respiratory tract (35%), the bloodstream (21%), and the urinary tract (21%). The most common organisms isolated were Gram-negative bacteria (53%, Gram-positive bacteria (27%), and fungi (9%). Variables significantly associated with the development of nosocomial infections included age, weight, Pediatric Risk of Mortality (PRISM) score, device utilization ratio, antimicrobial therapy, histamine-2 (H2) receptor blocker use, immune status, parenteral nutrition, and length of stay. When combined in a multivariate logistic regression model, the significant variables were operative status, PRISM score, device utilization ratio, antimicrobial therapy, parenteral nutrition, and length of stay before the onset of infection. The area under the receiver operating characteristic curve was 0.868. At a probability of 0.15, the sensitivity was 66.67%, and the specificity was 87.82%. Patients at risk for developing nosocomial infection can be identified using a multivariate logistic regression model with a high degree of sensitivity and specificity. These data indicate that institutional nosocomial rates need to be adjusted for risk factors. This model could help target patients at high risk for developing nosocomial infections for preventive strategies.

The Association of average lenght of stay (ALOS) in intensive care units (ICUs) with device-utilization ratio: G. Emori, RN, MS,∗ J. Edwards, MS, R. Gaynes, MD. Centers for Disease Control and Prevention, Atlanta, GA, and the National Nosocomial Infections Surveillance (NNIS) System

The Association of average lenght of stay (ALOS) in intensive care units (ICUs) with device-utilization ratio: G. Emori, RN, MS,∗ J. Edwards, MS, R. Gaynes, MD. Centers for Disease Control and Prevention, Atlanta, GA, and the National Nosocomial Infections Surveillance (NNIS) System