Between 1972 and 1973, Britt and colleagues conducted 1-day infection prevalence surveys in 18 hospitals each with fewer than 75 beds and all located in the rural intermountain west. The lessons learned from that study were incorporated into a book chapter entitled “Infection Control in Small Hospitals” by Dr. Britt. Since that study no substantial nor systematic review of nosocomial infections in small community or rural hospitals has been reported. A recent editorial in Infection Control posed four questions that still needed to be answered for the smaller (less than 100-bed) hospital:1. Given the statistical realities of small hospitals, what types of surveillance methods—periodic prevalence surveys, general surveillance, focused surveillance, etc.—are the most reliable? Are any of them necessary?2. Which of the many infection control practices recommended by the CDC, the Joint Commission on Accreditation of Hospitals, and others are applicable to small hospitals?3. What resource sharing of existing expertise, from larger hospitals, health departments, groups such as the Association of Practitioners of Infection Control and the Society of Hospital Epidemiologists of America, and others can be developed for smaller hospitals in cost effective and realistic ways?4. Should smaller hospitals be required to have the same type of multidisciplinary infection control committees required of larger hospitals or can the responsibilities of the committee be delegated to a smaller group such as one nurse and one staff physician?The purpose of this report is to provide detailed infection control information obtained from 15 hospitals located in rural areas of Southwestern Wisconsin. This article will focus on data derived from an initial comprehensive prevalence survey that replicated the Britt study in the Wisconsin sites in 1983. Additional data were derived from ongoing bi-monthly prevalence studies done over 6 consecutive months in each of the 15 rural hospitals. Data from 6 months of ongoing comprehensive surveillance from each of the 15 hospitals and final conclusions from the project will be the subject of a subsequent paper.
Fifteen rural Wisconsin acute care community hospitals with an average approved bed size of 55 and an average daily census of 28 patients participated in a nosocomial infection control project. Each hospital Infection Control Practitioner (ICP) was trained and conducted prospective nosocomial infection surveillance on all patients admitted to the hospital for 6 consecutive months between May 1,1984 and April 30, 1985. Two hundred twenty nosocomial infections were reported among 13,420 discharged patients for an incidence rate of 1.64 infections per 100 discharged patients. One hundred sixty-four patients had one nosocomial infection. Twenty-three patients had two or more. Infection rates were highest among gynecology— 4.9% and general surgery patients— 4.0%, and lowest among newborns—0.3% and pediatric patients—0%. 39.7% of the infections were of the urinary tract, 27.9% of surgical wounds, 16% pneumonia, and 1.4% primary bacteremia. The other infections were in seven additional sites. Risk factors associated with acquisition of infections included old age, urinary catheterization, and/or a surgical procedure. The overall nosocomial surgical wound infection incidence for inpatient procedures was 1.9%, with incidences of 0.4% for hernia repair, 1.3% for cholecystectomy, 3.3% for appendectomy, 4.0% for total abdominal hysterectomy, and 3.9% for cesarean sections; The incidence of nosocomial infections was 2.7 infections per 100 discharged patients age 65 years or over and 0.9 infections per 100 discharged patients less than 65 years. Two hundred thirty-six microorganisms were cultured from 175 of the infections. Staphylococcus aureus, coagulase-negative Staphylococcus, and Enterococcus were the most common gram-positive organisms. E. coli, Pseudomonas, Proteus, and Klebsiella were the most common gram-negative organisms cultured. The overall nosocomial infection incidence was much lower than reported rates for other groups of hospitals. These data have implications for the review and potential modification of complex guidelines and requirements for infection control in smaller rural hospitals.
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