In a representative sample of US general hospitals, the authors found that the establishment of intensive infection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tract infection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for other characteristics of the hospitals and their patients. Essential components of effective programs included conducting organized surveillance and control activities and having a trained, effectual infection control physician, an infection control nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with these components reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs, however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s, leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effective programs, the overall infection rate increased by 18% from 1970 to 1976.

The distribution of sites of infection in medical ICUs differed from that previously reported in NNIS ICU surveillance studies, largely as a result of anticipated low rates of surgical site infections. Primary bloodstream infections, pneumonia, and urinary tract infections associated with invasive devices made up the great majority of nosocomial infections. Coagulase-negative staphylococci were more frequently associated with primary bloodstream infections than reported from NNIS ICUs of all types in the 1980s, and enterococci were a more frequent isolate from bloodstream infections than S. aureus. Fungal urinary tract infections, often asymptomatic and associated with catheter use, were considerably more frequent than previously reported. Invasive device-associated infections were associated with specific pathogens. Although device-associated site-specific infection rates are currently our most useful rates for performing comparisons between ICUs, the considerable variation in these rates between ICUs indicates the need for further risk adjustment.

Nosocomial infections in MS ICUs at the most frequent infection sites (bloodstream, urinary, and respiratory tract) almost always were associated with use of an invasive device. Device-associated infection rates were the best available comparative rates between combined MS ICUs, but the distribution of device-associated rates should be stratified by a hospital's major teaching affiliation status.

To determine trends in the microbial etiology of nosocomial infections in the 1980s, surveillance data on the microbiology of documented nosocomial infection reported to the National Nosocomial Infections Surveillance System and from the University of Michigan Hospital were analyzed. Antimicrobial susceptibility data on selected pathogens from both sources were also reviewed. Overall, Escherichia coli decreased from 23% of infections in 1980 to 16% in 1986-1989, Klebsiella pneumoniae dropped from 7% to 5%, whereas coagulase negative staphylococci increased from 4% to 9% and Candida albicans increased from 2% to 5%. Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacter species and enterococci had minor increases, but antimicrobial resistant strains for these pathogens as well as coagulase-negative staphylococci were seen more frequently. In contrast to the 1970s, major shifts in the etiology of nosocomial infection have occurred in the decade of the 1980s. Taken as a whole, the shifts are away from more easily treated pathogens toward more resistant pathogens with fewer options for therapy. These shifts underscore the continued need for prevention and control to accompany new developments in therapy.

The risk of HIV infection after percutaneous exposure increases with a larger volume of blood and, probably, a higher titer of HIV in the source patient's blood. Postexposure prophylaxis with zidovudine appears to be protective.

No abstract

No abstract

No abstract