Impact of an infection control program in an intensive care unit in France
ABSTRACT To evaluate the impact of an infection control program in an intensive care unit (ICU).
Prospective before-after study. Two 6-month study periods were compared; between these periods, an infection control program based on isolation was implemented.
Polyvalent ICU of Montpellier Teaching Hospital.Patients. Any patient who was hospitalized in the ICU for >48 hours and was discharged during 1 of the 2 periods.
The main patient-related variables were sex, age at admission, type of patient (surgical, medical, or trauma), Simplified Acute Physiology Score II, length of ICU stay, need for intubation, duration of exposure to invasive devices, onset of nosocomial infection and pathogens responsible, and death. We compared the 2 study periods with respect to the incidence of 4 nosocomial infections (pneumonia, urinary tract infection, bacteremia, and catheter-associated infection), the frequency of infection with the main multidrug-resistant pathogens, and patient survival.
Patients in periods 1 and 2 were similar with regard to sex, age, physiology score, and exposure to invasive devices. The rates of infection with multidrug-resistant pathogens were significantly lower during period 2 than during period 1 (infection rate: 28.1% of patients in period 1 and 9.6% of patients in period 2 [P = .01]; pneumonia rate: 32.6% of patients in period 1 and 4.2% of patients in period 2 [P = .008]). The mortality rate among patients with nosocomial pneumonia was 38.2% in period 1 and 4.3% in period 2 (P = .009).
After implementation of an infection control program, the rate of infection with multidrug-resistant pathogens decreased, as did the mortality rate among patients with nosocomial pneumonia.
SourceAvailable from: Giovane Mendieta IzquierdoEdited by Asociación Colombiana de Infectología Capítulo Central, 01/2010; Asociación Colombiana de Infectología Capítulo Central., ISBN: 978-958-99588-0-3
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ABSTRACT: Nosocomial infections, especially those caused by antibiotic resistant bacteria, are increasing at an alarming rate over the globe. Unfortunately, standard infection control practices, such as pre-emptive isolation of high-risk patients, wide and targeted surveillance cultures, and proper ventilation systems are lacking in developing countries mainly due to insufficient resources. Patients shed bacteria and contaminate their pyjamas and sheets. The temperature and humidity between the patients and the bed are appropriate conditions allowing for effective bacterial proliferation. Bed making releases large quantities of micro-organisms into the air, which contaminate the immediate and non-immediate surroundings. Personnel in contact with contaminated textiles can also cross-contaminate other surfaces or patients. Thus textiles in hospitals can be an important source of microbes contributing to endogenous, indirect-contact, and aerosol transmission of nosocomial related pathogens. The use of safe wide-spectrum antimicrobial textiles, especially in those textiles that are in close contact with the patients, may significantly reduce bioburden in clinical settings and consequently reduce the risk of nosocomial infections. This is of special significance in resource poor developing countries, where wards are overcrowded and population infection burdens are very high. The use of biocidal textiles is a simple, cost-affordable and feasible measure that may be especially important in developing countries where essential infection control measures are not implemented.The Open Biology Journal 09/2010; 3(3). DOI:10.2174/1874196701003030081
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ABSTRACT: Bloodstream infections resulting from intravascular catheters (catheter-BSI) in critical care increase patients' length of stay, morbidity and mortality, and the management of these infections and their complications has been estimated to cost the NHS annually £19.1-36.2M. Catheter-BSI are thought to be largely preventable using educational interventions, but guidance as to which types of intervention might be most clinically effective is lacking. To assess the effectiveness and cost-effectiveness of educational interventions for preventing catheter-BSI in critical care units in England. Sixteen electronic bibliographic databases - including MEDLINE, MEDLINE In-Process & Other Non-Indexed Citations, Cumulative Index to Nursing and Allied Health Literature (CINAHL), NHS Economic Evaluation Database (NHS EED), EMBASE and The Cochrane Library databases - were searched from database inception to February 2011, with searches updated in March 2012. Bibliographies of systematic reviews and related papers were screened and experts contacted to identify any additional references. References were screened independently by two reviewers using a priori selection criteria. A descriptive map was created to summarise the characteristics of relevant studies. Further selection criteria developed in consultation with the project Advisory Group were used to prioritise a subset of studies relevant to NHS practice and policy for systematic review. A decision-analytic economic model was developed to investigate the cost-effectiveness of educational interventions for preventing catheter-BSI. Seventy-four studies were included in the descriptive map, of which 24 were prioritised for systematic review. Studies have predominantly been conducted in the USA, using single-cohort before-and-after study designs. Diverse types of educational intervention appear effective at reducing the incidence density of catheter-BSI (risk ratios statistically significantly < 1.0), but single lectures were not effective. The economic model showed that implementing an educational intervention in critical care units in England would be cost-effective and potentially cost-saving, with incremental cost-effectiveness ratios under worst-case sensitivity analyses of < £5000/quality-adjusted life-year. Low-quality primary studies cannot definitively prove that the planned interventions were responsible for observed changes in catheter-BSI incidence. Poor reporting gave unclear estimates of risk of bias. Some model parameters were sourced from other locations owing to a lack of UK data. Our results suggest that it would be cost-effective and may be cost-saving for the NHS to implement educational interventions in critical care units. However, more robust primary studies are needed to exclude the possible influence of secular trends on observed reductions in catheter-BSI. The study is registered with PROSPERO as CRD42012001840. The National Institute for Health Research Health Technology Assessment programme.02/2014; 18(15):1-365. DOI:10.3310/hta18150