Nosocomial infections: prospective survey of incidence in five French intensive care units

Objective: To assess the incidence and to evaluate the feasibility of inter-unit continuous surveillance of intensive care unit (ICU)-acquired infections. Design: Prospective multicentre, longitudinal, incidence survey. Setting: Five ICUs in university hospitals in western France. Patients: All patients admitted to the ICU during two 3-month periods (1994–1995). Measurements and results: The main clinical characteristics of the patients, ICU-acquired infections, length of exposure to invasive devices and the micro-organisms isolated were analysed. The study included 1589 patients (16 970 patient-days) and the infection rate was 21.6 % (13.1 % of patients). The ventilator-associated pneumonia rate was 9.6 %, sinusitis 1.5 %, central venous catheter-associated infection 3.5 %, central venous catheter-associated bacteraemia 4.8 %, catheter-associated urinary tract infection 7.8 % and bacteraemia 4.5 %. The incidence density rate of ICU-acquired infections was 20.3 ‰ patient-days. Ventilator-associated pneumonia and sinusitis rates were 9.4 and 1.5 ‰ ventilation-days, respectively. Central venous catheter-associated infection and central venous catheter-associated bacteraemia rates were 2.8 and 3.8 ‰ catheter-days, respectively. The catheter-associated urinary tract infection rate was 8.5 ‰ urinary catheter-days and the bacteraemia rate 4.2 ‰ patient-days. Six independent risk factors for ICU-acquired infection were found by stepwise logistic regression analysis: absence of infection on admission, age > 60 years, length of stay, mechanical ventilation, central venous catheter and admission to one particular unit. A total of 410 strains of micro-organisms were isolated, 16.8 % of which were Staphylococcus aureus (58.0 % methicillin-resistant). Conclusion: This prospective study using standardised collection of data on the ICU-acquired infection rate in five ICUs identified six risk factors. It also emphasized the difficulty of achieving truly standardised definitions and methods of diagnosis of such infections. Received: 21 October 1997 Accepted: 4 June 1998     

Prevention of catheter-related bloodstream infections in the neonatal intensive care setting

Nosocomial infection causes substantial morbidity and mortality among neonates treated in the neonatal intensive care setting. Colonization and subsequent infection of central venous catheters leading to catheter-related bloodstream infection is among the most common causes of nosocomial sepsis in this patient population. Prevention of catheter-related bloodstream infection is a major challenge and numerous strategies have been attempted in this context with varying success. Given the dynamic epidemiology of nosocomial infection among neonates and the emergence of antimicrobial resistance, novel prevention strategies are urgently required.     

重症监护病房中产Ampc酶革兰阴性杆菌致院内感染的临床调查

目的分析重症监护病房（ICU）中革兰阴性杆菌产Ampc酶所致院内感染的临床特点及细菌的耐药情况。方法收集2004年5月-2004年12月ICU临床分离的革兰阴性杆菌82株，通过酶粗提物三维试验检测产Ampc酶，并采用K-B法对临床常用抗生素进行体外药敏试验。结果82株革兰阴性杆菌中共检测到AmrC酶阳性菌株27株，阳性率为32．9％；感染部位主要分布于下呼吸道和外科手术部位。药敏结果显示上述产Ampc酶革兰阴性杆菌均对亚胺培南和美罗培南高度敏感。结论产Ampc酶革兰阴性杆菌已成为ICU中院内感染的主要致病菌之一，亚胺培南和美罗培南对其仍有显著的抗菌活性，临床应加强对此类细菌感染的重视。     

Nosocomial infections caused by methicillin-resistantStaphylococcus aureus in Japan

Conclusion It is very important to develop better antibacterial agents and employ them properly in the treatment of large numbers of patients. This is also crucial for any future improvement of the health care system. However, if antibacterial agents are used too freely, problems will arise in the future. The problem of MRSA in Japan is a typical example. It is necessary to reconsider urgently the Japanese health care system to overcome this problem. Re-education of medical professionals, especially instruction on the proper use of antibiotics, is also needed to cope with the increasing number of patients who are placed at risk for developing antibiotic-resistant nosocomial infections because of their act of seeking medical treatment. However, the most important point after developing an excellent system is to have the wisdom not to be overly constrained by it, I believe that the only way to achieve this is through education. In this article, I have described the current status of nosocomial MRSA infections in Japan. I hope that this article will help people all over the world obtain greater benefits from antibiotics in the future.     

神经外科重症监护室侵入性导管感染发生情况分析及对策

目的了解神经外科重症监护室侵入性导管感染发生情况,分析其感染特点,为制订预防感染措施提供理论依据。方法回顾性分析和总结本科室563例次留置侵入性导管患者的临床资料。结果 563例次留置侵入性导管中,发生导管感染106例次,发生率为18.8%。各管道感染发生率以尿管居高,发生率为24.5%;其次是硬膜外引流管,发生率为16.9%。病原菌主要为凝固酶阴性葡萄球球菌。结论提高医护人员对侵入性操作感染危害性的认识,操作时遵守各种导管的护理操作规程和加强各种管道护理,对降低侵入性导管感染发生率,确保患者的安全具有重要的作用。     

Nosocomial infections in intensive care patients

Facilities must manage core system processes to minimize medication errors and other adverse outcomes, such as nosocomial infections. Characterization of specific risk factors for the development of nosocomial infections and efficacious evidence-based care interventions are expanding. Health care providers need to evaluate their patient populations and systems of care to minimize lack of knowledge, slips. and lapses in care and other system issues to assure that successful care practices are consistently used to minimize nosocomial infections.     

Catheter-related bloodstream infections in intensive care units: a systematic review with meta-analysis

Title. Catheter‐related bloodstream infections in intensive care units: a systematic review with meta‐analysis Aim. This paper is a report of a systematic review and meta‐analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter‐related bloodstream infections and catheter colonization in the intensive care unit setting. Background. Catheter‐related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter‐related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. Methods. A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords ‘catheterization – central venous’ with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter‐related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta‐analyses. Results. Twenty‐three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter‐related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. Conclusion. A range of interventions may reduce risks of catheter‐related bloodstream infection, in addition to antimicrobial catheters.     

Reducing nosocomial infection in neonatal intensive care: An intervention study

Nosocomial infection is a common cause of morbidity and mortality for hospitalized neonates. This report describes measures taken to reduce the prevalence of nosocomial infection within a 34‐bed neonatal intensive care unit in Malaysia. Interventions included a one‐to‐one education programme for nursing staff (n = 30); the education of cleaners and health‐care assistants allocated to work in the unit; and the introduction of routine (weekly) screening procedure for all infants with feedback given to staff. The education programme for nurses focused on the application of standard precautions to three common clinical procedures: hand washing, tracheobronchial suctioning and nasogastric tube feeding. These were evaluated using competency checklists. The prevalence of nosocomial blood and respiratory tract infections declined over the 7‐month study period. This study highlights the importance of education in contributing to the control of nosocomial infection in the neonatal intensive care unit.     

黄杆菌属导致的医院感染及护理对策分析

为建立一套有效预防黄杆菌属医院感染的护理对策，对279例黄杆菌属所致医院感染的细菌来源、用药治疗情况、相关危险因素等方面进行了综合分析。认为，强化黄杆菌属感染专门知识的培训；加强病区管理力度，认真落实消毒、灭菌措施；严格操作规程，正确处理易感人群的护理合作性问题等是预防、监控黄杆菌属医院感染的重要对策。     

Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System.

OBJECTIVE: To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States. DESIGN: Analysis of ICU surveillance data collected through the National Nosocomial Infections Surveillance (NNIS) System between 1992 and 1997. SETTING: Medical ICUs in the United States. PATIENTS: A total of 181,993 patients. MEASUREMENTS AND MAIN RESULTS: Nosocomial infections were analyzed by infection site and pathogen distribution. Urinary tract infections were most frequent (31%), followed by pneumonia (27%) and primary bloodstream infections (19%). Eighty-seven percent of primary bloodstream infections were associated with central lines, 86% of nosocomial pneumonia was associated with mechanical ventilation, and 95% of urinary tract infections were associated with urinary catheters. Coagulase-negative staphylococci (36%) were the most common bloodstream infection isolates, followed by enterococci (16%) and Staphylococcus aureus (13%). Twelve percent of bloodstream isolates were fungi. The most frequent isolates from pneumonia were Gram-negative aerobic organisms (64%). Pseudomonas aeruginosa (21%) was the most frequently isolated of these. S. aureus (20%) was isolated with similar frequency. Candida albicans was the most common single pathogen isolated from urine and made up just over half of the fungal isolates. Fungal urinary infections were associated with asymptomatic funguria rather than symptomatic urinary tract infections (p < .0001). Certain pathogens were associated with device use: coagulase-negative staphylococci with central lines, P. aeruginosa and Acinetobacter species with ventilators, and fungal infections with urinary catheters. Patient nosocomial infection rates for the major sites correlated strongly with device use. Device exposure was controlled for by calculating device-associated infection rates for bloodstream infections, pneumonia, and urinary tract infections by dividing the number of device-associated infections by the number of days of device use. There was no association between these device-associated infection rates and number of hospital beds, number of ICU beds, or length of stay. There is a considerable variation within the distribution of each of these infection rates. CONCLUSIONS: The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.     

重症监护室住院患者医院感染危险因素分析

目的探讨重症监护室（ICU）住院患者发生医院感染的危险因素,为制订医院感染预防控制措施提供科学依据。方法收集重庆市璧山县人民医院814例ICU住院患者资料,按医院感染诊断标准分为感染组和非感染组,对其进行回顾调查。按照相关因素先进行单因素分析,并通过建立多因素非条件Logistic回归模型筛检ICU住院患者发生医院感染的危险因素。研究数据采用SAS9．1统计软件包进行统计分析。结果814例1CU患者中,382例发生医院感染,发生率为46．93％。经Logistic回归模型分析显示,年龄、病情、住院时间、手术因素、侵袭性操作、使用广谱抗菌药物、使用激素、放疗和化疗治疗、血液透析等是造成ICU患者发生医院感染的危险因素。结论开展ICU医院感染专项监测,针对重要危险因素加强防范措施可减少医院感染发生。     

神经内科重症监护病房医院感染调查及护理对策

目的 对神经内科重症监护病房(NICU)患医院感染发生情况及病原菌流行病学进行调查分析，提出医院感染控制措施。方法 调查2001年4月至9月期间NICU6l例住院思医院感染发生情况，分析所分离出病原菌的分布及耐药情况。结果 医院感染发生率为63．9％(39／61)，其中肺部感染发生率54．9％(28／51)。分离出的病原菌仍以革兰阴性菌为主(34／70)，其次为革兰阳性菌(24／70)和真菌(12／70)。革兰阴性菌以铜绿假单胞菌居首位，且呈多重耐药，MRSA分离率占葡萄球菌的66．7％(10／15)。结论 NICU内医院感染发生率较普通病房高，医院感染病原菌复杂且对抗菌药物呈现多重耐药。应合理选用抗菌药物，医护人员要严格无菌技术操作和消毒隔离管理，预防交叉感染。     

神经外科重症监护病房医院感染的临床调查

目的通过调查分析神经外科重症监护病房（NICU）医院感染发生情况、感染部位病原菌的构成及感染影响因素,以寻求有效的预防措施。方法通过自制调查表收集贵州省铜仁医院2008年1月至2010年5月362例NICU患者的临床资料,包括患者年龄、感染部位、感染诱发因素、病原菌种类及其耐药性、可能的影响因素等并作分析。结果医院感染发生率为18．5％,8．2例／1000床日,高于同期医院其他科室的感染率;发生医院感染的主要疾病为中枢神经系统炎症和医院获得性肺炎,分别为58．2％和34．3％;共检出病原菌220株,其中革兰阴性杆菌103株（46．8％）,革兰阳性球菌96株（43．6％）,真菌21株（9．5％）。金葡菌除对万古霉素呈敏感外．对其余测试抗菌药物的耐药率均高于80．0％,大肠埃希菌除对亚胺培南耐药率低,为1．1％外,对其余测试抗菌药物的耐药率均高于20．0％。单因素分析和多因素逐步logistic回归分析发现,患者发生医院感染与住院时间、是否机械通气、侵袭性操作、H2受体拮抗剂的使用有关。结论NICU患者中医院感染发生率高,感染部位集中,影响因素复杂,应采取综合措施控制医院感染,加强病室管理,在治疗及护理过程中应特别注意对呼吸系统和泌尿系统的无菌操作,合理使用抗生素,监测病原菌及其耐药性,减少住院期间的交叉感染等。     

Nosocomial infections in a respiratory intensive care unit

A total of 250 consecutive admissions to an open-plan respiratory ICU were analyzed prospectively to identify the incidence of secondary hospital-acquired infections and possible predisposing factors. Despite preventative measures and a restricted antibiotic policy, 23.6% of patients developed secondary infections. Patients admitted after multiple trauma were the only diagnostic category of patients who showed a significantly increased incidence of secondary infections. The length of hospitalization and number of patients who had intubations or tracheostomies was higher in the group with secondary infection; the causal relationship was difficult to establish. Patients who were not intubated or tracheostomized did not develop secondary infection. Prior administration of antibiotics did not appear to influence the incidence of secondary infection. There was a significant increase in secondary infections in patients with a higher therapeutic intervention scoring system score. The predominant pathogens cultured were highly resistant Gram-negative organisms, particularly Acinetobacter sp. and Pseudomonas sp. Staphylococcus aureus was the most common Gram-positive pathogen. The ICU course was probably prolonged by the complication of nosocomial infection, which may have contributed to the deaths.     

Nosocomial infections in a pediatric intensive care unit

In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infections/100 admissions). Primary bacteremias comprised 38% of PICU infections and lower respiratory infections comprised 15%. The remaining infections were divided equally among GI, skin, eye, upper respiratory, postoperative wounds, and other sites. Coagulase-negative staphylococci, Pseudomonas aeruginosa, and Staphylococcus aureus were the most prevalent pathogens. Surgical patients had similar rates of infection to medical patients. Patients in the first 2 yr of life, particularly those between 7 and 30 days of age, had the highest rate of infection. Onset of infection was more common after the first week in the PICU with 11% of patients staying 14 to 20 days, 27% of patients staying 21 to 27 days, 48% of patients staying 28 to 34 days, and 52% of patients staying more than 35 days before the onset of infection. The risk of nosocomial infection increases with arterial and central line use, prolonged intubation, ventilation, intracranial pressure monitoring, and paralysis.     

Effectiveness of hand-washing teaching programs for families of children in paediatric intensive care units

Aims. The authors developed a video‐centred teaching program based on social learning principles to demonstrate hand‐washing technique. A comparison was made between families who viewed the video and families who were taught the same techniques with the aid of an illustrated poster in terms of compliance and improvement in hand‐washing skills. Background. Nosocomial infections are a significant cause of morbidity and mortality in paediatric intensive care unit patients. Hand hygiene is considered the most important preventive action against hospital‐acquired infections. A number of studies have shown that increased compliance with hand‐washing guidelines for health‐care workers leads to decreases in nosocomial infection rates. Furthermore, recommendations have been made to ensure that parents who visit their children in intensive care units wash their hands first. Study design. Quasi‐experimental time series. Compliance and accuracy measurements were collected during one to five visits following the initial teaching intervention. Methods. A total of 123 families, who visited paediatric intensive care units, were recruited and assigned to two groups – one experimental (61 families) and the other a comparison group (62). Participants in the comparison group were taught hand‐washing skills using simple illustrations. A 20‐item hand‐washing checklist was used to examine hand‐washing compliance and accuracy. Results. No significant differences were noted in terms of demographics between the two groups. Results from a general estimated equation analysis showed that families in the experimental group had higher compliance and accuracy scores at statistically significant levels. Conclusion. The video‐based teaching program was effective in increasing compliance and accuracy with a hand‐washing policy among families with children in intensive care units. Relevance to clinical practice. The education program is a simple, low‐cost, low technology intervention for substantially reducing the incidence of nosocomial infection.     

心外科实施医院感染干预措施的效果

  目的  评估感染控制干预措施在预防心外科医院感染中的有效性。  方法  收集北京大学人民医院2007年1月至2009年12月间外科病历资料, 自2008年5月起对心外科医院感染开展目标性监测, 并针对问题和风险实施感染控制措施干预, 至2009年所有措施得到落实。比较采取干预措施前后感染发生率的变化。  结果  2007年和2008年心外科住院患者医院感染发生率较高, 分别为6.07%和7.56%, 而同期外科系统医院感染发生率分别为1.34%和1.38%。采取一系列感染控制干预措施之后, 2009年心外科医院感染发生率下降为3.62%, 与干预前相比差异有统计学意义(χ²=7.584, P=0.006)。  结论  心外科患者处于医院感染的高危状态, 采取积极有效的感染控制干预措施可有效控制并降低心外科医院感染发生率。