Nosocomial Infection—The Irreducible Minimum

Abstract

Prevalence surveys in different countries have shown that about 1 in 10 hospitalized patients at any one time have acquired an infection and the incidence of infection is usually about 3% to 5%. Can this infection rate be significantly reduced and is there an irreducible minimum below which further reduction cannot be obtained? Cross-infection could probably be almost eliminated by the use of plastic isolators or life islands, and endogenous infections reduced by the wider and more rational prophylactic use of topical and systemic antimicrobial agents, and possibly a range of vaccines. However, the use of these techniques on all patients would clearly be impractical and too expensive for use in the foreseeable future. Excessive isolation techniques would have a detrimental psychological effect on many patients. In addition, failure to eradicate the organisms of the normal flora might be associated with more infections caused by antibiotic-resistant bacteria, fungi and viruses which would be more difficult to treat. Even if organisms could be eradicated, morbidity and mortality might not be correspondingly reduced. Priorities must therefore be set on the most effective use of staff and finances. These not only involve a consideration of infection, but all areas of clinical practice, eg, costs of cardiac transplants and provision of geriatric facilities. It therefore seems likely that little additional finance will be available for control of infection, other than possibly for transmissible infections with high mortality such as AIDS.

Nosocomial infections and hospital mortality: a multicentre epidemiological study

“…Although it has been estimated that 32% of all NI are preventable, 24 the high percentage of peritonitis resulting directly from complications of a underlying condition reflects the limits of preventive measures in some categories of patients, as previously reported. 25 The total number of in-hospital deaths in France that could be extrapolated from the present data is likely to be smaller than previous estimates. 3,5 Hence, in France, 9000 deaths per year, corresponding to 149 deaths per year per million inhabitants, would be a reasonable approximation of the total number of deaths to which NI contributed.…”

Hospital Infection Surveillance in the United Kingdom

“…A large prevalence survey was carried out in the Birmingham region of England between 1968 and 1970'" and surveys have been carried out almost annually since then in our hospital. The prevalence rate has remained remarkably constant 15 and similar to that of a large national study made in 1980.'" However, prevalence surveys, although providing rates and much useful information, are of little value in routine infection control.…”

Results from the second Scottish national prevalence survey: the changing epidemiology of healthcare-associated infection in Scotland

“…The incidence of SSI following hip arthroplasty surgery has fallen significantly since 2003 but has remained stable for the last three years of reporting and consideration for whether the irreducible minimum has been reached is required. 21,22 The higher proportion of BSI in acute hospitals may reflect the underlying medical conditions of the hospital population and the increasing complexity of care during inpatient stays. Onethird of all BSIs were of unknown origin at the time of survey indicating the complexity in identifying IPC interventions to reduce these sources of infection and indicating the need for enhanced surveillance to better describe the causes.…”