Hospital infections in surgical wards

Nosocomial infections are defined as these which develop during the patient's stay at hospital or shortly after its leaving. In Poland The Society of Nosocomial Infections has been trying to estimate the problem. To deal with it the card for registration of nosocomial infection has been developed. The data used in this project embraces the registration of the nosocomial infections in 1998. The registration cards were sent to the computer centre where they were analysed. 91 hospitals took part in the project. The material consisted of 301,813 cards. The number of patients taken into account in operative departments reached 170,036. In 2,384 cases nosocomial infections were discovered which is 1.4 per cent of all. Nosocomial infections were observed to be similarly frequent in regional hospitals and teashing hospitals. The immune system, not well developed (newborns) or weakened (old age) proroves the danger of nosocomial infection. The time of the infected patient's stay at hospital is twice longer than usually. It needs additional treatment, both operative and pharmacological, which is connected with high costs. The most common systems that usually get infected are respiratory, urinary and wounds. Clinical course of nosocomial infections is rather mild. The programme of nosocomial infections registration allows to better estimate the scale of the problem.     

Hospital infections in general surgery wards

In 1997 the hospital infections programme was accepted by the National Association for Infectious Diseases (Polskie Towarzystwo Zakazeń Szpitalnych--PTZSz). About 100 hospitals from Poland participated in the surveillence system introducing nosocomial infection registration cards in their units. The results of the research were sent to the PTZSz. The results from general surgery departments in 1998 were analysed. This year 79 general surgery units took part in nosocomial infection programme of PTZSz, sending from 1 to 2259 questionnaires. The analysis included 48,964 nosocomial infection registration cards. Nosocomial infection developed in 1,031 cases in the general surgery departments what accounted for 2.11% of all treated patient in that period. Surgical site infections were the most often place of nosocomial infections (37.1%), next skin and soft tissue infections (20.1%), and finally respiratory tract infections (17.6%). The average duration of hospitalization in general surgery departments was 10.2 days. In case of nosocomial infection occurrence the time of treatment was extended three times. The most frequent aetiological pathogenes of nosocomial infections were as follows: Escherichia coli and Staphylococcus aureus.     

Hospital infections with pigmented water bacteria.

Two types of cultures normally expected to be sterile, i.e., urine and blood, were chosen for review at a large university hospital. The bacteria isolated from urine cultures during 1966-70 and from blood cultures from 1966-73 are listed. Two organisms, Flavobacterium meningosepticum and Pseudomonas cepacia, were selected for more detailed study and review. The antibiotic susceptibility patterns for these two organisms are presented.     

Hospital acquired infections caused by hepatitis C virus

The purpose of the paper was to present opinions endosed in the literature regarding risk factors, modes of transmission and sources of hepatitis C virus (HCV) infections in the hospital settings. Infections occurring among health care workers and patients, residual risks to the blood supply and blood transfusion, routes of hepatitis C transmission in haemodialysis centers were analyzed. In the paper significance of disinfection, sterilization, work practices designed to minimize or eliminate exposure, and use of personal protective equipment (universal precautions) wa showed. The importance of the invasive diagnostic and therapeutic procedures in HCV transmission was stressed. Based on the presented findings, procedures to prevent nosocomial infections of HCV should be defined and implemented in all hospitals.     

Characteristics of Staphylococcus aureus infections, Chicago Pediatric Hospital

Invasive and skin community-associated (CA)-methicillin-resistant Staphylococcus aureus isolates from children were matched with invasive CA-methicillin-sensitive S. aureus strains during 2000-2004. Isolates were analyzed for presence of Panton-Valentine leukocidin. A USA400 lineage clone (n = 6) and the predominant USA300 lineage clone emerged.     

Hospital economic impact of an outbreak of Pseudomonas aeruginosa infections

A total of 67 patients involved in an outbreak of Pseudomonas aeruginosa in the intensive care unit (ICU) were retrospectively followed to determine whether case patients experienced differences in cost, length of stay and survival rates when compared with non-affected patients. The method of microcosting, a technique that involves detailed identification and measurement of all care items and services offered by the hospital, was used to identify attributable costs related to diagnostic procedures, pharmacy and ICU stay of each patient. Seventeen patients developed nosocomial P. aeruginosa infection. On average, these patients incurred adjusted hospital costs of euro 27,917, 66% higher than non-case patients (P=0.002). The extra length of ICU stay attributable to P. aeruginosa infection was 70 days (P=0.0001). In multiple linear regression analysis, we found that P. aeruginosa infection was an independent predictor of increased hospital costs and length of hospital stay. On the basis of these findings, a conservative estimate of the extra cost attributable to P. aeruginosa infection in our ICU was euro 312,936 (95% confidence interval: 305,676-320,196).     

Five-year surveillance of nosocomial infections in Ankara Training and Research Hospital

The objective of this study was to assess the rate of nosocomial infections (NIs), frequency of nosocomial pathogens and antimicrobial susceptibility changes in a 530-bed hospital over a five-year period. Hospital-wide laboratory-based NI surveillance was performed prospectively between 1999 and 2003. The Centers for Disease Control and Prevention's definitions were used for NIs and nosocomial surgical site infections, and NI rates were calculated by the number of NIs per number of hospitalized patients on an annual basis. NI rates ranged between 1.4% and 2.4%. Higher rates were observed in the neurology, neurosurgery, paediatric and dermatology departments; the low rate of NIs overall may be due to the surveillance method used. The most commonly observed infections were urinary tract, surgical site and primary bloodstream infections, and the most frequently isolated pathogens were Escherichia coli, Klebsiella pneumoniae, Enterococcus spp. and Staphylococcus aureus. Carbapenems were the most effective agents against enterobacteriaceae. Meticillin resistance among S. aureus isolates was less than 50%, and all S. aureus and Enterococcus spp. isolates were susceptible to glycopeptides apart from one glycopeptide-resistant E. faecium isolate identified in 2003. Data obtained by the same method enabled comparison between years and assisted in the detection of recent changes. Antimicrobial susceptibility data on nosocomial pathogens provided valuable guidance for empirical antimicrobial therapy of NIs.