The Journal is Indexed in
4 - The epidemiology of nosocomial infections acquired in intensive care units of a state hospital
Ahsen Öncül, Safiye Koçulu, Keziban Elevli
Objective: The aim of this study is to determine hospital infection rates, types, causing microorganisms and the epidemiologic features in intensive care units(ICU) of Giresun Prof. Dr. A. İlhan Özdemir State Hospital.
Methods: The data was collected by infection control nurses daily visits, infection control doctors consultations and weekly visits of infection control team among 5 intensive care units between January 1, 2011-December 31, 2011. 1632 patients were hospitalized for a total of 13116 patient days in these 5 ICUs through this time interval. Patients were evaluated with prospective, patient and laboratory based surveillance. The infection rates, incidence densities, devise associated infections, causing pathogens, co morbid diseases and invasive procedures among infected patients were evaluated.
Results: 148 hospital infections were observed in 104 patients. 52 of the patients (50%) were women and 52 (50%) were men. Mean age was 73,5±13,8 (min:24, max:94). 42 (28,4%) of the acquired infections were primer bacteremia including central venous catheter related bloodstream infections (CVC-BSI), 40 (27%) were ventilator associated pneumonia(VAP) or tracheobronchitis (VAT), 22 (14,9%) were pneumonia or lower respiratory infections other than pneumonia, 38 (25,7%) urinary tract infections (UTI), and 6 of them (4,1%) skin-soft tissue infections including surgical site infections (SSI). Respiratory tract infections were the majority of infections seen in anesthesiology, neurology and internal medicine ICUs, whereas bacteremia was the leading infection in surgical ICU and urinary tract infections in coronary ICU. Although ventilator usage rate was above 90 percentile in anesthesiology ICU, VAP occurred at 10-25 percentile ranges. The leading pathogen microorganisms were 90% nonfermentative gram-negatives, mostly Acinetobacter spp and Pseudomonas spp in respiratory tract infections especially when it was device associated. İt was found that coagulase negative staphylococci were the major pathogen of pimer bacteremia without origin and CVC-BSI, both Pseudomonas spp and Candida spp were isolated in 31,6% of UTIs, followed by E. coli at a 14,6%. E. coli was the major bacteria isolated from 50% of soft tissue infections that were mostly SSI, followed by nonfermentative gram negatives. S. aureus was isolated in 2% and coagulase negative staphylocci in 12,5% of all positive cultures. None of the cultures grew vancomycin resistant enterococcus. It was demonstrated that resistant non fermentatives were the major problem in our hospital flora. Cerebrovascular diseases were the leading comorbid disease among all infected patients, and soft tissue infections were mostly seen in diabetics. Invasive procedures were performed extensively except for drains. Conclusions Our hospitals intensive care unit data demonstrate that infection rates are lower than university, and parallel to state hospitals. Respiratory tract infections caused by Acinetobacter and Pseudomonas spp seem to be a problem. Ward specific precautions has to be taken for more prevalent infections, and practices should be done to improve compliance to infection control standards.
Keywords: Hospital infection, intensive care unit, device associated infections
To read full article click