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PREZIES: Prevention of hospital-acquired infections through surveillance. Infections in Intensive Care Unit, 1997-1999

PREZIES: PREventie van ZIEkenhuisinfecties door Surveillance. Deelcomponent infecties op de Intensive Care, 1997-1999

Synopsis

Objective: To conduct a standardised surveillance of infections acquired in the Intensive Care Unit (ICU) in a network of hospitals and to generate reference data for individual hospitals and the Dutch government. dised using a protocol, uniform software and workshops attended by representatives from participating hospitals. Patients in the ICU for more than 48 hours were included in the surveillance and followed until discharge from the ICU. Results: Standardised surveillance of ICU-acquired infections yielded usable data on 2795 patients from 16 hospitals with a total stay in the ICU in the July 1997 to December 1999 period. The median length of stay was six days. The median APACHE II score was 17 and the median age 67 years. Surgical patients and patients admitted for internal medicine constituted more than half of the total ICU population. In total, 749 patients (27% of all patients) became infected, with 1177 ICU-acquired infections (42 infections per 1000 patient-days). Of these, 501 were due to pneumonias, 238 to sepsis (of which 72 central catheter-related), 247 to urinary tract infections and 191 to other infections. ICU-acquired pneumonias were found in 17% of the patients (18 pneumonias per 1000 patient-days), central catheter-related sepsis was seen in 2% of the patients (3 cases per 1000 patient-days) and urinary tract infections in 8% (9 urinary tract infections per 1000 patient-days). Differences between infection rates per speciality for which a patient is admitted were not statistically significant. Of all patients admitted to the ICU, 62% were mechanically ventilated; 64% had at least one central vascular catheter and 89% had a urinary catheter in place. Patients were ventilated for 608 days of the 1000 patient-days and had a urinary catheter for 864 days. Per 1000 patient-days, 681 central vascular-days were recorded. The number of ventilation-related pneumonia's was 27 per 1000 ventilation-days; the number of catheter-related urinary tract infections was 10 per 1000 catheter-days and the number of central catheter-related sepsis was 4 per 1000 central catheter-days. Selective decontamination of the gastrointestinal tract was used for 12% of the patients for 130 days and systemic antibiotics for 68% for 526 days assuming 1000 patient-days. The most frequently isolated micro-organisms were Pseudomonas aeruginosa in pneumonia's, Staphylococcus epidermidis in central catheter-related sepsis and Escherichia coli in urinary tract infections. Conclusions: Data providing insight into the incidence of nosocomial infections and risk factors in patients admitted to the ICU reference figures were collected on the basis of standardised surveillance of ICU-acquired infections in a network of hospitals. Participating hospitals will be able to use the data as reference figures. Because validation is limited and figures are based on a relatively small number of ICUs, results should be considered as an indicative national standard.
 

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