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Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

Published online by Cambridge University Press:  21 June 2016

François L'Hériteau ,
Corinne Alberti ,
Yves Cohen ,
Gilles Troché ,
Pierre Moine  and
Jean-François Timsit
François L'Hériteau
Affiliation:
C-CLIN Paris Nord, Paris VI University, Paris, France
Corinne Alberti
Affiliation:
Public Health Department, Robert Debré Hospital, Paris VII University, Paris, France
Yves Cohen
Affiliation:
Medical-Surgical ICU, Avicenne Teaching Hospital, Bobigny, France
Gilles Troché
Affiliation:
Surgical ICU, Antoine Béclère Teaching Hospital, Clamart, France
Pierre Moine
Affiliation:
Surgical ICU, Lariboisière Teaching Hospital, Paris, France
Jean-François Timsit*
Affiliation:
Medical ICU, Bichat Teaching Hospital, Paris, France
*
réanimation médicale, Hôpital Michallon et département d'épidemiologie INSERM U578, Grenoble, France[email protected]
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Abstract

Objectives:

To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.

Design:

A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.

Participants:

Three hundred ninety-five responder ICUs (69%) in France.

Results:

In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.

Conclusion:

This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 13 - 20
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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