Hostname: page-component-7479d7b7d-m9pkr Total loading time: 0 Render date: 2024-07-13T05:33:44.000Z Has data issue: false hasContentIssue false
  • English
  • Français

Surveillance and Infection Control in an Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Giovanni Battista Orsi ,
Massimiliano Raponi ,
Cristiana Franchi ,
Monica Rocco ,
Carlo Mancini  and
Mario Venditti
Giovanni Battista Orsi*
Affiliation:
Department of Public Health Sciences, University “La Sapienza” Rome, Rome, Italy Infection Control Committee (CIO) of the Policlinico Umberto I, Rome, Italy
Massimiliano Raponi
Affiliation:
Department of Public Health Sciences, University “La Sapienza” Rome, Rome, Italy
Cristiana Franchi
Affiliation:
Division of Infectious Diseases, Internal Medicine Department, Policlinico Umberto I, Rome, Italy
Monica Rocco
Affiliation:
Intensive Care Unit, Policlinico Umberto I, Rome, Italy
Carlo Mancini
Affiliation:
Department of Public Health Sciences, University “La Sapienza” Rome, Rome, Italy
Mario Venditti
Affiliation:
Division of Infectious Diseases, Internal Medicine Department, Policlinico Umberto I, Rome, Italy
*
Dipartimento di Sanità Pubblica, Università “La Sapienza” Roma, P. le Aldo Moro 5, 00185 Roma, Italygiovanni.orsi@uniromal.it
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality.

Design:

Prospective study.

Setting:

A 2,000-bed, university-affiliated hospital in Italy.

Patients:

All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001.

Methods:

The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility.

Interventions:

Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified.

Results:

Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P <.05).

Conclusion:

Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAIs and mortality.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 3 , March 2005 , pp. 321 - 325
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Eggimann, P, Pittet, D. Infection control in the ICU. Chest 2001;120: 2059–2093.Google Scholar
2.Fridkin, SK, Welbel, SF, Weinstein, RA. Magnitude and prevention of nosocomial infections in the intensive care unit. Infect Dis Clin North Am 1997;11:479–496.CrossRefGoogle ScholarPubMed
3.Jarvis, WR, Edwards, JR, Culver, DH, et al.Nosocomial infection rates in adult and pediatric intensive care units in the United States. Am J Med 1991;91(suppl 3B):185S–191S.CrossRefGoogle ScholarPubMed
4.Moro, ML, Stazi, MA, Marasca, G, Greco, D, Zampieri, A. National prevalence survey of hospital-acquired infections in Italy 1983. J Hosp Infect 1986;8:72–85.Google Scholar
5.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-April 2000, issued June 2000. Am J infect Control 2000;28:429–448.Google Scholar
6.Spencer, RC. Epidemiology of infection in ICUs. Intensive Care Med 1994;20:S2–S6.Google Scholar
7.Trilla, A. Epidemiology of nosocomial infections in adult intensive care units. Intensive Care Med 1994;20(suppl 3):S1–S4.Google Scholar
8.Vincent, JL, Bihari, DJ, Suter, PM, et al.The prevalence of nosocomial infection in intensive care units in Europe. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed
9.Orsi, GB, Di Stefano, L, Noah, ND. Hospital-acquired, laboratory confirmed bloodstream infection: increased hospital stay and direct costs. Infect Control Hosp Epidemiol 2002;23:190–197.Google Scholar
10.Pittet, D, Tarara, D, Wenzel, RP. Nosocomial bloodstream infection in critically ill patients: excess length of stay, extra costs and attributable mortality. JAMA 1994;271:1598–1601.CrossRefGoogle ScholarPubMed
11.Haley, RW, Culver, DH, White, JW, et al.The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.Google Scholar
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. In: Olmsted, RN, ed. APIC Infection Control and Applied Epidemiology: Principles and Practice. St. Louis, MO: Mosby; 1996:A1–A20.Google Scholar
13.Franchi, C, Venditti, M, Pietropaoli, P, et al. Hospital infection surveillance by CIN-2000 software in ICU: preliminary results. Presented at the 13th International Conference of the European Society of Intensive Care Medicine; October 1-4, 2000; Rome, Italy.Google Scholar
14.Polderman, KH, Girbes, AR. Central venous catheter use: Part 2. Infectious complications. Intensive Care Med 2002;28:18–28.Google Scholar
15.Centers for Disease Control and Prevention. Guideline for prevention of nosocomial pneumonia. Respir Care 1994;39:1191–1236.Google Scholar
16.Martin, CM, Bookrajian, EN. Bacteriuria prevention after indwelling urinary catheterization. Arch Intern Med 1962;110:703–711.CrossRefGoogle Scholar
17.Mermel, LA. Prevention of intravascular catheter-related infections. Ann Intern Med 2000;132:391–402.CrossRefGoogle ScholarPubMed
18.Wilson, ML. General principles of specimen collection and transport. Clin Infect Dis 1996;22:776–777.Google Scholar
19.Emori, TG, Culver, DH, Horan, TC. National Nosocomial Infections Surveillance System (NNIS): description of surveillance methods. Am J Infect Control 1991;19:19–35.Google Scholar
20.Burke, JP. Surveillance, reporting, automation and interventional epidemiology. Infect Control Hosp Epidemiol 2003;24:10–12.Google Scholar
21.Haley, RW, Quade, D, Freeman, HE, et al.Study on the Efficacy of Nosocomial Infection Control (SENIC Project): summary of study design. Am J Epidemiol 1980;111:472–485.Google Scholar
22.Schneeberger, PM, Smits, MHW, Zick, REF, Wille, JC. Surveillance as a starting point to reduce surgical-site infection rates in elective orthopaedic surgery. J Hosp Infect 2002;51:179–184.CrossRefGoogle ScholarPubMed
23.Gattinoni, L, Tognoni, G, Pesenti, A, et al.Effect of prone positioning on the survival of patients with acute respiratory failure. N Engl J Med 2001;345:568–573.Google Scholar
24.Silvestri, L, Monti Bragadin, C, Milanese, M, et al.Are most ICU infections really nosocomial? A prospective observational cohort study in mechanically ventilated patients. J Hosp Infect 1999;42:125–133.CrossRefGoogle ScholarPubMed
25.Crowe, M, Towner, KJ, Humphreys, H. Clinical and epidemiological features of an outbreak of Acinetobacter infection in an intensive therapy unit. J Med Microbiol 1995;43:55–62.Google Scholar
26.Raymond, DP, Pelletier, SJ, Crabtree, TD, et al.Impact of a rotating empiric antibiotic schedule on infectious mortality in an intensive care unit. Crit Care Med 2001;30:1877–1882.Google Scholar