Prevalence and Risk Factors for Nosocomial Infections in Four University Hospitals in Switzerland | Infection Control & Hospital Epidemiology | Cambridge Core (original) (raw)

Article contents

Abstract

Objective:

To determine the prevalence and risk factors for nosocomial infections (NIs) in four Swiss university hospitals.

Design and Setting:

A 1-week period-prevalence survey conducted in May 1996 in medical, surgical, and intensive-care wards of four Swiss university hospitals (900-1,500 beds). Centers for Disease Control and Prevention definitions were used, except that asymptomatic bacteriuria was not categorized as NI. Study variables included patient demographics, primary diagnosis, comorbidities, exposure to medical and surgical risk factors, and use of antimicrobials. Risk factors for NIs were determined using logistic regression with adjustment for length of hospital stay, study center, device use, and patients' comorbidities.

Results:

176 NI were recorded in 156 of 1,349 screened patients (11.6%; interhospital range, 9.8%-13.5%). The most frequent NI was surgical-site infection (53; 30%), followed by urinary tract infection (39; 22%), lower respiratory tract infection (27; 15%), and bloodstream infection (23; 13%). Prevalence of NI was higher in critical-care units (25%) than in medical (9%) and surgical wards (12%). Overall, 65% of NIs were culture-proven; the leading pathogens were Enterobacteriaceae (44; 28%), Staphylococcus aureus (20; 13%), Pseudomonas aeruginosa (17; 11%), and Candida species (16; 10%). Independent risk factors for NI were central venous catheter (CVC) use (odds ratio [OR], 3.35; 95% confidence interval [CI95], 2.91-3.80), admission to intensive care (OR, 1.75; CI95, 1.30-2.21), emergency admission (OR, 1.57; CI95, 1.15-2.00), impaired functional status (Karnofsky index 1-4: OR, 2.56; CI95, 1.95-3.17), and McCabe classification of ultimately fatal (OR, 2.50; CI95, 2.04-2.96) or rapidly fatal (OR 2.25; CI95,1.52-2.98) underlying condition.

Conclusions:

According to the results of this survey, NIs are frequent in Swiss university hospitals. This investigation confirms the importance of CVCs as a major risk factor for NI. Patient comorbidities must be taken into account to adjust for case mix in any study comparing interhospital or intrahospital infection rates.

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Type

Original Articles

Copyright

Copyright © The Society for Healthcare Epidemiology of America 1999

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References

  1. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG, Munn, VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182–205.CrossRefGoogle ScholarPubMed

  2. Haley, RW. The scientific basis for using surveillance and risk factor data to reduce nosocomial infection rates. J Hosp Infect 1995;30(suppl):3–14.CrossRefGoogle ScholarPubMed

  3. Vincent, JL, Biliari, DJ, Suter, PM, Bruining, HA, White, J, Nicolas-Chanoin, MH, et al. The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 1995;274:639–644.CrossRefGoogle ScholarPubMed

  4. EPINE Working Group. Prevalence of hospital-acquired infections in Spain. J Hosp Infect 1992;20:1–13.CrossRefGoogle Scholar

  5. French, GL, Cheng, AF, Wong, SL, Donnan, S. Repeated prevalence surveys for monitoring effectiveness of hospital infection control. Lancet 1989;2:1021–1023.CrossRefGoogle ScholarPubMed

  6. Pittet, D, Francioli, P, von Overbeck, J, Raeber, PA, Ruef, C, Widmer, AF. Infection control in Switzerland. Infect Control Hosp Epidemiol 1995;16:49–56.CrossRefGoogle ScholarPubMed

  7. Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections. Am J Infect Control 1988;16:128–140.CrossRefGoogle ScholarPubMed

  8. International Classification of Diseases, 9th Revision, Clinical Modification: ICD-9-CM. Publication PHS 89-1260. Washington, DC: US Public Health Service; 1989.Google Scholar

  9. Pittet, D, Davis, CS, Li, N, Wenzel, RP. Identifying the hospitalized patient at risk for nosocomial bloodstream infection: a population-based study. Proceedings of the Association of American Physicians 1997;109:58–67.Google ScholarPubMed

  10. McCabe, WR, Jackson, GG. Gram-negative bacteremia, I: etiology and ecology. Arch Intern Med 1962;110:847–855.CrossRefGoogle Scholar

  11. Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Disease (England) 1987;40:373–383.CrossRefGoogle ScholarPubMed

  12. Karnofsky, DA, Burchenal, JH. The clinical evaluation of chemotherapeutic agents in cancer. In: MacLeod, CM, ed. Evaluation of Chemotherapeutic Agents. New York, NY: Columbia University Press; 1949:191–205.Google Scholar

  13. McLaws, ML, Gold, J, King, K, Irwig, LM, Berry, G. The prevalence of nosocomial and community-acquired infections in Australian hospitals. Med JAust 1988;149:582–590.Google ScholarPubMed

  14. Aavitsland, P, Stormark, M, Lystad, A. Hospital-acquired infections in Norway: a national prevalence survey in 1991. Scand J Infect Dis 1992;24:477–483.CrossRefGoogle ScholarPubMed

  15. Emmerson, AM, Enstone, JE, Griffin, M, Kelsey, MC, Smyth, ET. The second national prevalence survey of infection in hospitals—overview of the results. J Hosp Infect 1996;32:175–190.CrossRefGoogle ScholarPubMed

  16. Mertens, R, Kegels, G, Stroobant, A, Reybrouck, G, Lamottet, JM, Potvliege, C, et al. The national prevalence survey of nosocomial infections in Belgium, 1984. J Hosp Infect 1987;9:219–229.CrossRefGoogle ScholarPubMed

  17. Pittet, D, Harbarth, S. The intensive care unit. In: Bennett, JV, Brachman, PS, eds. Hospital Infections. Boston, MA: Little, Brown and Co; 1998:381–402.Google Scholar

  18. Broderick, A, Mori, M, Nettleman, MD, Streed, SA, Wenzel, RP. Nosocomial infections: validation of surveillance and computer modeling to identify patients at risk. Am J Epidemiol 1990;131:734–742.CrossRefGoogle ScholarPubMed

  19. Josephson, A, Karanfil, L, Alonso, H, Watson, A, Blight, J: Risk-specific nosocomial infection rates. Am J Med 1991;91:131S–137S.CrossRefGoogle ScholarPubMed

  20. Widmer, AF. IV-related infections. In: Wenzel, RP, ed. Prevention and Control of Nosocomial Infections. Baltimore, MD: Williams & Wilkins; 1997:771–805.Google Scholar

  21. Valles, J, Leon, C, Alvarez-Lerma, F. Nosocomial bacteremia in critically ill patients: a multicenter study evaluating epidemiology and prognosis. Spanish collaborative group for infections in intensive care units. Clin Infect Dis 1997;24:387–395.CrossRefGoogle Scholar

  22. Rüden, H, Gastmeier, P, Daschner, F, Schumacher, M. Nosocomial infections in Germany. Their epidemiology in old and new Federal Länder. Dtsch Med Wochenschr 1996;121:1281–1287.CrossRefGoogle ScholarPubMed

  23. Haley, RW, Culver, DH, Morgan, WM, White, JW, Emori, TG, Hooton, TM. Increased recognition of infectious diseases in US hospitals through increased use of diagnostic tests, 1970-1976. Am J Epidemiol 1985;121:168–181.CrossRefGoogle ScholarPubMed

  24. Quenon, JL and the Comité Technique national des Infections Nosocomiales. Ministère du travail et des affaires sociales, Paris, France. Projet "Hôpital propre": Première enquête nationale de prévalence des infections nosocomiales. 1992;28–47.Google Scholar

  25. Valinteliene, R, Jurkuvenas, V, Jepsen, OB. Prevalence of hospital-acquired infection in a Lithuanian hospital. J Hosp Infect 1996;34:321–329.CrossRefGoogle Scholar