Incidence Rate Of Nosocomial Infections Research Articles

Evaluation of the application effect of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital

Objective To investigate the application effect of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital. Methods The first-time qualification rate of cleaning,packaging and sterility test and incidence rate of nosocomial infection before and after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center of hospital.The application effect was comprehensively evaluated. Results The first-time qualification rate of cleaning,packaging and sterility test after the application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center were significantly increased.The incidence rate of nosocomial infection was 1.5％ before and 5.5％ after the application of cleaning packaging of surgical medical apparatus and instruments,the difference was significant. Conclusions Application of cleaning packaging of surgical medical apparatus and instruments in sterilization and supply center can effectively control the cleaning and packaging quality,guarantee the thoroughness of subsequent disinfection and sterilization,decrease the incidence rate of nosocomial infection caused by poor quality of surgical medical apparatus and instruments.It creates reliable medical environment for patients and obtain good social and economic benefit,which is worthy of wide application. Key words: Surgical medical apparatus and instruments; Sterilization and supply center; , Quality control of cleaning packaging; Nosocomial infection control

Nosocomial infections and risk factors in the intensive care unit of a teaching and research hospital: A prospecive cohort study

SummaryBackgroundTo evaluate the incidence, risk factors and etiology of nosocomial infections (NIs) in the intensive care unit (ICU) of our hospital in order to improve our infection control policies.Material/MethodsA 1-year prospective cohort study of nosocomial infection (NI) surveillance was conducted in our ICU in 2008.ResultsOut of 1134 patients hospitalized in the ICU for a period of 6257 days, 115 patients acquired a total of 135 NIs distributed as follows: 36.3% bacteremia, 30.4% ventilator-associated pneumonia (VAP), 18.5% catheter-associated urinary tract infection, 7.4% central-line infection, 5.9% cutaneous infection, and 1.3% meningitis. The incidence rate of NI was 21.6 in 1000 patient-days, and the rate of NI was 25.6%. Length of ICU stay, central venous catheterisation, mechanical ventilation and tracheostomy were statistically significant risk factors for NI. Of all NI, 112 (83%) were microbiologically-confirmed and 68.8% of the isolates were Gram-negative, 27.6% were Gram-positive, and 3.6% were fungi. 23 (17%) were clinically-defined infections. The most frequently isolated organism was P. aeruginosa (25%), followed by S. aureus (21.4%), E. coli (18.7%) and A. baumannii (16.9%).ConclusionsThe bloodstream was the most common site and Gram-negatives were the most commonly reported causes of ICU infections.

A retrospective study about the influence of early nutritional support on mortality and nosocomial infection in the critical care setting

To determine whether early nutritional support reduces mortality and the incidence of nosocomial infection, in critically ill patients in the current practice. A retrospective observational study was conducted in all critically ill patients who had been prescribed nutritional support, throughout one year, in an Intensive Care Unit. The time to start and the route of delivery of nutritional support were determined by the attending clinician's assessment of gastrointestinal function and hemodynamic stability. Age, gender, severity of illness, start time and route of nutritional support, prescribed and delivered daily caloric intake for the first 7 days, whether they were a medical or surgical patient, length of stay in ICU, incidence rate of nosocomial infections and ICU mortality were recorded. Patients were classified according to whether or not they received nutritional support within 48 h of their admission to ICU and Binary Logistic Regression was performed to assess the effect of early nutritional support on ICU mortality and ICU nosocomial infections after controlling for confounders. Ninety-two consecutive patients were included in the study. Start time of nutritional support showed a mean of 3.1 ± 1.9 days. Patients in the early nutritional support group had a lower ICU mortality in an unadjusted analysis (20% vs. 40.4%, p = 0.033). Early nutritional support was found to be an independent predictor of mortality in the regression analysis model (OR 0,28; 95% confidence interval, 0.09 to 0,84; p = 0.023). Our study did not demonstrate any association between early nutritional support and the incidence of nosocomial infection (OR 0.77; 95%. confidence interval, 0.26 to 2,24; p = 0.63), which was related to the route of nutritional support and the caloric intake. The delayed nutritional support group showed a longer length of stay and nosocomial infections than the early group, although these differences were not statistically significant. Our study shows that early nutrition support reduces ICU mortality in critically ill patients, although it does not demonstrate any influence over nosocomial infection in the current practice in intensive care.

Reduction of nosocomial infections and mortality attributable to nosocomial infections in pediatric intensive care units in Lithuania

The aim of the study was to identify the most important risk factors for nosocomial infections, evaluate the incidence rates and risk changes after the multimodal intervention, and to assess mortality attributable to nosocomial infections. This was a prospective surveillance study. Data were collected from January 2005 until December 2007 in three pediatric intensive care units. All patients aged between 1 month and 18 years hospitalized in units for more than 48 hours were included in the study. The patients were divided into preintervention (2006) and postintervention (2007) groups. The multimodal intervention included education of the staff and implementation of evidence-based infection control measures. A total of 755 children were included in the study. Major risk factors for nosocomial infections were identified: mechanical ventilation, central line, intracranial pressure device, and tracheostomy. Overall, the incidence rate (15.6 vs. 7.5 cases per 100 patients, P=0.002), incidence density (19.1 vs. 10.4 cases per 1000 patient-days, P=0.015), and the incidence of pneumonia (5.6 vs. 1.9 per 100 patients, P=0.016) have decreased in the postintervention as compared with the preintervention group. The relative risk reduction, absolute risk reduction, and number needed to treat were statistically significant for ventilator-associated pneumonia (66.5%, 3.7%, 27, respectively; P=0.016). There was no significant difference in survival time by the presence of nosocomial infection (83.67 patient-days without vs. 74.33 patient-days with infection, P>0.05) The most important risk factors for nosocomial infections were mechanical ventilation, central line, intracranial pressure device, and tracheostomy. After the multimodal intervention, there was a statistically significant decrease in the incidence rates of nosocomial infections and the risk reduction for ventilator-associated pneumonia. No significant impact of nosocomial infections on mortality was determined.

Nosocomial infections in the pediatric intensive care units in Lithuania

The aim of the study was to collect the data on incidence rates, pathogens of nosocomial infections, and antimicrobials for treatment of nosocomial infections. Data were collected between March 2003 and December 2005 in five pediatric intensive care units using a modified patient-based HELICS protocol. Nosocomial infection was identified using the Centers for Disease Control definitions. All patients aged between 1 month and 18 years that stayed in the units for more than 48 hours were eligible for inclusion in this study. A total of 1239 patient admissions and 7601 patient-days were evaluated. In 169 children (13.6%), 186 nosocomial infections occurred. The incidence density was 24.5 per 1000 patient-days, the incidence rate--15.0 per 100 admissions. The highest incidence density was observed in the 6-12-year age group (31.2 per 1000 bed-days). Nosocomial infection rates per 1000 device-days were 28.8 for ventilator-associated pneumonia, 7.7--for bloodstream infection, and 3.4--for urinary tract infection. The most common site of infection was respiratory tract (58.8%). Secondary bacteremia developed in 18 (10.6%) patients. Haemophilus influenzae (20.1%), Acinetobacter spp. (14.2%), and Staphylococcus aureus (17.6%) were the most frequently isolated microorganisms. The most common antimicrobials used were first- and second-generation cephalosporins 74 (31.0%) and broad-spectrum penicillins 70 (29.3%). In Lithuanian pediatric intensive care units, the incidence rates of nosocomial infections were comparable to the available data from other countries, except for the ventilator-associated pneumonia rate, which was relatively high. H. influenzae, Acinetobacter spp., and S. aureus were the most prevalent pathogens. The first- and second-generation cephalosporins and broad-spectrum penicillins were the most common antimicrobials in the treatment of nosocomial infections.

Are KISS Data Representative of German Intensive Care Units?

Data collected within the German nosocomial infection surveillance system KISS are recommended as reference data for judging nosocomial infection rates in German intensive care units (ICUs). It is unknown whether the KISS data tend to under- or overestimate the true infection incidence rates. In this article, methodological aspects of the SIR1 study on the incidence of nosocomial infections are discussed, with the aim of estimating unbiased incidence rates of nosocomial infections in interdisciplinary German ICUs and examining whether the KISS data are representative. We discuss the following methodological issues: 1) Sample size estimation. 2) Stratified random sampling of German ICUs. 3) Investigation of seasonal effects. 4) Statistical modeling of incidence rates using a negative binomial regression model. 5) Comparison of weighted incidence rates with the standardized rate ratio (SRR). Random sampling proved difficult to realize in practice since many ICUs refused to participate, particularly those in small hospitals. Analysis was adjusted for hospital size. No seasonal trends were found in the KISS data. Due to marked differences between ICUs, the number of infections is over-dispersed compared to a Poisson model, so negative binomial regression was used. Fifty ICUs were observed for two consecutive months each, corresponding to 21,832 patient days, during which 262 infections occurred. Infections were more frequent in large hospitals. The incidence rates provided by the SIR study are on average (SRR) 1.89 (1.63-2.20) times as large as those estimated by the KISS system. For estimating nosocomial infection incidence rates, random sampling and statistical modeling of over-dispersion were successfully performed. The study provides evidence that the KISS surveillance system tends to underestimate the true incidence rates of nosocomial infections in German ICUs.

Relations between undernutrition and nosocomial infections in elderly patients

Hospital-acquired infections and malnutrition are of major concern in public health in elderly patients. However, the interactions between these two entities are not well established. To determine the incidence of nosocomial infections (NI) and its association with malnutrition. 185 hospitalised older adults aged 81.6+/-0.6 years old were nutritionally assessed on admission by measurement of anthropometric variables, serum nutritional proteins and evaluation of dietary intake. During hospitalisation, patients' progress was closely monitored, particularly for the detection of nosocomial infections. The incidence rate of NI was 59% and the global infection rate was 7.6/1,000 bed days. The most common infection site was the urinary tract (n=63). The nutritional status of the population was studied by comparing three groups defined according to the absence (group I, n=116), presence of one infection (group II, n=38) or presence of more than one infection (group III, n=31). All but one anthropometric parameters varied among the three groups. Total energy intake also varied among the three groups. The group I had higher daily nutrient intake than the other two groups (respectively P=0.004 and P<0.0001). Albumin, transthyretin, and C-reactive protein levels differed significantly among the three groups (respectively P<0.0001, P<0.0001 and P=0.0003). Age, energy intake, length of hospital stay and the presence of a urinary catheter were independent risk factors of nosocomial infection. Our findings show that patients with multiple NI were older, showed an altered nutritional status, a prolonged recovery, more frequently had urinary catheters and more discharge placement.

Surveillance of nosocomial infections in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, 1999-2002

Nosocomial infection are one of the main problem in hospital which are associated with significant morbidity, mortality and increased economic cost. Surveillance should be attempted regularly to obtain local data of incidence of nosocomial infections, types of infection, pathogen and resistance pattern. We reported the results of nosocomial surveillance in Dr. Cipto Mangunkusumo National General Hospital, Jakarta, in year 1999 to 2002. The data were obtained from surveillance, conducted by Nosocomial Infection Control Committee. Surveillance were performed to patient in risk of nosocomial infections such as underwent surgical procedure, urinary catheter, peripheral or central venous catheter, ventilator and other invasive procedure. Criteria for nosocomial infection which were used, based on technical guidelines of nosocomial infection in Dr. Cipto Mangunkusumo National General Hospital, year 1999; which referred to CDC definition of nosocomial infections. Incidence rate of nosocomial infections in year 1999, 2000, 2001 and 2002 were 1.1, 0.9, 0.6 and 0.4 % respectively. Type of nosocomial infection include catheter related, surgical wound, urinary tract and respiratory tract infections, ranged between 0 to 5.6 %. Gram negative bacteria consist of Pseudomonas sp, Enterobacter aerogenes, Escherichia coli, Proteus mirabilis were the most common nosocomial pathogen. Gram positive bacteria consist of Staphylococcus epidermidis, Staphylococcus aureus and Streptococcus anhemolyticus. Trend of increasing incidence of Gram positive nosocomial infection also showed in our surveillance. Mostly Gram negative bacteria had been resistant to penicillin, co amoxicillin-clavulanic acid and 3rd generation cephalosporin, but still sensitive to 4th generation cephalosporin and aminoglycoside. The Gram positive bacteria were still sensitive to penicillin, co amoxicillin-clavulanic acid, 4th generation cephalosporin and aminoglycoside. (Med J Indones 2004; 13: 107-12) Keywords : nosocomial infection, surveillance, resistance pattern

A prospective incidence study of nosocomial infections in a neonatal care unit

Background Health care improvements and technical advances for diagnostic and therapeutic management in the neonatal care unit (NCU) have made possible the increasing survival of neonates with severe pathologic conditions. However, nosocomial infections (NI) still represent an important cause of morbidity and mortality in this population. Objective To describe the epidemiologic profile of NI in the NCU. Methods A prospective surveillance study was performed in the NCU at a university hospital in Barcelona during 6 months. Two hundred sixty-eight neonates were admitted during the study period. Centers for Disease Control and Prevention criteria were used as standard definitions for NI. Data including risk factors associated with NI were recorded. Results Sixty-five neonates had a total of 88 NI. The incidence rate of NI was 1.6 per 100 patient-days. The accumulative rate of NI was 32.7 per 100 admissions. Bacteremia (28.4%), conjunctivitis (19.5%), respiratory infection (10.2%), and urinary tract infection (7.9%) were the most common episodes observed. Gram-positive bacteria were the most commonly isolated germs (76.4%), with coagulase-negative Staphylococcus (72.5%) being the main pathogen. Intrinsic risk factors related to NI were low birth weight (<1000 g) and urinary catheter and peripheral venous catheter (P<.01). Conclusions NI represent an important and frequent problem in neonates. Knowledge of the incidence of NI allows the targeting and implementation of preventive strategies for reducing morbidity and mortality related to NI in an NCU.

Mortalité hospitalière imputable aux infections nosocomiales

Objectives – The authors had for aim to determine the relationship between the hospital deaths and nosocomial infections (NI). Patients – The study was made in the Rennes University Hospital (France) in 1997 on 1,371 patient deaths. Two hundred of these patient files were randomly selected (14% deaths). A three level scale was made to classify the link between deaths and NI. Level 0: no link, level 1: unlikely link, level 2: very likely link. The files were studied by an expert comity and difficult files with hospital physicians having dealt with the patient. Results – The 200 randomly chosen files were similar to the other 1,171 files. The median age was 67 years ± 20, with 61% male patients. The disease was cancer in 28% of the cases, cardiac or hepatic insufficiency in 20%. Fifty nine patients presented with at least one nosocomial infection (30%). Mortality was attributable to NI in 6% of the cases (CI at 95%: 3.1–10.2%) and NI mortality rate was estimated at 4%. Comments – It is possible to conclude that a NI increases the risk of death. If the same scale were used on a national level, the number of deaths attributable to NI in France would reach 14,000 (range: 6,800–19,800 deaths). This range is large because the relationship is difficult to establish, the number of patient files studied was small, and the incidence rate of NI is not well documented in France.

Epidemiological study of an Acinetobacter baumannii outbreak by using a combination of antibiotyping and ribotyping.

From June to November 1994 (period 1) and from February to June 1995 (period 2), multiresistant Acinetobacter baumannii strains were isolated in intensive care units and surgical wards of the Amiens Teaching Hospital Center (Amiens, France). Eighteen isolates were obtained from 17 (1%) of 1,706 patients admitted during both of these periods, giving an incidence rate of nosocomial infection per 1,000 patient days of 0.6%. Of 17 infected patients, 9 had pneumonia, 3 had urinary tract infection, 2 had peritonitis, 1 had septicemia, 1 had a catheter infection, and 1 had pneumonia and urinary tract infection. According to typing results, four antibiotic resistance profiles were detected: a, b, c, and d; seven ribotypes were distinguished by both restriction enzymes EcoRI and SalI (A, B, C, D, E, F, and G). By combining antibiotyping and ribotyping, we obtained eight groups of strains (groups I to VIII). Group I contained five strains (strains 4, 5, 7, 8, and 9) which had antibiogram pattern a and ribopattern A and constituted the outbreak strains. The strains of group II (strains 3, 10, 11, 13, and 14) were closely related to outbreak strain A and appeared to be variants of ribotype A (A2 [strain 3]; A4 [strain 10]; A5 [strains 11, 13, and 14]). Groups III, IV, V, VI, VII, and VIII included strains which were epidemiologically unrelated to the strains of group I and were considered nonoutbreak strains.

Nosocomial infections in HIV infected patients. Gruppo HIV e Infezioni Ospedaliere.

To determine the incidence of nosocomial infections (NI) in HIV-infected patients and to analyse some of the associated risk factors. Multicentre prospective study on consecutive HIV-infected patients admitted to 19 Italian acute-care infectious disease wards. All patients admitted during a 1-year period were followed-up for NI until their discharge. Univariate and multivariate analyses were performed for NI risk factors. As of June 1998 a total of 344 NI occurred in 4330 admissions, with at least one NI in 273 admissions (6.3%). The incidence rate of NI was 3.6 per 1000 patient days [95% confidence interval (CI), 3.2-4.1]. Overall distribution by site was 36.6% bloodstream infections (BSI), 30.5% urinary tract infections, 18.4% pneumonia, 5.2% skin/soft tissue infections, 2.0% surgical wound infections and 7.3% others. Fifty-five out of the 126 BSI were related to a central venous catheter (CVC); the rate of CVC-associated infections was eight infections per 1000 devices. At multivariate analysis, variables independently associated with NI included CD4 T-lymphocyte count < 200 x 10(6)/l [odds ratio (OR), 2.21; 95% CI, 1.35-3.62], Karnofsky Performance Status < 40 (OR, 1.89; 95% CI, 1.28-2.78), therapy with corticosteroids (OR, 1.78; 95% CI, 1.29-2.45), CVC (OR, 3.24; 95% CI, 2.41-4.35), urinary catheter (OR, 6.53; 95% CI, 4.81-8.86) and surgery (OR, 3.13; 95% CI, 1.90-5.15). Results suggest that NI occur commonly in HIV-infected patients. As the number of cases of HIV continues to increase, the number of HIV-infected patients requiring hospitalization may also increase. Clinicians need to be aware of the risk factors for NI and must consider these infections in the overall management of HIV-infected, hospitalized patients.

Infecciones nosocomiales. Experiencia en un hospital pediátrico de tercer nivel

OBJETIVO. Se describen los resultados de la vigilancia epidemiológica en un nuevo hospital pediátrico de alta especialidad, de 1990 al primer semestre de 1997, y se comparan con resultados previos del mismo. MATERIAL Y MÉTODOS. Se analizaron el número total y el tipo de infecciones, para obtener la tasa de incidencia y la densidad de incidencia de acuerdo con el servicio, la división médica o quirúrgica para los diferentes grupos de edad y el estado inmunológico. RESULTADOS. La incidencia global de infecciones nosocomiales durante este periodo fue de 25.7 por 100 egresos, con una disminución progresiva durante los últimos tres años. Aunque los pacientes inmunocomprometidos se infectaron más que los inmunocompetentes, la diferencia no fue significativa. Las tres infecciones más frecuentes fueron las neumonías, las infecciones relacionadas con líneas vasculares y las infecciones respiratorias altas. Es posible que estas últimas contribuyan a la elevación de las tasas globales de incidencia de infecciones nosocomiales. CONCLUSIONES. El cambio en la epidemiología de las infecciones respecto a experiencias propias previas, ha creado la necesidad de implantar programas para prevenir los problemas más frecuentes. Es necesario intensificar los diferentes programas de prevención y fomentar su difusión para abatir estas infecciones a corto plazo.

An evaluation of the efficacy of a hospital infection control program

To establish the credibility of the hospital infection control program at a major southeastern medical university hospital, the incidence rates of nosocomial infections were analyzed statistically following the implementation of an extensive infection control program. Continuous hospital-wide surveillance included documentation of all detected nosocomial infections by both site and service. Chi-square analysis of the incidence of infection during the years 1977 to 1979 revealed significant decreases in several distinct areas. The overall incidence rate of infection steadily declined from 100.8/1000 admissions in 1977 to 59.9/1000 in 1979. Decreases in the incidence of urinary tract, respiratory tract, and surgical wound infections were primarily involved. Analysis of incidence rates by service revealed that general surgery was responsible for much of the observed decrease. In contrast, none of the intensive care units exhibited a significant decline in morbidity rates over the 3-year period. It is concluded that involvement of infection control personnel at all levels of patient care as a part of a sophisticated hospital infection control program can result in a significant reduction in the incidence of nosocomial infections.