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How Many Nosocomial Infections are Associated with Cross-Transmission? A Prospective Cohort Study in A Surgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Klaus Weist
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Kathrin Pollege
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Hospital Ernst von Bergmann, Potsdam, Germany
Ines Schulz
Affiliation:
Department of Microbiology, Hospital Ernst von Bergmann, Potsdam, Germany
Henning Rüden
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany

Abstract

Objective:

To determine the percentage of cross-transmissions in an intensive care unit (ICU) with high nosocomial infection (NI) rates according to the data of the German Nosocomial Infection Surveillance System.

Setting:

A 14-bed surgical ICU of a 1,300-bed, tertiary-care teaching hospital.

Method:

Prospective surveillance of NIs during a period of 9 months. If an NI was present, the isolates of the following indicator pathogens were stored and typed by species: Staphylococcus aureus, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter species. Pulsed-field gel electrophoresis was performed for typing of S. aureus strains and arbitrarily primed polymerase chain reaction was applied for the other pathogens. The presence of two indistinguishable strains in two patients was considered as one episode of cross-transmission.

Results:

Two hundred sixty-two patients were observed during a period of 2,444 patient-days; 96 NIs were identified in 59 patients and the overall incidence density of NI was 39.3 per 1,000 patient-days. For 104 isolates, it was possible to consider typing results. Altogether, 36 cross-transmissions have lead to NIs in other patients. That means at least 37.5% of all NIs identified were due to cross-transmissions.

Conclusion:

Because of the method of this study, the percentage of NIs due to cross-transmission identified for this ICU is an “at least number”. In reality, the number of cross-transmissions, and thus the number of avoidable infections, may have been even higher. However, it is difficult to assess whether the percentage of NIs due to cross-transmission determined for this ICU may be the crucial explanation for the relatively high infection rate in comparison to other surgical ICUs.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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References

1.Tablan, OC, Anderson, LJ, Arden, NH, Breiman, RF, Butler, JC, McNeil, MM. Guideline for prevention of nosocomial pneumonia. Infect Control Hosp Epidemiol 1994;15:587627.CrossRefGoogle ScholarPubMed
2.Pearson, ML. Guideline for prevention of intravascular device-related infections. Infect Control Hosp Epidemiol 1996;17:438473.CrossRefGoogle ScholarPubMed
3.Mangram, AT, Horan, TC, Pearson, ML, Silver, LC, Jarvis, WR. Guideline for prevention of surgical site infection, 1999. Infect Control Hosp Epidemiol 1999;20:250278.CrossRefGoogle ScholarPubMed
4.Chetchotisakd, P, Phelps, CL, Hartstein, AI. Assessment of bacterial cross-transmission as a cause of infections in patients in intensive care units. Clin Infect Dis 1994;18:929937.CrossRefGoogle ScholarPubMed
5.Gastmeier, P, Sohr, D, Just, HM, Nassauer, A, Daschner, F, Ruden, H. How to survey nosocomial infections. Infect Control Hosp Epidemiol 2000;21:366370.CrossRefGoogle ScholarPubMed
6.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.CrossRefGoogle ScholarPubMed
7.Horan, TC, Gaynes, RP, Martone, WJ, Jarvis, WR, Emori, TG. CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical wound infections. Infect Control Hosp Epidemiol 1992;13:606608.CrossRefGoogle ScholarPubMed
8.Emori, TG, Culver, DH, Horan, TC, et al. National Nosocomial Infections Surveillance System (NNIS): description of surveillance methods. Am J Infect Control 1991;19:1935.CrossRefGoogle ScholarPubMed
9.Witte, W, Grimm, H. Occurrence of quinolone resistance in Staphylococcus aureus from nosocomial infection. Epidemiol Infect 1992;109:413421.CrossRefGoogle ScholarPubMed
10.Tenover, FC, Arbeit, RD, Goering, RV. How to select and interpret molecular strain typing methods for epidemiological studies of bacterial infections: a review for healthcare epidemiologists. Infect Control Hosp Epidemiol 1997;18:426439.CrossRefGoogle ScholarPubMed
11.Grundmann, HJ, Towner, KJ, Dijkshoorn, L, et al. Multicenter study using standardized protocols and reagents for evaluation of reproducibility of PCR-based fingerprinting of Acinetobacter spp. J Clin Microbiol 1997;35:30713077.Google ScholarPubMed
12.Geffers, C, Gastmeier, P, Brauer, H, Daschner, F, Ruden, H. Surveillance of nosocomial infections in ICUs: is postdischarge surveillance indispensable? Infect Control Hosp Epidemiol 2001;22:157159.CrossRefGoogle ScholarPubMed
13.Weller, TM. Methicillin-resistant Staphylococcus aureus typing methods: which should be the international standard? J Hosp Infect 2000;44:160172.CrossRefGoogle ScholarPubMed
14.Haley, RW, Cushion, NB, Tenover, FC, et al. Eradication of endemic methicillin-resistant Staphylococcus aureus infections from a neonatal intensive care unit. J Infect Dis 1995;171:614624.CrossRefGoogle ScholarPubMed
15.Barbier, N, Saulnier, P, Chachaty, E, Dumontier, S, Andremont, A. Random amplified polymorphic DNA typing versus pulsed-field gel electrophoresis for epidemiological typing of vancomycin-resistant enterococci. J Clin Microbiol 1996;34:10961099.Google ScholarPubMed
16.Grundmann, HJ, Hahn, A, Ehrenstein, B, Geiger, K, Just, H, Daschner, FD. Detection of cross-transmission of multiresistant gram-negative bacilli and Staphylococcus aureus in adult intensive care units by routine typing of clinical isolates. Clin Microbiol Infect 1999;5:355363.CrossRefGoogle Scholar
17.Webster, CA, Towner, KJ. Use of RAPD-ALF analysis for investigating the frequency of bacterial cross-transmission in an adult intensive care unit. J Hosp Infect 2000;44:254260.CrossRefGoogle Scholar
18.Vincent, JL, Bihari, DJ, Suter, PM, et al. The prevalence of nosocomial infection in intensive care units in Europe: results of the European Prevalence of Infection in Intensive Care (EPIC) Study. JAMA 1995;274:639644.CrossRefGoogle ScholarPubMed
19.Chevret, S, Hemmer, M, Carlet, J, Langer, M. Incidence and risk factors of pneumonia acquired in intensive care units: results from a multicenter prospective study on 996 patients. Intensive Care Med 1993;19:256264.CrossRefGoogle ScholarPubMed
20.Merrer, J, Santoli, F, Appere de Vecchi, C, Tran, B, De Jonghe, B, Outin, H. “Colonization pressure” and risk of acquisition of methicillin-resistant Staphylococcus aureus in a medical intensive care unit. Infect Control Hosp Epidemiol 2000;21:718723.CrossRefGoogle Scholar
21.Haley, RW, Culver, DH, White, JW, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985;121:182205.CrossRefGoogle ScholarPubMed
22.Gastmeier, P, Forster, D, Geffers, C, Rath, A, Daschner, F, Rüden, H. Reduction of nosocomial infections (NI) through a comprehensive infection control program. Infection Control Hosp Epidemiol 1999;20:281.Google Scholar
23.Eggimann, P, Harbarth, S, Constantin, MN, Touveneau, S, Chevrolet, JC, Pittet, D. Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 2000;355:18641868.CrossRefGoogle ScholarPubMed
24.Bukhari, SS, Sanderson, PJ, Richardson, DM, Kaufman, ME, Aucken, HM, Cookson, BD. Endemic cross-infection in an acute medical ward. J Hosp Infect 1993;24:261271.CrossRefGoogle Scholar
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