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Surveillance of Nosocomial Infections in a Neurologic Intensive Care Unit

Published online by Cambridge University Press:  21 June 2016

Dirk Zolldann ,
Christoph Spitzer ,
Helga Häfner ,
Birgit Waitschies ,
Wolfgang Klein ,
Dorit Sohr ,
Frank Block ,
Rudolf Lütticken  and
Sebastian W. Lemmen
Dirk Zolldann*
Affiliation:
Department of Infection Control, Aachen University Hospital, Aachen, Germany
Christoph Spitzer
Affiliation:
Department of Neurology, Aachen University Hospital, Aachen, Germany
Helga Häfner
Affiliation:
Department of Infection Control, Aachen University Hospital, Aachen, Germany
Birgit Waitschies
Affiliation:
Department of Infection Control, Aachen University Hospital, Aachen, Germany
Wolfgang Klein
Affiliation:
Department of Neurology, Aachen University Hospital, Aachen, Germany
Dorit Sohr
Affiliation:
Institute for Hygiene, Free University of Berlin, Berlin, Germany
Frank Block
Affiliation:
Department of Neurology, Aachen University Hospital, Aachen, Germany
Rudolf Lütticken
Affiliation:
Institute of Medical Microbiology, Aachen University Hospital, Aachen, Germany
Sebastian W. Lemmen
Affiliation:
Department of Infection Control, Aachen University Hospital, Aachen, Germany
*
Department of Infection Control, Aachen University Hospital, Pauwelsstraße 30, 52074 Aachen, Germany[email protected]
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Abstract

Objective:

To assess data on the epidemiology of nosocomial infection (N1) among neurologic intensive care patients.

Design:

Prospective periodic surveillance study.

Setting:

An 8-bed neurologic intensive care unit (ICU).

Patients:

All those admitted for more than 24 hours during five 3-month periods between January 1999 and March 2003.

Methods:

Standardized surveillance within the German infection surveillance system.

Results:

Three hundred thirty-eight patients with a total of 2,867 patient-days and a mean length of stay of 8.5 days were enrolled during the 15-month study period. A total of 71 NIs were identified among 52 patients. Urinary tract infections (UTIs) were the most frequent N1 (36.6%), followed by pneumonia (29.6%) and bloodstream infections (BSIs) (15.5%). The overall incidence and incidence density of NIs were 21.0 per 100 patients and 24.8 per 1,000 patient-days, respectively. Incidence densities were 9.8 UTIs per 1,000 urinary catheter-days (CI95, 6.4-14.4), 5.6 BSIs per 1,000 central venous catheter-days (CI95, 2.8-10.0), and 12.8 cases of pneumonia per 1,000 ventilation-days (CI95, 8.0-19.7). Device-associated UTI and pneumonia rates were in the upper range of national and international reference data for medical ICUs, despite the intensive infection control and prevention program in operation in the hospital.

Conclusion:

Neurologic intensive care patients have relatively high rates of device-associated nosocomial pneumonia and UTI. For a valid comparison of surveillance data and implementation of targeted prevention strategies, we would strongly recommend provision of national benchmarks for the neurologic ICU setting.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 8 , August 2005 , pp. 726 - 731
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Vincent, JL. Nosocomial infections in adult intensive-care units. Lancet 2003;361:2068–2077.Google Scholar
2.Arunodoya, GR. Infections in neurology and neurosurgery intensive care units. Neurol India 2001;49(suppl 1):S51–S59.Google Scholar
3.Hilker, R, Poetter, C, Findeisen, N, et al.Nosocomial pneumonia after acute stroke: implications for neurological intensive care medicine. Stroke 2003;34:975–981.Google Scholar
4.Prass, K, Meisel, C, Hoflich, C, et al.Stroke-induced immunodeficiency promotes spontaneous bacterial infections and is mediated by sympathetic activation reversal by poststroke T helper cell type 1-like im-munostimulation. J Exp Med 2003;198:725–736.Google Scholar
5.Meert, KL, Long, M, Kaplan, J, Sarnaik, AP. Alterations in immune function following head injury in children. Crit Care Med 1995;23:822–828.CrossRefGoogle ScholarPubMed
6.Coello, R, Gastmeier, P, De Boer, AS. Surveillance of hospital-acquired infection in England, Germany, and the Netherlands: will international comparison of rates be possible? Infect Control Hosp Epidemiol 2001;22:393–397.Google Scholar
7.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
8.Gastmeier, P, Geifers, C, Sohr, D, Dettenkofer, M, Daschner, F, Rüden, H. Five years working with the German Nosocomial Infection Surveillance System (Krankenhaus Infektions Surveillance System). Am J Infect Control 2003;31:316–321.CrossRefGoogle ScholarPubMed
9.Dettenkofer, M, Ebner, W, Els, T, et al.Surveillance of nosocomial infection in a neurology intensive care unit. J Neurol 2001;248:959–964.Google Scholar
10.Zolldann, D, Poetter, C, Hilker, R, et al.Periodic surveillance of nosocomial infections in two neurology intensive care units: a valuable tool for quality management in intensive care medicine. Anaesthesist 2003;52:690–696.CrossRefGoogle Scholar
11.Lemmen, SW, Zolldann, D, Gastmeier, P, Lütticken, R. Implementing and evaluating a rotating surveillance system and infection control guidelines in four intensive care units. Am J Infect Control 2001;29:89–93.CrossRefGoogle Scholar
12.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.Google Scholar
13.Wong, ES, Hooton, TM. Guideline for prevention of catheter-associated urinary tract infections. Infect Control 1981;2:126–130.Google Scholar
14.Pearson, ML. Guideline for prevention of intravascular device-related infections: Hospital Infection Control Practices Advisory Committee. Infect Control Hosp Epidemiol 1996;17:438–473.Google ScholarPubMed
15.Tablan, OC, Anderson, LJ, Arden, NH, Breiman, RF, Butler, JC, McNeil, MM. Guideline for the prevention of nosocomial pneumonia: the Hospital Infection Control Practices Committee, Centers for Disease Control and Prevention. Infect Control Hosp Epidemiol 1994;15:587–627.Google Scholar
16.German Reference Center for the Surveillance of Nosocomial Infections: data summary from January 1997 to June 2003. Berlin: German Reference Center for the Surveillance of Nosocomial Infections; 2003. Available at www.nrz-hygiene.de.Google Scholar
17.National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2003, issued August 2003. Am J Infect Control 2003;31:481–498.Google Scholar
18.National Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
19.Hilker, R, Zakzuk, M, Schneweis, S, Rudolf, J, Jacobs, A, Neveling, M. Nosocomial pneumonia after acute cerebral ischemia: evaluation of incidence and risk factors in the neurological intensive care. Intensivmedizin und Notfallmedizin 1999;36:526–533.CrossRefGoogle Scholar
20.Legras, A, Malvy, D, Quinioux, AI, et al.Nosocomial infections: prospective survey of incidence in five French intensive care units. Intensive Care Med 1998;24:1040–1046.Google Scholar
21.Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP, the National Nosocomial Infections Surveillance System. Nosocomial infections in medical intensive care units in the United States. Crit Care Med 1999;27:887–892.Google Scholar
22.Neundorfer, B, Hilz, MJ, Wimbauer, M. Course of disease and prognosis of neurological intensive care unit patients with special respect to age. Fortschr Neurol Psychiatr 1996;64:285–291.Google ScholarPubMed
23.Celis, R, Torres, A, Gatell, JM, Almela, M, Rodriguez-Roisin, R, Agusti-Vidal A. Nosocomial pneumonia: a multivariate analysis of risk and prognosis. Chest 1988;93:318–324.Google Scholar
24.Chevret, S, Hemmer, M, Carlet, J, Langer, M, the European Group on Nosocomial Pneumonia. Incidence and risk factors of pneumonia acquired in intensive care units: results from a multicenter prospective study on 996 patients. Intensive Care Med 1993;19:256–264.Google Scholar
25.Relio, J, Ausina, V, Castella, J, Net, A, Prats, G. Nosocomial respiratory tract infections in multiple trauma patients: influence of level of consciousness with implications for therapy. Chest 1992;102:525–529.Google Scholar
26.Schmidt, J, Holas, M, Halvorson, K, Reding, M. Videofluoroscopic evidence of aspiration predicts pneumonia and death but not dehydration following stroke. Dysphagia 1994;9:7–11.CrossRefGoogle Scholar
27.Kidd, D, Lawson, J, Nesbitt, R, MacMahon, J. The natural history and clinical consequences of aspiration in acute stroke. QJM 1995;88:409–413.Google Scholar
28.Craven, DE, Goularte, TA, Make, BJ. Contaminated condensate in mechanical ventilator circuits: risk factor for nosocomial pneumonia? Am Rev RespirDis 1984;129:625–628.Google Scholar
29.Combes, P, Fauvage, B, Oleyer, C. Nosocomial pneumonia in mechanically ventilated patients: a prospective, randomized evaluation of the Stericath closed suctioning system. Intensive Care Med 2000;26:878–882.CrossRefGoogle ScholarPubMed
30.Dreyfuss, D, Djedaini, K, Weber, P, et al.Prospective study of nosocomial pneumonia and of patient and circuit colonization during mechanical ventilation with circuit changes every 48 hours versus no change. Am Rev Respir Dis 1991;143:738–743.Google Scholar
31.Kollef, MH, Shapiro, SD, Fraser, VJ, et al.Mechanical ventilation with or without 7-day circuit changes: a randomized, controlled trial. Ann Intern Med 1995;123:168–174.Google Scholar
32.Heckmann, JG, Kraus, J, Niedermeier, W, et al.Nosocomial pneumonia in a neurological intensive care unit. Dtsch Med Wochenschr 1999;124:919–924.Google Scholar
33.Moine, P, Timsit, JF, De Lassence, A, et al.Mortality associated with late-onset pneumonia in the intensive care unit: results of a multi-center cohort study. Intensive Care Med 2002;28:154–163.CrossRefGoogle ScholarPubMed