Prevalence of nosocomial infections and use of antibiotics in long-term care facilities in Norway, 2002 and 2003

There were 42900 institution-beds in long-term care facilities for elderly persons in Norway in 2000. This is twice as many as in 1984. Of those living in an elderly people's care institution 77% were above 80 years. To determine the magnitude and distribution of nosocomial infections in such institutions, the Norwegian Institute of Public Health initiated a surveillance system. The system is based on two annual one-day prevalence surveys recording the four most common nosocomial infections: urinary tract infections, lower respiratory tract infections, surgical-site infections and skin infections, as well as antibiotic use. All long-term care facilities were invited to participate in the four surveys in 2002 and 2003. The total prevalence of the four recorded nosocomial infections varied between 6.6 and 7.3% in the four surveys. Nosocomial infections occurred most frequently in the urinary tract (50%), followed by infections of the skin (25%), of the lower respiratory tract (19%) and of surgical sites (5%). The prevalence of nosocomial infections was highest in rehabilitation and short-term wards, whereas the lowest prevalence was found in special units for persons with dementia. In all the surveys the prevalence of the four recorded nosocomial infections was higher than the prevalence of patients receiving antibiotics. The frequency of nosocomial infections in such facilities highlights the need for nosocomial infection surveillance in this population and a need to implement infection control measures, such as infection control programmes including surveillance of nosocomial infections.     

Nosocomial infections and misuse of antibiotics in a provincial community hospital, Saudi Arabia

The incidence of nosocomial infection and prevalence of antibiotic misuse were studied in a 174-bed community hospital in Saudi Arabia over a six-month period. Of 2445 patients admitted, 8.5% developed nosocomial infection, the rates were highest for nursery (35.8%), intensive care (19.8%), gynaecological (16.2%) and surgical (11.7%) patients. Urinary tract (31.3%), wound (27.1%) and blood (14.9%) infections accounted for more than 70% of the infections. Staphylococcus aureus (23%) and Pseudomonas aeruginosa (11%), caused more than 90% of the infections. The majority of the bacterial pathogens (79%) were multi-drug resistant. Over 80% of patients were administered prophylactic and/or therapeutic antibiotics, with 53% receiving multiple antibiotics; 72% of the antibiotics were judged to be misused. Both prophylaxis and treatment were mostly misguided and clinically unwarranted. Host- and hospital-associated infection risk factors were identified. The minimum government cost estimates for the nosocomial infections and misused antibiotics were US $273 180 and $565 603, respectively. The findings emphasize the need for effective measures to reduce both the high infection rates and widespread antibiotic misusage in the hospital. Such measures should include institution of an effective infection control committee and a hospital antibiotic policy.     

Nosocomial pneumonia in a Canadian tertiary care center: a prospective surveillance study

OBJECTIVE: To determine the contribution of etiologic agents, including Legionella pneumophila and respiratory viruses to nosocomial pneumonia at a tertiary care center. DESIGN: Prospective surveillance of nosocomial pneumonia with standardized laboratory investigations. SETTING: A 1,100-bed tertiary care center. PATIENTS: All adult inpatients. RESULTS: One hundred and thirty-five Nosocomial pneumonias (5.7/1,000 discharges) were identified. Four (3.0%) were L pneumophila serogroup 1 infections (0.17/1,000 discharges). Legionellosis occurred in non-high-risk patients, and three cases would not have been identified without active surveillance. Viral seroconversion was identified in seven (19%) of 36 cases with specimens available (0.59/1,000 discharges): five influenza B, one influenza A, and one respiratory syncytial virus. IgM serology was positive in one case each for Mycoplasma pneumoniae and Chlamydia species. No geographical clustering was observed for viral infections, and these would not have been identified without active surveillance. Mortality for all nosocomial pneumonia was 25%. Patient factors significantly associated with a poorer outcome included older age, underlying disease, low serum albumin, renal insufficiency, lower platelet count, endotracheal intubation, respiratory failure, bacteremia, and use of antacids. CONCLUSIONS: This prospective surveillance suggested that L pneumophila and viral agents were uncommon causes of nosocomial pneumonia at our institution during this surveillance period.     

Use of the French medico-administrative database (PMSI) to detect nosocomial infections in the University hospital of Lyon

BackgroundSurveillance is an effective element in the fight against nosocomial infections, but the monitoring methods are often cumbersome and time consuming. The detection of infection in computerized databases is a means to alleviate the workload of health care teams. The objective of this study was to evaluate the performance of using discharge summaries in medico-administrative databases (PMSI) for the identification of nosocomial infections in surgery, intensive care and obstetrics.MethodsThe retrospective assessment study included patients who were hospitalized in general surgery, intensive care and obstetrics at different periods of time in 2006 and 2007 depending on the wards. Patients were monitored according to standard protocols which are coordinated at the regional level by the Southeast coordinating centre (CCLIN). The performance of identifying cases of nosocomial infection from discharge diagnoses coded by using the International Classification of Diseases (tenth revision) was evaluated by a study of sensitivity, specificity, positive and negative predictive values with their 95% confidence intervals.ResultsUsing a limited number of diagnostic codes, the sensitivity and specificity were, respectively, 26.3% (95% CI 13.2–42.1) and 99.5% (95% 98.8–100.0) for the identification of surgical site infections. By expanding the number of diagnostic codes, the sensitivity and specificity were 78.9% (95% CI 65.8–92.1) and 65.7% (95% CI 61.0–70.3). The sensitivity and specificity for case identification of nosocomial infections in intensive care were 48.8% (95% CI 42.6–55.0) and 78.4% (95% CI 76.1–80.1), and were 42.9% (95% CI 25.0–60.7) and 87.3% (95% CI 85.2–89.3) for identification of postpartum infections.ConclusionThe PMSI is not a sufficiently efficient method in terms of sensitivity to be used in surveillance of nosocomial infections. A reassessment of the PMSI must be considered, with changes in coding of comorbidity that occurred in 2009.     

Epidemiology of nosocomial bacterial infections in a neonatal and pediatric Tunisian intensive care unit

OBJECTIVE: The authors had for aim to describe the epidemiology of nosocomial bacterial infections in the neonatal and pediatric intensive care unit of the Tunis children's hospital. DESIGN: A prospective surveillance study was made from January 2004 to December 2004. All patients remaining in the intensive care unit for more than 48 h were included. CDC criteria were applied for the diagnosis of nosocomial infections. RESULTS: 340 patients including 249 (73%) neonates were included. 22 patients presented with 22 nosocomial bacterial infections. The incidence and the density incidence rates of nosocomial bacterial infections were 6.5% and 7.8 per 1,000 patient-days, respectively. Two types of infection were found: bloodstream infections (68.2%) and pneumonias (22.7%). Bloodstream infections had an incidence and a density incidence rate of 4.4% and 15.3 per 1,000 catheter-days, respectively. Pneumonia had an incidence and a density incidence rate of 2% and 4.4 per 1,000 mechanical ventilation-days, respectively. The most frequently isolated pathogens were Gram-negative bacteria (68%) with Klebsiella pneumoniae isolates accounting for 22.7%. The most common isolate in bloodstream infections was K. Pneumoniae (26.7%), which was multiple drug-resistant in 85% of the cases, followed by Staphylococcus aureus (20%). Pseudomonas aeruginosa was the most common isolate in pneumonia (28.6%). Associated factors of nosocomial infection were invasive devices and colonization with multiple drug-resistant Gram-negative bacteria. CONCLUSIONS: The major type of nosocomial bacterial infections in our unit was bloodstream infection and the majority of infections resulted from Gram-negative bacteria. Factors associated with nosocomial bacterial infections were identified in our unit.     

Relationship between nosocomial infection and mortality in a neurology intensive care unit in Turkey

Few previous studies have evaluated the relationship between nosocomial infection and mortality in a neurology intensive care unit (ICU). In this study, patients treated for more than 24h in the neurology ICU of the Ankara Training and Research Hospital, Turkey were followed until death or two days after discharge by prospective daily surveillance. The study period was 14 months. One hundred and sixty-nine ICU-acquired infections occurred in 74 (38.9%) of 190 patients during 2006 patient-days. The overall rate of ICU-acquired nosocomial infection was 88.9/100 patients and 84.2/1000 patient-days. While the overall mortality rate was 60%, mortality in patients with nosocomial infections was 69%. In univariate analysis, infection (nosocomial and community-acquired) (P=0.002), nosocomial infection (P<0.05), mechanical ventilation (P<0.0001), presence of two or more underlying diseases (P=0.01), parenteral nutrition (P<0.0001), steroid treatment (P=0.003) and a low Glasgow Coma Scale (GCS) score (P=0.0001) were identified as risk factors for mortality. Stepwise logistic regression analysis showed nosocomial infection (P<0.05), mechanical ventilation (P=0.009), the presence of two or more underlying diseases (P<0.05) and a low GCS score (P=0.0001) to be risk factors for ICU mortality. It was concluded that nosocomial infection increases the risk of mortality by a factor of 1.69. The impact of nosocomial infection on mortality in our ICU was higher in patients with high GCS scores and patients aged between 66 and 75 years. In particular, nosocomial infection increased mortality among patients with less severe illnesses.     

Association between APACHE II score and nosocomial infections in intensive care unit patients: A multicenter cohort study

Objective To examine whether nosocomial infection risk increases with APACHE II score, which is an index of severity-of-illness, in intensive care unit (ICU) patients. Methods Using the Japanese Nosocomial Infection Surveillance database, 8,587 patients admitted to 34 participating ICUs between July 2000 and May 2002, aged 16 years or older, who had stayed in the ICU for 2 days or longer, had not transferred to another ICU, and had not been infected within 2 days after ICU admission, were followed until ICU discharge, Day 14 after ICU admission, or the development of nosocomial infection. Adjusted odds ratios with their 95% confidence intervals for nosocomial infections were calculated using logistic regression models, which incorporated sex, age, operation, ventilator; central venous catheter, and APACHE II score (0–5, 6–10, 11–15, 16–20, 21–25, 26–30, and 31+). Results There were 683 patients with nosocomial infections. Adjusted odds ratios for nosocomial infections gradually increased with APACHE II score. Women and elective operation showed significantly low odds ratios, while urgent operation, ventilator, and central venous catheter showed significantly high odds ratios. Age had no significant effect on the development of nosocomial infection. Conclusions Nosocomial infection risk increases with APACHE II score. APACHE II score may be a good predictor of nosocomial infections in ICU patients.     

Trauma case mix and hospital payment: the potential for refining DRGs.

Uniform hospital discharge abstract data from Maryland were used to examine the homogeneity of trauma-related DRGs with respect to a well-established measure of injury severity, the Injury Severity Score (ISS). Thirty DRGs were identified as including trauma cases with a wide range of severity; for each of these DRGs, ISS explains a significant amount of variation in length of stay. By applying statistical techniques similar to those used to create the original DRG groupings, these 30 DRGs were subdivided by severity and age categories to create a new set of severity-modified DRGs. The potential effects of using DRGs and modified DRGs to pay for inpatient care within the Maryland state regionalized system of trauma care were examined. Payments based on regional averages per DRG and per modified DRG were compared to actual hospital charges regulated by the state's Health Services Cost Review Commission. Using average charges per DRG as a basis of payment, approximately !1.4 million (11 percent of total hospital charges) would be shifted from trauma centers to nontrauma centers. This shift represents an 18 percent loss in revenues to trauma centers and a 30 percent gain in revenues to nontrauma centers. Using a payment system based on severity-modified DRGs, trauma centers would still experience a net loss in revenues and the nontrauma centers a net gain, but the total amount of the shift would be reduced from $11.4 million to $9.8 million. The results argue for the need to explore alternative payment systems not strictly based on current DRGs. Because of DRGs do not adequately reflect severity differences, using them to pay hospitals will create financial incentives that discourage regionalization of trauma care.     

Multiple nosocomial infections. An incidence study

Prospective surveillance for nosocomial infections was performed for a five-year admission cohort (1980-1984) at North Carolina Memorial Hospital. One or more nosocomial infections developed in 2,662 patients (2.6%) from 102,206 patients at risk; greater than or equal to 2 nosocomial infections developed in 775 of these 2,662 patients (29.1%), and greater than or equal to 3 nosocomial infections in 304 of 775 patients with greater than or equal to 2 infections (39.2%). Hospital stay was significantly prolonged for infected compared with never-infected patients (38.1 vs. 7.9 days, p less than 0.0001) and for multiply-infected versus once-infected patients (57.9 vs. 30.0 days, p less than 0.0001). Total nosocomial infections numbered 4,031 with 2,144 multiple infections (53%); the average number of nosocomial infections per infected patient was 1.5 (4,031 infections in 2,662 patients). Among all nosocomial infections, 64% of bacteremias, 55% of respiratory infections, 55% of surgical wound infections, and 40% of urinary tract infections occurred in patients with multiple nosocomial infections. Surgical patients had 56% of multiple infections. Intensive care unit patients had significantly more multiple infections than non-intensive care unit patients. Nosocomial infections in intensive care unit patients were 71% multiple nosocomial infections. The probability of developing multiple infections was 11 times greater after the first infection occurred. This emphasizes the need to prevent initial nosocomial infections and to identify risk factors for multiple nosocomial infections. Determining risk factors for multiple nosocomial infections could focus infection control efforts on a subpopulation of patients who acquire over 50% of all nosocomial infections and who have significantly prolonged and costly hospital stays.     

An approach to the study of potentially preventable nosocomial infections.

OBJECTIVE: To analyze a method that identifies potentially preventable nosocomial infections, as a tool to evaluate the performance of infection control programs through quantification of their potential for reducing nosocomial infections. METHODS: The database of the Study of the Prevalence of Nosocomial Infections in Spain (EPINE) was reanalyzed. The method was based on the use of false negatives of the classification table obtained from application of a fixed multiple logistic regression model, as an estimator of the number of potentially preventable nosocomial infections. RESULTS: The calculated number of patients with preventable infections was 7,493, which constituted 21.6% of the infected patients. Among hospital areas, intensive care had the lowest preventability rate (4.6%), whereas gynecology and obstetrics had the highest (40.6%). There was a significant inverse exposure-effect relationship between the proportion of preventable infections and the National Nosocomial Infections Surveillance (NNIS) System risk index. No correlation was observed between the prevalence of patients with nosocomial infection and the percentage of preventable infections. CONCLUSION: This analysis suggests that fewer nosocomial infections may be preventable in Spanish hospitals than previously assumed.     

Impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit.

OBJECTIVE: To identify factors predictive of length of stay (LOS) and the level of functional improvement achieved among patients admitted to an acute rehabilitation unit for the first time, with special reference to the role of nosocomial infection. SETTING: A 40-bed acute rehabilitation unit within a 300-bed, tertiary-care, public, university-affiliated hospital. STUDY POPULATION: All patients admitted to the unit between January 1997 and July 1998. DESIGN: Prospective cohort study in which demographic and clinical data, including occurrence of nosocomial infection, were collected during the entire unit admission of each patient. Multivariate linear regression analysis was used to identify factors predictive of unit LOS or improvement in functional status as measured by the change in the Functional Independence Measure (FIM) score between admission and discharge (deltaFIM). RESULTS: There were 423 admissions to the rehabilitation unit during the study period, of which 91 (21.5%) had spinal cord injury (SCI) as a principal diagnosis. One hundred seven nosocomial infections occurred during 84 (19.9%) of the 423 admissions. The most common infections were urinary tract (31.8% of all infections), surgical-site (18.5%), and Clostridium difficile diarrhea (15%). Only one patient died of infection. After controlling for severity of illness on admission, functional status on admission, age, and other clinical factors, the significant positive predictors of unit LOS were as follows: SCI (P<.001), pressure ulcer (.002), and nosocomial infection (<.001). Significant negative predictors of deltaFIM were age (P<.001), FIM score on admission (<.001), prior hospital LOS (.002), and nosocomial infection (.007). CONCLUSIONS: Several variables were identified as contributing to a longer LOS or to a smaller improvement in functional status among patients admitted for the first time to an acute rehabilitation unit. Of these variables, only nosocomial infection has the potential for modification. Studies of new approaches to prevent infections among patients undergoing acute rehabilitation should be pursued.     

192例老年关爱病房医院感染患者的护理对策

目的 研究老年关爱病房医院感染患者的临床特点、危险因素及护理对策.方法 回顾性调查2006年1月-2010年12月老年关爱病房192例＞75岁医院感染患者的临床资料进行综合分析.结果 医院感染291例次,以呼吸道感染为首占55.0％,其次为泌尿道感染占27.5％、消化道感染占5.8％、皮肤感染占5.2％;医院感染与老年患者长期卧床、免疫力低下、住院时间长、基础疾病多、广泛应用抗菌药物、应用激素、侵入性操作等密切相关.结论 老年关爱病房医院感染发生率高,危险因素多,护理工作必须采取积极的对策进行防范.     

Risk factors for nosocomial infection during extracorporeal membrane oxygenation

An increasing number of patients receive extracorporeal membrane oxygenation (ECMO) for life support. This study aimed to investigate the incidence and risk factors for nosocomial infection in adult patients receiving ECMO. We reviewed the medical records of adult patients who received ECMO support for more than 72 h at Far Eastern Memorial Hospital from 2001 to 2007. ECMO-related nosocomial infections were defined as infections occurring from 24 h after ECMO initiation until 48 h after ECMO discontinuation. There were 12 episodes of nosocomial infection identified in 10 of the 114 (8.77%) patients on ECMO, including four cases of pneumonia, three cases of bacteraemia, three surgical site infections and two urinary tract infections. The incidence of ECMO-related nosocomial infection was 11.92 per 1000 ECMO-days. The length of ECMO use and intensive care unit (ICU) stay were significantly different between patients with, and without, nosocomial infection (P < 0.001). More than 10 days of ECMO use was associated with a significantly higher nosocomial infection rate (P = 0.003). Gram-negative bacilli were responsible for 78% of the nosocomial infections. In the univariate analysis, the duration of ICU stay and duration of ECMO use were associated with nosocomial infection. In the multivariate analysis, only the duration of ECMO was independently associated with nosocomial infection (P = 0.007). Overall, the only independent risk factor for ECMO-related nosocomial infection identified in this study was prolonged ECMO use.     

Quality management for preventing healthcare-acquired infections. The importance of surveillance

Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.     

整形修复科手术室医院感染的控制与管理

目的 探讨整形修复科手术室医院感染的预防与管理方法,防止医院感染,确保医疗护理安全及质量.方法 针对整形修复科手术室的工作特点,加强医院感染控制管理,落实医院感染管理的规章制度和工作规范,严格执行有关技术操作规范和工作标准,有效预防和控制医院感染,防止医院感染对患者造成的危害,确保患者和工作人员的身体健康,创造合格的手术环境.结果 2009年3月-2011年6月共进行整形修复手术3026例,从未因手术室各环节因素造成的医院感染.结论 严格贯彻落实医院感染控制管理制度,可有效防止医院感染的发生,是整形手术医疗安全和质量的重要保障.     

A survey of nosocomial infections and their influence on hospital mortality rates

Nosocomial infections play an important role in contributing to hospital mortality. In order to obtain a large sample a survey was conducted between 1978 and 1989 of more than 66000 patients in German acute care hospitals. The data were used to assess the influence of nosocomial infections on mortality rates. Hospital infections were more frequent in female patients, but mortality with or without nosocomial infection was higher in male patients. Nosocomial infections increased hospital mortality threefold when raw numbers were used. Controlling for age and sex, the existence of at least one nosocomial infection (diagnosed at the second or a later day of hospital stay) increased hospital mortality by a factor of two. The influence of nosocomial infections was shown to be small for some diseases, such as malignancy, but was greater for others such as metabolic and immunological diseases or trauma. In the case of trauma, nosocomial infections increased hospital mortality rates by a factor of three even after controlling for age.     

Assessment of the value of repeated point-prevalence surveys for analyzing the trend in nosocomial infections.

OBJECTIVE: To assess the value of repeated point-prevalence surveys in measuring the trend in nosocomial infections after adjustment for case mix. SETTING: A 3,500-bed teaching facility composed of 4 acute care hospitals. METHODS: From May 1992 to June 1996, eight point-prevalence surveys of nosocomial infections were performed in the hospitals using a sampling process. The trend of adjusted nosocomial infection rates was studied for the four surveys that collected data on indwelling catheters. Adjusted rates were calculated using a logistic regression model and a direct standardization method. RESULTS: From 1992 to 1996, a total of 20,238 patients were included in the 8 point-prevalence surveys. The nosocomial infection rate decreased from 8.6% in 1992 to 5% in 1996 (P < .001). The analysis of adjusted nosocomial infection rates included 9,600 patients. Four independent risk factors were identified: length of stay greater than 12 days, hospitalization in an intensive care unit, presence of an indwelling urinary catheter, and history of a surgical procedure. After adjustment for case mix, the nosocomial infection rate still showed a downward trend (from 7.2% in 1993 to 5.1% in 1996; P = .02). CONCLUSION: Adjusted prevalence rates of nosocomial infections showed a significant downward trend during the period of this study.     

超声科侵入性操作医院感染管理

目的 探讨超声科侵入性操作医院感染控制措施,提高侵入性操作的安全性.方法 参照国家法律法规,修订超声科医院感染管理制度及检查评分标准,不定期督查医院感染管理制度落实整改情况,体现持续质量改进;对开展超声引导下穿刺及术中超声的患者由院感科专职人员进行目标性监测,了解医院感染发生率.结果 2011年开展了超声侵入性检查及治疗共40 233例,其中经阴道超声检查35 413例,经直肠超声检查3688例,超声引导下穿刺833例,术中超声299例,患者间均未发生医院感染和手术切口感染;医务人员标准预防措施落实,手卫生依从性＞80.0％.结论 落实超声科侵人性操作的医院感染控制措施是防止医院感染、减少或避免各种并发症、保证治疗成功的重要环节.     

眼科住院患者医院感染分析与对策

目的 探讨眼科住院患者医院感染的危险因素及其预防与控制措施.方法 对2006年1月-2010年12月眼科住院患者医院感染危险因素进行回顾性调查与分析.结果 眼科住院患者2464例,发生医院感染62例,感染率为2.52％;危险因素包括年龄、并发症、住院天数、手术等.结论 医院感染管理是现代医院管理中的一项重要内容,加强医院感染管理是全面控制医院感染,提高医疗质量,保证医疗安全的重要环节,严格无菌操作,合理使用抗菌药物,减少医院感染的发生.     

NICU医院感染相关因素及护理对策

目的 探讨新生儿重症监护病房(NICU)医院感染影响因素及护理对策.方法 2009年1月-2010年12月NICU患儿作为研究对象,以合并医院感染患儿为观察组,按照1∶1比例选择无医院感染患儿为对照组,比较两组发生医院感染的危险因素.结果 572例新生儿中发生医院感染50例占8.7％,单因素x2及t检验7个变量,是NICU医院感染的相关因素,差异有统计学意义(P＜0.05);logistic回归分析医院感染的相关因素为:日龄小、实施侵入性操作、应用抗菌药物、非母乳喂养,OR值分别为3.32、3.13、2.87、2.80.结论 NICU医院感染发生率较高,与多种因素有关,应针对相关因素实施护理措施.