Headlines from Press Publicatons – Hospital Acquired Infections (nosocomial)

Transmission of Infections,

The most important modes of transmission are:

Headlines

Some figures

The sources

Aspergillus.

A prospective study on factors influencing aspergillus spore load in the air during renovation works in a Neonatal Intensive Care Unit.

Dr. L.Mahieu, Department of Paediatrics, Division Neonatology, University Hospital of Antwerp: http://www.uza.uia.ac.be

©The Hospital Infection Society http://www.harcourt-international.com

Summary:
The relationship between air contamination (cfu/m³) with fungal spores especially Aspergillus spp. in three renovation areas of a neonatal intensive care unit (NICU) and colonization and infection rates in a high care area (HC) equipped with high efficiency particulate air (HEPA) filtration and a high pressure system, was evaluated.

Multivariate analysis revealed that renovation works and air concentration of Aspergillus spp. spores in the medium care area (MC) resulted in a significant increase of the concentration in the HC of the NICU. The use of a mobile HEPA air filtration system caused a significant decrease of the Aspergillus spp. concentration.

 

Europe

"40,000 deaths annually in the Federal Republic of Germany"
source: Institut für Sozialmedizin und Epidemiologie, Bundesgesundheitsamtes Berlin.

"Results: nosocomial pneumonia developed in 328 patients (16.6%) whose mortality was 52.4 % compared with 22.4% for patients without ICU-acquired pneumonia".
source: JAMA 1996 Mar20;275(11):866-9

"25 % of all ICU-patients acquire one or more nosocomial infections"
source: Rijks Instituut voor Volksgezondheid en Milieuhygiene (RIVM)

Annually around 100,000 nosocomial infections, estimated costs 1,6 billion euro.
source: U.K. National Audit

For a 1,000 bed university hospital, the annual extra costs of nosocomial infections was $6-$7 million. The extra cost per infected patient was $2,200. Hospital infections are generating high extra costs and morbidity in countries with good general health care and with few problems with resistant bacteria.
source: Infect Control Hosp Epidemiol 1998 Oct;19(10):805-7

Nosocomial infections are a major challenge for modern medicine and contribute to increased resource use in health care systems.
source: Schweiz Med Wochenschr 1998 Dec 12;128(50):1973-83

Nosocomial infections constitute an important health problem with morbidity, and high mortality, prolongation of hospital stay, and increased costs of direct patient care.
source: J Chemother 1997 Dec;9(6):411-4

USA

Extra hospital and SICU length of stay attributable to bloodstream infection was 24 and 8 days, respectively. Extra costs attributable to the infection averaged $40,000 per survivor.
source: JAMA 1994 May 25;271(20):1598-601

Mexico

The mortality rate associated with intrahospitalary infections is ranking them in the third place of the most frequent causes of death in Mexico.
source: Departamento de Infectologia, Instituto Nacional de la Nutricion Salvador Zubiran.

Taiwan

The intensive care unit (ICU) is one of the most common locations in the hospital for the development of nosocomial respiratory tract infections (RTIs).
source: Chung Hua I Hsueh Tsa Chih (Taipei) 1998 Oct;61(10):589-95

Brazil

Treatment of cancer has contributed to a growing number of immunocompromised patients with life-threatening nosocomial infections (NI). High mortality with considerable cost is observed when they are admitted to the intensive care unit (ICU).
source: Am J Infect Control 1997 Dec;25(6):458-62

Official Journal of the Society for Healthcare Epidemiology of America.
http://www.slackinc.com

a.o. Volume 19 (10) October 1998.
University Hospital Oslo Norway 1.000 beds.
Infection rate patients 8.5 % in 1995.
14.500 days of extra stay in the hospital
Direct related economic consequences of hospital infections in this hospital:
between $ 6 – $ 7 million.
Extra direct costs per infected patient $ 2.200

Infection Control and Hospital Epidemiology
http://healthlinkusa.com

a.o. Volume 17 (8) August 1996
From the Fourth International Conference on the Prevention of Infection (abstract)

Selected aspects of the socioeconomic Impact of Nosocomial Infections Morbidity, Mortality, Cost and Prevention.

Journal of Hospital Infection
http://hbuk.co.uk

Hospital Infection Society
http://his.org.uk
http://harcourt-international.com

http://medscape.com
search for medline – hospital infections

Summary from a selection of scientific Publications on Hospital or Nosocomial Infections.

Nosocomial infection as the cause of death.

Gesundheitswesen 1994 Mar;56(3):122-5
Zastrow KD, Schoneberg I
Institut für Sozialmedizin und Epidemiologie, Bundesgesundheitsamtes Berlin.

Summary Quote

"Hospital-acquired infections are a worldwide problem especially in hospitals for the treatment of acute cases. These infections are among the leading causes of death. Certificates of death of 4,656 patients who died in hospitals were analysed. Of these, 564 deaths were caused by nosocomial infections

(12.1 %).

It was estimated that annually ariound 40,000 deaths in the Federal republic of Germany are attributable to infections acquired in the hospital."

Werner Schell (05/99)

Summary Quote

"Krankenhausinfektionen können bis zu 8 % der Patienten betreffen. In der Bundesrepublik

Deutschland werden 700.000-900.000 infizierte Patienten im Jahr angegeben. Durchschnittlich

erfordern Krankenhausinfektionen 10 Tage zusätzlichen Krankenhausaufenthalt…….

Die Jährlichen Todesfälle werden in unterschiedlicher Höhe geschätzt (mindestens ca. 40.000)


A survey of nosocomial infections and their influence on hospital mortality rates

Journal of Hospital Infections 1994;(4):297-304

Dinkel RH, Lebok U

Otto-Friedrich-Universität Bamberg

Summary Quote

"Nosocomial infections play an important role in contributing to hospital mortality".

 

Hospital infections and their consequences in patients of advanced age.

Gesundheitswesen 1994 Mar;56(3):126-31

Dinkel RH, Lebok U.

Otto-Friedrich-Universität Bamberg

Summary Quote

"Using realistic assumptions on incidence and mortality and on possible degrees of infection

the number of 'preventable deaths' due to nosocomial infections are calculated. For 1990 the

results sum up to more than 6.000 deaths at ages above 60 alone for the Federal Republic of

Germany within its former borders.

 

Influence of nosocomial infection on mortality rate in an intensive care unit.

Crit Care Med 1994 Jan;22(1):55-60

Department of Preventive Medicine, University of Granada Hospital, Spain

Summary Quote

"Mortality risk was 2.48 times higher in patients with a nosocomial infection than in

noninfectedpatients."

"Nosocomial infection increases the risk of death".

 

Noscomial infection surveillance in a vascular surgery unit.

Ann Vasc Surg 1990 Nov;4(6):553-7

Laboratoire d'Epidemiologie, Hopital Purpan, Toulouse, France

Summary Quote

"In infected patients the hospitalization time was increased by 11 days and that antibiotics

were used four times as often".

"Nosocomial infections prolonged hospitalization by 57 %."

 

Nosocomial pneumonia and mortality among patients in intensive care units

JAMA 1996 Mar20;275(11):866-9

Service de Reanimation Medicale, Hopital Bichat, Paris, France.

Summary Quote

"Results: nosocomial pneumonia developed in 328 patients (16.6%) whose mortality was

52.4 % compared with 22.4% for patients without ICU-acquired pneumonia".

"Conclusion:these data suggest that, in addition to the severity of underlying medical

conditions and nosocomial bacteremia, nosocomial pneumonia independently contributes to

ICU-patient mortality".

 

Impact of hospital infection on medical expenditures in a continuing care and rehabilitation service at a geriatric hospital.

Pathol Biol (Paris) 1998 Jun;46(6):398-402

United'Hygiene Hospitaliere, Groupe Hospitalier Charles Foix-Jean Rostand, Ivry-sur-Seine, France

Summary Quote

"Nosocomial infections are associated with an increased pharmaceutical dispensing: medication

(mainly antibiotics) and medical device's cost; and an increased nurse's workload."

 

Status of public health in hospitals in France.

Zentralbl Hyg Umweltmed 1996 Dec;199(2-4):156-67

Assistance-Publique-Hopitaux de Paris.

Summary Quote

"Nosocomial prevalence rates are between 6 and 16 %".

"Prevention of nosocomial infections is now considered by French Health Authorities and health

care providers as a public health priority giving their frequency, morbidity and mortality rates,

and costs."

 

Prolongation of hospital stay and extra costs due to hospital acquired infection in a neonatal unit.

Journal of Hospital Infection 1997 Jan;35(1):37-45

Public Health unit, hopital Robert Debre, Paris, France

Summary Quote

"Among a cohort of 616 neonates, 34 (5.5%) had one or more hospital acquired infections."

"The mean extra cost per infected case was 52,192 FF (US$10,440) corresponding to 5.2 extra

days in hospital.

 

Fever in the ICU.

Chest 2000 Mar;117(3):855-69

Department of Internal Medicine, Section of Critical Care, Washington Hospital Center, Washington, DC 20010-2975, USA. pem4@mhg.edu

Summary Quote

"Fever is a common problem in ICU patients. The presence of fever frequently results in the performance of diagnostic tests and procedures that significantly increase medical costs and expose the patient to unnecessary invasive diagnostic procedures and the inappropriate use of antibiotics. ICU patients frequently have multiple infectious and noninfectious causes of fever, necessitating a systematic and comprehensive diagnostic approach. Pneumonia, sinusitis, and blood stream infection are the most common infectious causes of fever."

 

Nosocomial bloodstream infection in critically ill patients. Excess length of stay, extra costs, and attributable mortality.

JAMA 1994 May 25;271(20):1598-601

Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City.

Summary Quote

"OBJECTIVE. To determine the excess length of stay, extra costs, and mortality attributable to nosocomial bloodstream infection in critically ill patients."

"Extra costs attributable to the infection averaged $40,000 per survivor. The attributable mortality from nosocomial bloodstream infection is high in critically ill patients. The infection is associated with a doubling of the SICU stay, an excess length of hospital stay of 24 days in survivors, and a significant economic burden."

 

Economic consequences of hospital infections in a 1,000-bed university hospital in Norway.

Infect Control Hosp Epidemiol 1998 Oct;19(10):805-7

Clinic of Preventive Medicine, Department of Hospital Infections, Ulleval University Hospital, Oslo, Norway.

Summary Quote

"Hospital infections were studied among 41,000 patients admitted to a 1,000-bed university hospital in Oslo, Norway. A prevalence rate of 8.5% in 1995 contributed to 14,500 days of extra stay in the hospital. The direct economic consequences of hospital infections was 40 to 50 million Norwegian kroner ($6-$7 million). The extra direct cost per infected patient was 14,300 Norwegian kroner ($2,200). Hospital infections are generating high extra costs and morbidity in countries with good general health care and with few problems with resistant bacteria."

 

Nosocomial infections in Ulleval hospital. Occurrence and economic consequences.

Tidsskr Nor Laegeforen 1996 Oct 10;116(24):2903-7

Seksjon for sykehushygiene Klinikk for forebyggende medisin Ulleval sykehus, Oslo.

Summary Quote

"The present study concerns the prevalence, extra days in hospital, and direct extra costs of hospital infections in patients admitted to Ulleval University Hospital; a hospital with 1,000 beds in Oslo, Norway. Extra stay was calculated as mean of four extra days per patient or the extra stay connected with the different types of infection. Cost was determined as cost per day per patient in the different clinical departments, including all supportive services. Cost was also determined from the hospital's DRG-index (Diagnosis-Related Groups). A prevalence rate of 8.5% contributed in 1995 to 14,410 extra days in hospital, corrigated for the type of hospital infection. Calculated using a mean of four extra days per patient the figure was 14,000 extra days. In 1995, the direct economic consequence for the hospital was NOK 40-50 million (6-8 mill. US dollars)."

 

Hospital infections. Extended hospital queues and unnecessary costs of the health services.

Tidsskr Nor Laegeforen 1992 Jan 30;112(3):368-70

Mikrobiologisk avdeling, Regionsykehuset i Tromso.

Summary Quote

"In Norway the prevalence of nosocomial infections is 5-20%; more than 50,000 patients per year. The consequences may be serious for the individual patient and his family, a serious problem for the hospital department concerned and a burden on the Norwegian health services. Nosocomial infections can be treated by antimicrobial drugs which generate selective pressure towards more resistant organisms. Infections caused by resistant strains may result in longer hospitalization, more difficult treatment, and more severe illness. In future, efforts must be directed at preventing nosocomial infections by means of education, surveillance and control."

 

Infectious complications in critically injured children.

J Pediatr Surg 2000 Aug;35(8):1174-8

Department of Surgery, University of Florida, Health Science Center Jacksonville, 32209-6511, USA.

Summary Quote

"CONCLUSIONS: Infection is a significant source of morbidity in the critically injured child. Nosocomial infections predominate, and a majority of these are device related, emphasizing the need for continued vigilance toward prevention in this high-risk group."

 

Managing the cost of care: a predictive study to identify critical care patients at risk for nosocomial pneumonia.

J Health Care Finance 2000 Spring;26(3):73-82

Resource Group, Ltd., Dallas, Texas, USA.

Summary Quote

"Nosocomial infections represent a major health problem and can have a significant impact on the cost of treating a patient. Hospital-acquired pneumonia (HAP) is the second most common nosocomial infection in the United States and the leading cause of death due to a nosocomial infection."

 

Nosocomial infections in medical intensive care units in the United States.

National Nosocomial Infections Surveillance System.

Crit Care Med 1999 May;27(5):887-92

Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Summary Quote

"OBJECTIVE: To describe the epidemiology of nosocomial infections in medical intensive care units (ICUs) in the United States."

" Nosocomial infections were analyzed by infection site and pathogen distribution. Urinary tract infections were most frequent (31%), followed by pneumonia (27%) and primary bloodstream infections (19%). Eighty-seven percent of primary bloodstream infections were associated with central lines, 86% of nosocomial pneumonia was associated with mechanical ventilation"

 

MRSA–what every health care provider should know.

Todays Surg Nurse 1998 Mar-Apr;20(2):20-4

Phoenix Baptist Hospital, AZ, USA.

Summary Quote

"Found in both children and adults, MRSA can most often be recognized by abscess formation. MRSA infection results in an increased rate of stay and increased costs to facilities, and has been associated with a higher mortality rate. This isolation of patients, strict handwashing, environmental cleaning, and the use of barrier protections are all methods that prevent the spread of MRSA."

 

The impact of nosocomial infections on patient outcomes following cardiac surgery.

Chest 1997 Sep;112(3):666-75

Department of Internal Medicine, Pulmonary and Critical Care, Washington University School of Medicine, St. Louis, MO 63110, USA. marin@wupulm3.wustl.edu

Summary Quote

"21.7% patients acquired at least one nosocomial infection following cardiac surgery."

"5.0% of the patients died during their hospitalization.

"The mortality rate of patients acquiring a nosocomial infection (11.5%) was significantly greater than

the mortality rate of patients without a nosocomial infection (3.2%)."

 

Intrahospital infections and quality of medical care. Is it possible to save in health?

Salud Publica Mex 1991 Jan-Feb;33(1):3-8

Departamento de Infectologia, Instituto Nacional de la Nutricion Salvador Zubiran.

Summary Quote

"The mortality rate associated with intrahospitalary infections, estimating a five per cent crude mortality, would be 32.1 in one hundred thousand inhabitants, ranking them in the third place of the most frequent causes of death in Mexico." " The economic consequences of this complications are enormous."

 

Prevalence and risk factors for nosocomial infections in four university hospitals in Switzerland.

Infect Control Hosp Epidemiol 1999 Jan;20(1):37-42

University Hospitals of Geneva, Switzerland.

Summary Quote

"OBJECTIVE: To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss

university hospitals."

" Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards

(12%).

 

Nosocomial infections in Swiss university hospitals: a multi-centre survey and review of the published experience. Swiss-Noso Network.

Schweiz Med Wochenschr 1999 Oct 23;129(42):1521-8

University Hospital Geneva.

Summary Quote

"This study offers a reliable measure of the prevalence of nosocomial infections in selected wards at 4 Swiss university hospitals and confirms the importance of nosocomial infections as a heavy burden on health services at the end of this century."

 

Secondary costs due to nosocomial infections in 2 pediatric intensive care units.

Salud Publica Mex 1999;41 Suppl 1:S51-8

Unidad de Investigacion en Epidemiologia Hospitalaria, Centro Medico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico.

Summary Quote

"OBJECTIVE: We estimated associated costs to nosocomial infections in two pediatric intensive care units in Mexico City. MATERIAL AND METHODS: A transversal study in the neonatal (NICU) and pediatric (PICU) intensive care units, was done. We reviewed use and cost of diagnostic procedures, medications, and excess of hospital stay. RESULTS: There were 102 infections, 46 in the NICU and 56 in the PICU. The average cost per infection was $11,682 USD and the overall expense was 1,184.71 USD. Infected children had an excess of hospital stay of 9.6 days, 13.7 more laboratory tests and 3.3 more cultures. Hospital stay represented 97% of the overall cost."

 

The costs of hospital infections in a group of patients in a tertiary-care hospital.

Gac Med Mex 1999 Sep-Oct;135(5):457-62

Hospital de Pediatria, Centro Medico Nacional CMN Siglo XXI, IMSS.

Summary Quote

"OBJECTIVE: To know the cost generated by nosocomial infections, to establish the proportion of the total hospital budget used in extra-days of stay, drugs, laboratory and others items used for the treatment."

"Total cost in 3 months was $3'516,421.00, nosocomial infections would take $14'065,684.00 in a year, involving 12.1% of the hospital total budget. Preventive measures must be taken trying to diminish these costs."

 

Prevalence of nosocomial infections in a university hospital: distribution, predisposing factors and diagnostic indices.

Schweiz Med Wochenschr 1998 Dec 12;128(50):1973-83

Unite de prevention et controle de l'infection des Hopitaux Universitaires de Geneve.

Summary Quote

"Nosocomial infections are a major challenge for modern medicine and contribute to increased resource use in health care systems.".

 

Nosocomial infection in Auckland Healthcare hospitals.

N Z Med J 1997 Aug 22;110(1050):314-6

Auckland Hospital.

Summary Quote

"Nosocomial infections cause patient morbidity and prolong hospital stay."

"One hundred and ten (12%) of 932 patients had 129 nosocomial infections"

"The highest prevalence was in intensive care unit patients, 7 of 31 (23%)."

"Our results are comparable with hospitals of similar size overseas"

 

Prevalence of nosocomial infections in general hospitals in Belo Horizonte.

Infect Control Hosp Epidemiol 1998 Nov;19(11):872-6

Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil.

Summary Quote

"Of the 2,339 patients surveyed, 267 patients had 328 nosocomial infections."

"The global prevalence rate of NI was 14.0%, ranging from 4.6% to 27.3% in the hospitals surveyed."

"The most prevalent infections were found to be pneumonia and surgical-wound infections, representing 19.5% and 19.2%, respectively, of the total infections. The highest prevalence rates of NI were observed in the cardiac surgery (31.9%), pediatric (27.2%), and orthopedic (20.7%) services."

 

Nosocomial infections in a rural regional hospital in a developing country: infection rates by site, service, cost, and infection control practices.

Infect Control Hosp Epidemiol 1998 Feb;19(2):136-40

Faculty of Medical Services, the Department of Pathology and Microbiology, University of the West Indies, St Augustine, Republic of Trinidad and Tobago.

Summary Quote

"RESULTS: Over the 4-year period, 7,158 nosocomial infections were identified from 72,532 patients (10.0/100 admissions). High nosocomial infection rates were found on the intensive-care unit (67/100 admissions), urology (30/100 admissions), neurosurgery (29.5/100 admissions), and newborn nursery (28.4/100 admissions)."

"The cost to the government for nosocomial infections was estimated at US $697,000 annually"

 

Economic analysis of nosocomial infections in a Turkish university hospital.

J Chemother 1997 Dec;9(6):411-4

Pamukkale University, Faculty of Medicine, Department of Infectious Diseases, Denizli, Turkey.

Summary Quote

"Nosocomial infections constitute an important health problem with morbidity, and high mortality, prolongation of hospital stay, and increased costs of direct patient care."

"Mortality rates were 19.6% for patients with nosocomial infections and 2.9% for uninfected controls."

"We conclude that the high economic expense which nosocomial infection represents justifies measures to control this entity."

 

Prevalence of nosocomial respiratory tract infections in the surgical intensive care units of a medical center.

Chung Hua I Hsueh Tsa Chih (Taipei) 1998 Oct;61(10):589-95

Department of Medicine, Veterans General Hospital-Taipei, Taiwan, ROC.

Summary Quote

"The intensive care unit (ICU) is one of the most common locations in the hospital for the development of nosocomial infections."

 

Prevalence of nosocomial infections in children: survey of 21 hospitals in Mexico.

Salud Publica Mex 1999;41 Suppl 1:S18-25

Hospital Infantil de Mexico Federico Gomez, Departamento de Epidemiologia, Mexico, D.F.

Summary Quote

"The purpose of this study was to determine the prevalence of nosocomial infections, associated risk factors, microbiology, use of antibiotics, and associated mortality among hospitalized children."

"The prevalence of nosocomial acquired infection was 9.8%. The more prevalent infections were pneumonia (25%), sepsis/bacteremia (19%), and urinary tract infection (5%)."

"The overall mortality was 4.8%; however, patients with nosocomial infection had two times greater risk to die as compared to non-infected children."

"Bacteremia/sepsis and pneumonia are the two nosocomial infections characterized by high prevalence and mortality."

 

Prevalence of nosocomial infections in Udornthanee Hospital 1990.

J Med Assoc Thai 1995 Jul;78 Suppl 1:S50-2

Udorthanee Hospital, Thailand.

Summary Quote

"The intensive care unit had the highest infection rate of 23.1% followed by paediatrics (18.2%)."

 

Nosocomial infections at the University Hospital of Caracas.

Rev Argent Microbiol 1989 Jan-Mar;21(1):25-30

Subcomision de Vigilancia Epidemiologica de las Infecciones Hospitalarias, Hospital Universitario de Caracas, Venezuela.

Summary Quote

"Over a period of one year at the University Hospital of Caracas, a program of epidemiological

surveillance was carried out on nosocomial infections."

"The Intensive Care Unit, the Neonatal Pediatric Service and the three Medicine Services recorded more than 50% of the cases."