Hospital-Acquired Infections I. Surveillance in a University Hospital

Wenzel, Richard P.; Osterman, Charles A.; Hunting, Kathryn J.; Gwaltney, Jack M.

doi:10.1093/oxfordjournals.aje.a112223

Cited by 197 publications

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“…Estes foram selecionados de acordo com quatro critérios, semelhantes aos utilizados por Wenzel (1976): diagnósticos (leucemia, linfoma, granulocitopenia, diabetes, AIDS, dermatose extensa); resultados de laboratório (hemocultura positiva); procedimentos invasivos (sonda vesical, catéter venoso central, cânula endotraqueal, traqueostomia, cirurgia de grande e médio porte); e tempo de internação (maior ou igual a sete dias). Além dos pacientes portadores de quaisquer destas características, foram também acompanhados todos os internados nas Unidades de Terapia Intensiva e Berçário de Alto Risco.…”

Section: Metodologiaunclassified

“…O maior número de pacientes e episódios de infecção hospitalar identificados pela busca ativa, neste estudo, confirma os resultados de outros autores (Haley, 1986;Hofherc, 1979;Wenzel, 1976). As diferenças encontradas entre a busca ativa e a notificação podem ser explicadas pelas características específicas de cada método.…”

Section: Discussão E Conclusõesunclassified

“…Assim, por exemplo, foram relatados valores relativamente altos de sensibilidade e especificidade do mé-todo de revisão retrospectiva de prontuários (Wenzel, 1976;Haley, 1980), o que não é suficiente para que este seja considerado o método preferido. Mesmo que valores semelhantes sejam encontrados em hospitais nacionais, o que depende principalmente da qualidade dos prontuários, trata-se de uma técnica passiva, limitada à coleta de dados retrospectivos e que, portanto, não estimula a interferência contínua da CCIH nos serviços e sua contribuição direta para a prevenção e controle das infecções.…”

Section: Discussão E Conclusõesunclassified

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Infecção hospitalar: comparação entre dois métodos de vigilância epidemiológica

Chor¹,

Klein²,

Marzochi³

1990

Cad. Saúde Pública

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INTRODUÇÃOO estudo das infecções hospitalares é um tema novo nas ciências médicas. As infecções hospitalares restringem-se àquelas que aparecem durante a internação de pacientes, não estando presentes ou em incubação no momento da admissão. Aquela denominação não indica, portanto, agente infeccioso específico, nem localização particular da infecção, mas apenas define o espaço físico onde se inicia.Cerca de 5% dos pacientes admitidos em hospitais gerais contraem infecção durante a internação, nos países desenvolvidos (Haley, 1985). No Brasil, apesar de não existirem estatísticas nacionais que revelem a magnitude real do problema, estima-se que entre 6,5% e 15% dos pacientes internados contraem um

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Section: Metodologiaunclassified

Section: Discussão E Conclusõesunclassified

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Infecção hospitalar: comparação entre dois métodos de vigilância epidemiológica

Chor¹,

Klein²,

Marzochi³

1990

Cad. Saúde Pública

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“…3 Son diversos los investigadores, además de los Centros para la Prevención y el Control de Enfermedades (CDC) de Estados Unidos de América (EUA), que proponen vigilar a todos los pacientes en todo el hospital. [4][5] No obstante, ya que no es posible, en términos prácticos y reales, revisar a todos los pacientes que ingresan al hospital, para detectar IN, se recomienda utilizar fuentes indirectas que permitan la detección de casos de infección; éstas incluyen: la revisión de los cultivos de microbiología, las indicaciones de antibióticos, las curvas de temperatura y el examen de pacientes con factores de riesgo para el desarrollo de infecciones, entre otras. 6 Si bien en otras instituciones este sistema ha tenido una sensibilidad de 82% y ha resultado sumamente eficaz, se recomienda su validación inicial y periódica contra un estándar.…”

Section: Introductionunclassified

Validación de un programa de vigilancia de infecciones nosocomiales

Morales-García

1999

Salud pública Méx

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Objective. To validate the nosocomial infections surveillance system, establish its impact in morbi-mortality. Material and methods. Surveillance of every single patient admited during a one month period was done by one of us (DMG). Each posibile case was discussed with two other hospital epidemiologists (SPLR, MSRF). This intensive surveillance was compared against the routinely surveillance performed by the nurses. We included all hospitalized patients between 11 th July and 12 th of August according to CDC (Atlanta, GA) nosocomial infections definitions. Patients were followed everyday and information about age, gender, underlying diagnosis, microorganisms responsible for nosocomial infections, hospital length of stay and mortality. Results. During the study period 429 were admitted, 45 developed a nosocomial infection (cases) and 384 did not (controls). The incidence of nosocomial infections was 10.48 cases/ 100 discharges. The sensitivity and specificity of the surveillance system was 95.3 and 98.7%, respectively. Mortality in infected was 11.11% and in non infected was 2.4%. The average length of stay was 20 and 11days for cases and non infected respectively (p< 0.01). Urinary tract infections were the most common NI (42%), secondary bacteremia (14-ˇ%), pneumonia (11.11%) and deep surgical site infection (9.25%). The surgical wound infection rates were: 1.3%, 1.9% and 1.9% for clean, clean-contaminated and contaminated wounds. Patients with rapidly fatal diseases had an increased frequency of infections. The microorganisms most commonly isolated were Escherichia coli (28%), Staphylococcus aureus (11.11%), and Pseudomonas aeruginosa (8.6%). The level of antibiotic resistance was in average of 43% for those antibiotics tested. Conclusions. The sensitivity and specifi- ResumenObjetivo. Validar el programa de vigilancia de infecciones nosocomiales y conocer la morbilidad y la mortalidad. Material y métodos. Un médico especialmente capacitado, realizó vigilancia intensiva de todos los pacientes admitidos en el hospital. Los casos de infección fueron discutidos con otros dos médicos y el resultado se comparó con la vigilancia rutinaria. Se incluyó a todos los pacientes hospitalizados del 11 de julio al 12 de agosto de 1995, que no tenían un proceso infeccioso activo o que no manifestaban un periodo de incubación a su ingreso. Se siguieron diariamente y se registraron datos de: edad, sexo y padecimiento de ingreso. Se recabó información sobre tratamiento antimicrobiano, microrganismo aislado y susceptibilidad. Se evaluó el estado clínico final y se estimó el tiempo de estancia hospitalaria. Resultados. De 429 pacientes, 45 desarrollaron infección nosocomial (casos) y 384 no lo hicieron (con-

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“…Thus, to ensure the comparability of HAI rates within a surveillance system, the methods for case finding and ascertainment should be defined [208]. For instance, the sensitivity of a systematic chart review of all patients -a very time-consuming method -has been reported to be as high as 94% [209][210][211], but to drop to 71% if the chart review is selected based on the ward liaison and a review of laboratory reports [212]. The sensitivity of a single method may also vary depending on infection type or patient subpopulation.…”

Section: Case Finding and Ascertainmentmentioning

confidence: 99%

314 Healthcare-Associated Infections in Pediatrics

SpringerReference

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Helsinki 2008 P u b l i c a t i o n s o f t h e N a t i o n a l P u b l i c H e a l t h I n s t i t u t e K T L A 1 1 / 2 0 0 8 Dr. Alexander Langmuir, 1963 Emmi Sarvikivi, Healthcare-associated infections in pediatrics Publications of the National Public Health Institute, A11/2008, 93 Pages ISBN 978-951-740-803-5; 978-951-740-804-2 (pdf-version) ISSN 0359-3584; 1458-6290 (pdf-version) http://www.ktl.fi/portal/4043 ABSTRACT Background and aims. Healthcare-associated infections (HAIs) are known to increase the risk for patient morbidity and mortality in different healthcare settings and thereby to cause additional costs. HAIs typically affect patients with severe underlying conditions, such as patients treated in intensive care units, or patients who have undergone medical procedures, e.g., surgery. HAIs are prevalent also among pediatric patients, but the distribution of the types of infection and the causative agents differ from those detected in adults. The aim of this study was to obtain information on pediatric HAIs in Finland through an assessment of the surveillance of bloodstream infections (BSIs), through two outbreak investigations in a neonatal intensive care unit (NICU), and through a study of postoperative HAIs after open-heart surgery.Methods. The Hospital for Children and Adolescents of the Helsinki University Central Hospital has participated in the BSI surveillance of the Finnish Hospital Infection Program since 1999. These data were utilized in all studies. The epidemiological features of pediatric BSIs were assessed. For the outbreak investigations, case definitions were set and data collected from microbiological and clinical records. The antimicrobial susceptibilities of the Serratia marcescens and the Candida parapsilosis isolates were determined. The S. marcescens isolates were genotyped with pulsed-field gel electrophoresis and the C. parapsilosis blood culture isolates (obtained between the years 1990 and 2002) with Southern blot hybridization by use of a DNA fingerprinting probe. Patient charts were reviewed for the case-control and cohort studies during the outbreak investigations, as well as for those patients who acquired surgical site infections (SSIs) after having undergone open-heart surgery. Also a prospective postdischarge study was conducted to detect postoperative HAIs after open-heart surgery.Results. During 1999During -2006, the overall annual BSI rate was 1.6/1,000 patient-days (range by year, 1.2-2.1). High rates (average, 4.9 and 3.2 BSIs/1,000 patient-days) were detected in hematology and neonatology units. Coagulase-negative staphylococci were the most common pathogens both hospital-wide and in each patient group. The overall mortality was 5%. The genotyping of the 15 S. marcescens isolates revealed three independent clusters. All of the 26 C. parapsilosis isolates studied proved to be indistinguishable. No common source was identified for either of the outbreaks, but the NICU was overcrowded during the S. marcescens clusters. In both investigations, low birth we...

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Hospital-Acquired Infections I. Surveillance in a University Hospital

Cited by 197 publications

References 0 publications

Infecção hospitalar: comparação entre dois métodos de vigilância epidemiológica

Infecção hospitalar: comparação entre dois métodos de vigilância epidemiológica

Validación de un programa de vigilancia de infecciones nosocomiales

314 Healthcare-Associated Infections in Pediatrics

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