A prospective study of hospital-acquired infection in 2330 cardiovascular surgery patients

Between March 1982 and May 1983, 2330 patients undergoing cardiovascular surgery were prospectively surveyed for hospital-acquired infections. During the first month of the study the overall incidence of infection was 8.2%, the incidence of postoperative wound infection was 3.8%, urinary tract infection 3.2%, lower respiratory tract infection 1.2% and bacteraemia 0.6%. In May 1983 the overall incidence was 3.2% and incidence of wound, urinary tract and lower respiratory infections were 1.3%, 0.6% and 1.3% respectively. Urinary tract infection was reduced by substituting a closed drainage system for open drainage. A peak of postoperative wound infection was observed in November 1982 and was related to changes in the functioning of the department resulting in inadequate pre-operative preparation. Two outbreaks of pseudobacteraemia occurred related to the arterial line stopcock and to heparin used for biochemistry tests. Antimicrobial prophylaxis was not modified during the study. However, wound infection rates dropped from 4% to 1.3%. In conclusion, this surveillance programme was associated with a significant reduction in hospital-acquired infection.     

Impact of contact and droplet precautions on the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus infection.

OBJECTIVE: To evaluate the efficacy of contact and droplet precautions in reducing the incidence of hospital-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections. DESIGN: Before-after study.Setting. A 439-bed, university-affiliated community hospital. METHODS: To identify inpatients infected or colonized with MRSA, we conducted surveillance of S. aureus isolates recovered from clinical culture and processed by the hospital's clinical microbiology laboratory. We then reviewed patient records for all individuals from whom MRSA was recovered. The rates of hospital-acquired MRSA infection were tabulated for each area where patients received nursing care. After a baseline period, contact and droplet precautions were implemented in all intensive care units (ICUs). Reductions in the incidence of hospital-acquired MRSA infection in ICUs led to the implementation of contact precautions in non-ICU patient care areas (hereafter, "non-ICU areas"), as well. Droplet precautions were discontinued. An analysis comparing the rates of hospital-acquired MRSA infection during different intervention periods was performed. RESULTS: The combined baseline rate of hospital-acquired MRSA infection was 10.0 infections per 1,000 patient-days in the medical ICU (MICU) and surgical ICU (SICU) and 0.7 infections per 1,000 patient-days in other ICUs. Following the implementation of contact and droplet precautions, combined rates of hospital-acquired MRSA infection in the MICU and SICU decreased to 4.3 infections per 1,000 patient-days (95% confidence interval [CI], 0.17-0.97; P=.03). There was no significant change in hospital-acquired MRSA infection rates in other ICUs. After the discontinuation of droplet precautions, the combined rate in the MICU and SICU decreased further to 2.5 infections per 1,000 patient-days. This finding was not significant (P=.43). In the non-ICU areas that had a high incidence of hospital-acquired MRSA infection, the rate prior to implementation of contact precautions was 1.3 infections per 1,000 patient-days. After the implementation of contact precautions, the rate in these areas decreased to 0.9 infections per 1,000 patient-days (95% CI, 0.47-0.94; P=.02). CONCLUSION: The implementation of contact precautions significantly decreased the rate of hospital-acquired MRSA infection, and discontinuation of droplet precautions in the ICUs led to a further reduction. Additional studies evaluating specific infection control strategies are needed.     

Proportion of mortality caused by severe hospital-acquired infection in open-heart surgery

OBJECTIVE: To investigate severe hospital-acquired infection as an independent risk factor for in-hospital mortality and the proportion of mortality caused by severe hospital-acquired infections in patients under going open-heart surgery. SETTING: A 1,300-bed teaching hospital in Spain. METHODS: A retrospective cohort study of 702 patients who underwent open-heart surgery procedures between January 1989 and December 1991. The mean age was 57 years, and 68% of the subjects were men. Of the 702 patients, 42% underwent a valve operation, 41% had coronary artery bypass grafting, 4% had both a valve operation and coronary artery bypass grafting, 5% underwent repair of congenital heart disease, and 8% had other surgical procedures. RESULTS: The cumulative incidence of severe hospital infection was 16.8%. The overall mortality rate was 5.4%. The mortality risk was 5.15 times higher in nosocomially infected patients than in uninfected patients. In addition, univariate analysis revealed up to 18 perioperative variables associated with in-hospital mortality. By multiple logistic regression, we identified four factors that independently predicted increased risk of mortality: preoperative New York Heart Association functional class level IV; long duration of cardiopulmonary bypass; low cardiac output syndrome; and severe hospital-acquired infection. The proportion of mortality caused by severe hospital-acquired infection in the cohort was 31.1%. CONCLUSIONS: Severe hospital-acquired infection is a principal factor in in-hospital mortality. One third of all deaths are caused by infection. Major efforts should be devoted to the prevention and control of severe nosocomial infections in open-heart surgery patients to prevent mortality.     

The prevalence and estimates of the cumulative incidence of hospital-acquired infections among patients admitted to Auckland District Health Board Hospitals in New Zealand.

OBJECTIVES: To report the pooled results of seven prevalence surveys of hospital-acquired infections conducted between November 1996 and November 1999, and to use the data to predict the cumulative incidence of hospital-acquired infections in the same patient group. DESIGN: The summary and modeling of data gathered from the routine surveillance of the point prevalence of hospital-acquired infections. SETTING: Auckland District Health Board Hospitals (Auckland DHBH), the largest publicly funded hospital group in New Zealand supplying secondary and tertiary services. PATIENTS: All inpatients. METHOD: Point-prevalence surveys were conducted including all patients in Auckland DHBH. Standard definitions of hospital-acquired infection were used. The data from the seven surveys were pooled and used in a modeling exercise to predict the cumulative incidence of hospital-acquired infection. An existing method for the conversion of prevalence to cumulative incidence was applied. Results are presented for all patients and stratified by clinical service and site of hospital-acquired infection. RESULTS: The underlying patterns of hospital-acquired infection by site and service were stable during the seven time periods. The prevalence rate for all patients was 9.5%, with 553 patients identified with one or more hospital-acquired infections from a population of 5,819. The predicted cumulative incidence for all patients was 6.33% (95% confidence interval, 6.20% to 6.46%). CONCLUSIONS: The prevalence and the predicted cumulative incidence are similar to rates reported in the international literature. The validity of the predicted cumulative incidence derived here is not known. If it were accurate, then the application of this method would represent a cost-effective alternative to incidence studies.     

Hospital-acquired infection with Streptococcus pneumoniae

A prospective survey was carried out in the winter of 1983-84 to determine the incidence of hospital-acquired pneumococcal chest infection in a district general hospital. Twenty-one patients (of a total of 103 infected with Streptococcus pneumoniae) were assessed as having hospital-acquired infection. The implication of this and the need for further studies are discussed.     

Comparison of hospital-acquired infection rates in paediatric burn patients

The objective of the present study was to determine risk factors for development of the most common hospital-acquired infections in paediatric burn patients in order to give recommendations for surveillance. The prospective cohort study in a paediatric burn centre was conducted over a period of two years using uni- and multivariate analysis for risk factor identification. In a group of 41 children with an mean total burn surface area (TBSA) of 18.9% 42 hospital-acquired infections were observed. The overall infection rate was 59.7 nosocomial infections per 1000 patient days, the device-associated nosocomial infection rates per 1000 device days were 55.2 for pneumonia, 8.9 for primary bloodstream infections and 41.7 for urinary tract infections. The incidence density of burn wound infections was 18.5 per 1000 patient days. The percentage of TBSA was a significant risk factor for burn wound infections, but percentage of TBSA was not a risk factor for the device-associated infections. Duration of urinary catheter use and ventilation were identified as risk factors for the corresponding hospital-acquired infection. Surveillance of hospital-acquired infections in burn intensive care units should be performed in the same way as other intensive care unit types, as recommended by the National Nosocomial Infections Surveillance system, without consideration of the percentage of TBSA. In addition, burn wound infections should be recorded using the percentage of TBSA for stratification of burn wound infection rates.     

2014年贵州省某三甲医院医院感染横断面调查分析

摘要:目的　了解医院感染现状,为医院感染防控措施的制定提供依据,并评价实时监控系统的灵敏性及特异性。方法　采用横断面调查和病历调查相结合方法进行医院感染横断面调查。结果　2014年医院感染现患率为3.47%,感染例次率为4.15%。科室分布以ICU感染率最高,为47.37%;感染部位以下呼吸道占首位,为55.56%;医院感染病原菌以革兰阴性菌为主,主要病原菌为肺炎克雷伯菌、铜绿假单胞菌、大肠埃希菌及鲍曼不动杆菌等。结论　对医院感染现患率高的科室,应提高医务人员医院感染控制意识,加强对医院危险因素及重点环节的管理,有效降低医院感染的发生;对医院感染误报率高的科室应提高医院感染正确诊断水平;我院使用的实时监测系统对于医院感染病例的监测有良好的敏感性和特异性。     

Surveillance for hospital-acquired infections on surgical wards in a Dutch university hospital.

OBJECTIVES: To determine incidence rates of hospital-acquired infections and to develop preventive measures to reduce the risk of hospital-acquired infections. METHODS: Prospective surveillance for hospital-acquired infections was performed during a 5-year period in the wards housing general and vascular, thoracic, orthopedic, and general gynecologic and gynecologic-oncologic surgery of the University Medical Center Utrecht, the Netherlands. Data were collected from patients with and without infections, using criteria of the Centers for Disease Control and Prevention. RESULTS: The infection control team recorded 648 hospital-acquired infections affecting 550 (14%) of 3,845 patients. The incidence density was 17.8 per 1,000 patient-days. Patients with hospital-acquired infections were hospitalized for 19.8 days versus 7.7 days for patients without hospital-acquired infections. Prolongation of stay among patients with hospital-acquired infections may have resulted in 664 fewer admissions due to unavailable beds. Different specialties were associated with different infection rates at different sites, requiring a tailor-made approach. Interventions were recommended for respiratory tract infections in the thoracic surgery ward and for surgical-site infections in the orthopedic and gynecologic surgery wards. CONCLUSIONS: Surveillance in four surgical wards showed that each had its own prominent infection, risk factors, and indications for specific recommendations. Because prospective surveillance requires extensive resources, we considered a modified approach based on a half-yearly point-prevalence survey of hospital-acquired infections in all wards of our hospital. Such surveillance can be extended with procedure-specific prospective surveillance when indicated.     

Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery

A surveillance programme was started after a period of high infection rates in an orthopaedic surgical department. The programme was aimed at reducing infection rates in elective hip and knee replacement procedures, and at creating awareness of infection control practices in an acute hospital. Possible causes of the initial high infection rates were analysed and discussed with healthcare workers involved in orthopaedic surgery. No specific cause could be found but substantial logistic improvements were achieved by studying for five years that may have contributed to the reduction of postoperative infections. Surveillance is an important part of any hospital-acquired infection surveillance programme. Its success depends on the ability of the infection control practitioner (ICP) to form a partnership with the surgical staff. Creating a sense of ownership of the surveillance initiative amongst the surgical staff enhances co-operation and ensures that the best use is made of the information generated. It is not possible to eliminate surgical-site infections (SSI) completely, but by a process of sharing information we have been able to influence behaviour to reduce the incidence of SSI.     

A targeted strategy to wipe out Clostridium difficile

This study evaluated daily cleaning with germicidal bleach wipes on wards with a high incidence of hospital-acquired Clostridium difficile infection (CDI). The intervention reduced hospital-acquired CDI incidence by 85%, from 24.2 to 3.6 cases per 10,000 patient-days, and prolonged the median time between hospital-acquired CDI cases from 8 to 80 days.     

鼠伤寒沙门氏菌病医院内感染调查

1987年6月至1988年底,河南省商丘地区医院收治鼠伤寒沙门氏菌病140例。其中大部分病例为医院内感染,该病医院内感染率为14.6%,占全病例的55.7%。发病年龄主要为婴幼儿。引起医院内感染的主要传染源为院外感染的散发病例收治入院的患者。消毒隔离制度不严是引起传播的重要因素。该病全年均可发病,但高峰在第四季度。病原菌耐药性强,尤其院内感染菌株,导致住院时间延长,增加病人痛苦,所以医院内感染急待控制,必须高度重视。     

Unexpected hospital-acquired bacteraemia in patients at low risk of bloodstream infection: the role of a heparin drip

Following a cluster of cases of unexpected hospital-acquired bacteraemia suspected to be related to an intravenous (iv) heparin drip, all cases of hospital-acquired primary bloodstream infection (BSI) in patients at low risk of bacteraemia were analysed over a four-year period. Ninety-six bacteraemic patients (6%) from 1618 episodes of hospital-acquired bacteraemia had a peripheral iv line as the only risk factor. These patients were divided into two groups: 60 patients with phlebitis and 36 without local signs of inflammation. Baseline features of the two groups were comparable, but in univariate and multivariate analysis, a significant association was found between iv heparin use, predominance of Gram-negative organisms (especially Klebsiella, Serratia and Enterobacter species), and absence of phlebitis. In spite of clear statistical association, however, the means by which the heparin solution became contaminated with Gram-negative organisms remained unknown. Following implementation of infection control methods concerning heparin handling, no more cases occurred. Unexpected hospital-acquired Gram-negative bacteraemia in patients with peripheral iv lines should prompt investigation of potential infusate-related infection, especially in patients without phlebitis and those receiving iv heparin.     

Nosocomial H1N1 infection during 2010-2011 pandemic: a retrospective cohort study from a tertiary referral hospital

This study aimed to estimate the incidence of hospital transmission of influenza A subtype H1N1 [A(H1N1)], to identify high-risk areas for such transmission and to evaluate common characteristics of affected patients. In this single-centre retrospective cohort study, 10 patients met the criteria for hospital-acquired A(H1N1) infection over a three-month period. All affected patients required an escalation of their care and the mortality rate was 20%. Clinicians should be aware of the risk of nosocomial A(H1N1) infection that exists despite routine infection control measures and should consider additional control measures including vaccination of hospital inpatients and healthcare staff.     

急性白血病患者医院感染特点及相关危险因素

目的探讨儿童急性白血病（AL）患者医院感染的特点及相关危险因素。方法对2005年1月-2006年12月457例AL患者进行了临床调查分析。结果457例AL患者医院感染80例，医院感染率17．51％，感染例次率22．32％，感染部位以上呼吸道感染占首位，为42．16％；医院感染的发生与患者的年龄、住院时间、血红蛋白、中性粒细胞绝对值等有明显关系。结论积极治疗原发病，缩短平均住院日，提高中性粒细胞数及血红蛋白含量，严格规范使用抗菌药物，控制和预防医院感染发生。     

The organization of infection control in Italy.

This paper describes the organization of infection control in Italy with respect to regulatory requirements, the tasks and training of the infection control physician and nurse, and the function and responsibilities of the infection control committee. Moreover, the paper reports on incidence and prevalence of hospital-acquired infections (HAI), antibiotic usage and antimicrobial resistance in Italy.     

Risk factors for hospital-acquired methicillin-resistant Staphylococcus aureus bacteraemia: a case-control study

A case-control study was undertaken in an acute district general hospital to identify risk factors for hospital-acquired bacteraemia caused by methicillin-resistant Staphylococcus aureus (MRSA). Cases of hospital-acquired MRSA bacteraemia were defined as consecutive patients from whom MRSA was isolated from a blood sample taken on the third or subsequent day after admission. Controls were randomly selected from patients admitted to the hospital over the same time period with a length of stay of more than 2 days who did not have bacteraemia. Data on 42 of the 46 cases of hospital-acquired bacteraemia and 90 of the 92 controls were available for analysis. There were no significant differences in the age or sex of cases and controls. After adjusting for confounding factors, insertion of a central line [adjusted odds ratio (aOR) 35.3, 95% confidence interval (CI) 3.8-325.5] or urinary catheter (aOR 37.1, 95% CI 7.1-193.2) during the admission, and surgical site infection (aOR 4.3, 95% CI 1.2-14.6) all remained independent risk factors for MRSA bacteraemia. The adjusted population attributable fraction, showed that 51% of hospital-acquired MRSA bacteraemia cases were attributable to a urinary catheter, 39% to a central line, and 16% to a surgical site infection. In the United Kingdom, measures to reduce the incidence of hospital-acquired MRSA bacteraemia in acute general hospitals should focus on improving infection control procedures for the insertion and, most importantly, care of central lines and urinary catheters.     

Mandatory public reporting of hospital-acquired infection rates: a report from California

One way to motivate hospitals to improve patient safety is to publicly report their rates of hospital-acquired infections, as California is starting to do this year. We conducted a baseline study of California's acute care hospitals just before mandatory reporting of hospital-acquired infection rates to the state began, in 2008. We found variability in many areas: For example, 70.1 percent of hospitals said that they were fully implementing evidence-based guidelines to fight infection by methicillin-resistant Staphylococcus aureus, but 22.8 percent of hospitals had not adopted any. Our analysis showed that rural hospitals, many of which lack resources to implement needed procedures, faced the greatest challenges in reporting and improving infection rates. Our findings should be of interest to Medicare policy makers who will implement the hospital-acquired infection performance measures in the Affordable Care Act, and to leaders in the thirty-eight states that have enacted legislation requiring reports of hospital-acquired infection rates. California's baseline data also present a unique opportunity to assess the impact of mandatory and public reporting laws.     

Incidence, risk factors and outcome of infection in a 1-year hysterectomy cohort: a prospective follow-up study

A prospective study was performed following 687 patients who underwent abdominal, vaginal and laparoscopic hysterectomy for benign conditions in Turku University Hospital. This study evaluates and compares infection after hysterectomy and determines risk factors associated with postoperative infection. Infective episodes were recorded during hospital stay, convalescence for 4 to 6 weeks at home and for 1 year of follow-up. Factors found to be statistically significant for hospital-acquired infection on univariate analysis were subsequently assessed by means of multivariate analysis. During the hospital stay 23.7% of the study population became infected, 38.1% after vaginal hysterectomy, 23.4% after abdominal hysterectomy and 3.0% after laparoscopic hysterectomy. Over half of all hospital-acquired infections were lower urinary tract infections. Infection during convalescence occurred in 19.2% of patients: 29.5% in the vaginal hysterectomy group, 17.4% in the abdominal hysterectomy group and 16.7% in the laparoscopic hysterectomy group. One year of follow-up did not find any infection directly attributable to surgery. Five factors were found to be related to in-hospital infection on multivariate analysis. These were lack of antibiotic prophylaxis, blood loss during operation, intermittent catheterization, anaemia and medication for urinary or bowel dysfunction after operation.     

Hospital-acquired infection surveillance in a neurosurgical intensive care unit

A prospective study on hospital-acquired infection (HAI) was undertaken in the eight-bed neurosurgical intensive care unit (NSICU) of a teaching hospital in Rome, Italy. All patients admitted for >48 h between January 2002 and December 2004 were included. The infection control team collected the following data from all patients: demographic characteristics, patient origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated micro-organisms and antibiotic susceptibilities. Overall, 323 patients were included in the study. Mean age was 55.5 years (range 17-91), and mean American Society of Anesthesiologists' score was 2.88. Seventy (21.7%) patients developed 132 NSICU HAIs: 43 pneumonias, 40 bloodstream infections (BSIs), 30 urinary tract infections (UTIs), 10 cases of meningitis associated with an external ventricular drain (EVD) and nine surgical site infections (SSIs). The SSI rate was high (5.6%), but a reduction was achieved during the three-year period. There were 7.2 bloodstream infection episodes per 1000 days of device exposure; 11.00 pneumonias per 1000 days of mechanical ventilation and 4.5 UTIs per 1,000 days of urinary catheterisation. Among patients with an EVD, the SSI relative risk was 11.3 [95% confidence intervals (CI) 4.2-30.6; P<0.01]. Sixty-one (18.9%) patients died. Logistic regression analysis showed that mortality was significantly associated with infection [odds ratio (OR)=2.28; 95%CI 1.11-4.71; P=0.02] and age (OR=1.04; 95%CI 1.01-1.06; P=0.002). Candida spp. were the leading cause of UTIs (40.0%) and the third most common cause of BSIs (12.7%). Antibiotic-resistant pathogens included meticillin-resistant staphylococci (77.5%), carbapenem-resistant Pseudomonas aeruginosa (36.4%), and extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (75.0%). Although the overall incidence of infection (21.7%) was within the range of published data, the associated mortality, the increasing severity of illness of patients, and the emergence of multi-drug-resistant organisms shows the need to improve infection control measures.     

Surveillance of hospital-acquired infections in an intensive care department-the benefit of the full-time presence of an infection control nurse

In the 42-bed intensive care department of a teaching hospital, the creation of a full-time infection control nurse post was followed by a 42% reduction in device-related hospital-acquired infection rates over a period of three years, and 33% reduction over a period of five years. Permanent surveillance accompanied by revision of procedures and bedside teaching were key factors in the improvement of quality of care. In the specific setting of an intensive care department, this study validates the previous conclusions reached in the SENIC study and emphasizes the essential role played by the infection control nurse in the care of critically ill patients.