Poor Infection Control Practices Research Articles

Nosocomial Infections in a Rural Regional Hospital in a Developing Country: Infection Rates by Site, Service, Cost, and Infection Control Practices

To assess the prevalence of nosocomial infections at a rural government hospital from 1992 to 1995. Retrospective review of data from 1992 to 1995 regarding rates of nosocomial infections, cost to government, and infection control practices. 653-bed rural hospital providing primary and tertiary care. Patients admitted to the hospital between 1992 and 1995 who were found with hospital-acquired infections during their stay. None. Over the 4-year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions). Urinary tract infections (4.1/100 admissions) accounted for most nosocomial infections (42%), followed by postoperative wound infections (26.8%) with a rate of 2.6/100 admissions. Nosocomial pneumonias and bloodstream infections also were common with 13.2% and 8.0%, respectively. The highest rates occurred on the intensive-care unit for both pneumonia (26.4/100 admissions) and bloodstream infection (7.0/100 admissions). The cost to the government for nosocomial infections was estimated at US $697,000 annually (US $1=$6 Trinidad and Tobago). Poor infection control practices, inadequate handwashing facilities, lack of supplies, and nonexistent garbage cans on most wards were quite evident. Strict adherence to proper infection control practices, such as handwashing techniques, and improvement of facilities are crucial steps in preventing cross-infections in the hospital environment. Implementing these measures may substantially reduce the massive drain on the hospital budget in treating nosocomial infections. The saved revenue could go toward improvement of ward facilities and reduction of overcrowding, thus further reducing cross-infection.

Risk Factors for the Spread of Antibiotic-Resistant Bacteria

The emergence of antibiotic resistance is primarily due to excessive and often unnecessary use of antibiotics in humans and animals. Risk factors for the spread of resistant bacteria in hospitals and the community can be summarised as over-crowding, lapses in hygiene or poor infection control practices. Increasing antibiotic resistance in bacteria has been exacerbated by the slow pace in developing newer antibiotics. Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multiresistant Gram-negative bacteria are spread primarily by direct or indirect person-to-person contact. Independent risk factors for MRSA include the use of broad spectrum antibiotics, the presence of decubitus ulcers and prosthetic devices while those for VRE include prolonged hospitalisation and treatment with glycopeptides or broad spectrum antibiotics. For the spread of resistant Gram-negative bacteria risk factors include urinary catheterisation, excessive use of antibiotics and contamination of humidifiers and nebulisers. The spread of penicillin-resistant pneumococci (PRP) and drug-resistant and multidrug-resistant tuberculosis (MDRTb) is due to airborne transmission. Risk factors for the spread of PRP include overcrowding, tracheostomies and excessive use of penicillins for viral respiratory infections; for MDRTb they include poor compliance, convergence of immunosuppressed patients, delayed diagnosis or treatment, and poor or inadequate ventilation and isolation facilities. Recent developments in the genomic mapping of many bacteria and advances in combinatorial chemistry promise to usher in a new era of antibiotic development. While this may result in our regaining some of the ground lost to resistant bacteria, there will still be a continuing need to minimise the spread of antibiotic resistance through the rational use of antibiotic agents and stringent infection control practice.

Vancomycin resistance: when failure becomes an opportunity for leadership.

To discuss the emergence of the enterococci as significant nosocomial pathogens and reports of glycopeptide resistance as demonstrating the failure of healthcare professionals to limit the clinical impact of these organisms. The enterococci have long occupied a peculiar position in medical and surgical patients. A component of the normal gastrointestinal tract, these organisms exhibit little overt pathogenicity in healthy hosts, but are frequently recovered in patients with severe debilitative or immunosuppresive disorders. While the enterococci have always demonstrated intrinsic resistance to a broad range of antiinfective agents, recent findings of moderate to high-level glycopeptide resistance potentially threaten the limited therapeutic options for methicillin-resistant gram-positive cocci. The emergence and dissemination of vancomycin-resistant enterococci are signs of much greater problems, which include incomplete success of formulary controls, unreliable detection and identification of resistant microorganisms within the hospital environment, and poor fundamental infection control practices by all healthcare professionals. The Hospital Infection Control Practices. Advisory Committee Recommendations for the Prevention and Spread of Vancomycin Resistance are an important step in resolving these issues through the elements of collegiality and shared leadership.