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Hospital-Acquired Infections in Intensive Care Unit Patients An Overview with Emphasis on Epidemics

Published online by Cambridge University Press:  02 January 2015

Richard P Wenzel ,
Robert L. Thompson ,
Sandra M. Landry ,
Brenda S. Russell ,
Patti J. Miller ,
Samuel Ponce de Leon  and
Grayson B. Miller Jr.
Richard P Wenzel*
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Robert L. Thompson
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Sandra M. Landry
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Brenda S. Russell
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Patti J. Miller
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Samuel Ponce de Leon
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
Grayson B. Miller Jr.
Affiliation:
Departments of Medicine and Nursing, University of Virginia Medical School, Department of Epidemiology, University of Virginia, Graduate School of Arts and Sciences, Charlottesville, Virginia and Virginia Commonwealth Health Department, Richmond, Virginia
*
Box 473, University of Virginia Medical Center, Charlottesville, VA 22908
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Abstract

Surveillance activities for the detection of nosocomial infections at the University of Virginia Hospital (Charlottesville, Virginia) and at hospitals participating in the Virginia Statewide Infection Control Program have focused on outbreaks and device-related infections which are potentially preventable. Eleven outbreaks of nosocomial infections were identified at the University of Virginia Hospital between January 1, 1978 and December 31, 1982 (9.8 outbreaks/100,000 admissions). Ten of the 11 were centered in critical care units. The 269 patients involved in the epidemics represented 0.2% of all hospital admissions and 3.7% of all patients who developed nosocomial infections. Eight of the 11 outbreaks involved infection of the bloodstream, and the 90 patients who developed a bloodstream infection as part of an epidemic represented 8% of all patients with nosocomial bloodstream infections identified during the five-year study period. The reservoir of the 11 outbreaks involved devices (5), contaminated cocaine (1), probable blood products (1), other patients (3), and nursing personnel (1). Forty-one percent of all nosocomial bloodstream infections and 41% of all nosocomial pneumonias occurred in intensive care units (ICUs).

In 38 hospitals in the state of Virginia with ICUs and practitioners who voluntarily reported surveillance data between June 1,1980 and May 31,1982, there were 264,757 patients admitted and a crude infection rate of 3%. Of note is that 1,867 of the 7,407 nosocomial infections (25%) occurred in the ICU patients. Several factors point to a compelling argument that the highest priority in infection control resources be assigned to the prevention and control of ICU infections: ICU patients often have serious device-related infections and may be identified as high risk prior to infection. Furthermore, they are at risk of being infected as part of a major outbreak. Such characteristics define a population of hospitalized patients, many of whose infections are preventable.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 4 , Issue 5 , October 1983 , pp. 371 - 375
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1983

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