Top

Published in:

01-03-2004 | Original

A continuous quality-improvement program reduces nosocomial infection rates in the ICU

Authors: Benoit Misset, Jean-François Timsit, Marie-Françoise Dumay, Maité Garrouste, Annie Chalfine, Isabelle Flouriot, Fred Goldstein, Jean Carlet

Published in: Intensive Care Medicine | Issue 3/2004

Abstract

Objective

To assess the impact of a continuous quality-improvement program on nosocomial infection rates.

Design and setting

Prospective single-center study in the medical-surgical ICU of a tertiary care center.

Patients

We admitted 1764 patients during the 5-year study period (1995–2000); 55% were mechanically ventilated and 21% died. Mean SAPS II was 37±21 points and mean length of ICU stay was 9.7±16.1 days.

Interventions

Implementation of an infection control program based on international recommendations. The program was updated regularly according to infection and colonization rates and reports in the literature.

Measurements and results

Prospective surveillance showed the following rates per 1000 procedure days: ventilator-associated pneumonia (VAP) 8.7, urinary tract infection (UTI) 17.2, central venous catheter (CVC) colonization 6.1, and CVC-related bacteremia and2.0; arterial catheter colonization did not occur. In the 5 years following implementation of the infection control program there was a significant decline in the rate per patient days of UTI, CVC colonization, and CVC-related bacteremia but not VAP. Between the first and second 2.5-year periods the time to infection increased significantly for UTI and CVC-related colonization.

Conclusions

A continuous quality-improvement program based on surveillance of nosocomial infections in a nonselected medical-surgical ICU population was associated with sustained decreases in UTI and CVC-related infections.

Available only for authorised users

Anonymous (1991) A report from the National Nosocomial Infections Surveillance System. Nosocomial infection rates for inter-hospital comparison: limitations and possible solutions. Infect Control Hosp Epidemiol 12:609–621PubMed

Emori TG, Edwards JR, Culver DH, Sartor C, Stroud LA, Gaunt EE, Horan TC, Gaynes RP (1998) Accuracy of reporting nosocomial infections in intensive-care-unit patients to the National Nosocomial Infections Surveillance System: a pilot study. Infect Control Hosp Epidemiol 19:308–316PubMed

Girou E, Stephan F, Novara A, Safar M, Fagon JY (1998) Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 157:1151–1158PubMed

Quality Indicator Study Group (1995) An approach to the evaluation of quality indicators of the outcome of care in hospitalized patients, with a focus on nosocomial infection indicators. Infect Control Hosp Epidemiol 16:308–316PubMed

Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med 27:887–892PubMed

Eggimann P, Habarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D (2000) Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care. Lancet 355:1864–1868PubMed

Zack JE, Garrison T, Trovillion E, Clinkscale D, Coopersmith CM, Fraser VJ, Kollef MH (2002) Effect of an education program aimed at reducing the occurrence of ventilator-associated pneumonia. Crit Care Med 30:2407–2412CrossRefPubMed

Groupe REANIS (1994) Guide pour la prévention des infections nosocomiales en réanimation. Arnette, Paris

Centers for Disease Control and Prevention (1994) Guideline for prevention of nosocomial pneumonia. Respir Care 39:1191–1236PubMed

10.

Drakulovic MB, Torres A, Bauer TT, Nicolas JM, Nogue S, Ferrer M (1999) Supine body position as a risk factor for nosocomial pneumonia in mechanically ventilated patients: a randomised trial. Lancet 354:1851–1858PubMed

11.

Wong ES (1983) Guideline for prevention of catheter-associated urinary tract infections. Am J Infect Control 11:28–36PubMed

12.

Centers for Disease Control and Prevention (1996) Guidelines for prevention of intravascular device-related infections. Am J Infect Control 24:262–293PubMed

13.

Timsit JF, Bruneel F, Cheval C, Mamzer MF, Garrouste-Orgeas M, Wolff M, Misset B, Chevret S, Regnier B, Carlet J (1999) Use of tunneled femoral catheters to prevent catheter-related infection: a randomized controlled trial. Ann Intern Med 130:729–735

14.

Jackson MM, Lynch P (1996) Guideline for isolation precautions in hospitals, 1996. Am J Infect Control 24:203–206PubMed

15.

Brun-Buisson C, Legrand P, Rauss A, Richard C, Montravers F, Besbes M, Meakins JL, Soussy CJ, Lemaire F (1989) Intestinal decontamination for control of nosocomial multi-resistant gram-negative bacilli. Study of an outbreak in an intensive care unit. Ann Intern Med 110:873–881PubMed

16.

Kahn RJ, Arich C, Baron D, Gutmann L, Hemmer M, Nitenberg G, Petitprez P (1990) Consensus development conferences in intensive care medicine: Diagnosis of nosocomial pneumonia in resuscitation. Ann Fr Anesth Reanim 9:318–320PubMed

17.

Campbell GD, Niederman NS, Broughton WA, Craven DE, Fein AM, Fink MP, Gleeson K, Hornick DB, Lynch JP, Mandell LA, Mason CM, Torres A, Wunderink RG (1996) Hospital-acquired pneumonia in adults: diagnosis, assessment of severity, initial antimicrobial therapy, and preventive strategies-a consensus statement. Am J Respir Crit Care Med 153:1711–1725PubMed

18.

Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M (1987) Diagnosis of central venous catheter-related sepsis. Critical level of quantitative tip cultures. Arch Intern Med 147:873–877PubMed

19.

Centers for Disease Control and Prevention (1989) CDC definitions for nosocomial infections. Am J Infect Control 17:42–43PubMed

20.

Le Gall JR, Lemeshow S, Saulnier F (1993) A new Simplified Acute Physiology Score (SAPS II) based on a European/North American multi-center study. JAMA 270:2957–2963PubMed

21.

Saulnier F, Hubert H, Omnus TM, Beague S, Nseir S, Grandbastien B, Renault CY, Idkiz M, Erb MP, Durocher AV (2001) Assessing excess nurse workload generated by multiresistant nosocomial bacteria in intensive care. Infect Control Hosp Epidemiol 22:273–278PubMed

22.

Keene AR, Cullen DJ (1983) Therapeutic Intervention Scoring System: update 1983. Crit Care Med 11:1–3PubMed

23.

National Nosocomial Infections Surveillance System report (2002) Am J Infect Control 30:458–475CrossRefPubMed

24.

Fagon JY, Chastre J, Vuagnat A, Trouillet JL, Novara A, Gibert C (1996) Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 275:866–869PubMed

25.

Hubmayr RD, Burchardi H, Elliot M, Fessler H, Georgopoulos D, Jubran A, Limper A, Pesenti A, Rubenfeld G, Stewart T, Villar J (2002) Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia-Chicago, Illinois, May 2002. Intensive Care Med 28:1521–1536CrossRef

26.

Raad II, Hohn DC, Gilbreath BJ, Suleiman N, Hill LA, Bruso PA, Marts K, Mansfield PF, Bodey GP (1994) Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion. Infect Control Hosp Epidemiol 15:231–238PubMed

27.

Maki DG, Ringer M, Alvarado CJ (1991) Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 338:339–343CrossRefPubMed

28.

Humar A, Ostromecki A, Direnfeld J, Marshall JC, Lazar N, Houston PC, Boiteau P, Conly JM (2000) Prospective randomized trial of 10% povidone-iodine versus 0.5% tincture of chlorhexidine as cutaneous antisepsis for prevention of central venous catheter infection. Clin Infect Dis 31:1001–1007CrossRefPubMed

29.

Rijnders BJA, Van Wijngaerden E, Peetermans WE (2002) Catheter-tip colonization as a surrogate end point in clinical studies on catheter-related bloodstream infection: how strong is the evidence? Clin Infect Dis 35:1053–1058CrossRefPubMed

30.

Vincent JL, Suter P, Bihari D, Bruining H (1997) Organization of intensive care units in Europe: lessons from the EPIC study. Intensive Care Med 23:1181–1184PubMed

31.

Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, Hooton TM (1985) The efficacy of infection surveillance and control programs in prevention of nosocomial infections in US hospitals. Am J Epidemiol 121:182–205PubMed

32.

Clemmer TP, Spuhler VJ (1998) Developing and gaining acceptance for patient care protocols. New Horiz 6:12–19PubMed

33.

Sznajder M, Aegerter P, Launois R, Merliere Y, Guidet B, CubRea (2001) A cost-effectiveness analysis of stays in intensive care units. Intensive Care Med 27:146–153PubMed

Title: A continuous quality-improvement program reduces nosocomial infection rates in the ICU
Authors: Benoit Misset
Jean-François Timsit
Marie-Françoise Dumay
Maité Garrouste
Annie Chalfine
Isabelle Flouriot
Fred Goldstein
Jean Carlet
Publication date: 01-03-2004
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 3/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-003-2096-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

A continuous quality-improvement program reduces nosocomial infection rates in the ICU

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Design and setting

Patients

Interventions

Measurements and results

Conclusions

Please log in to get access to this content

Other articles of this Issue 3/2004

A novel expiratory circuit for recovery of perfluorocarbon liquid during partial liquid ventilation

Lactic acidosis: An early marker of propofol infusion syndrome?

Evidence of myocardial ischaemia in severe scorpion envenomation

Renal impairment in cardiac surgery patients receiving hydroxyethyl starch

Expression of nitric oxide synthase, aquaporin 1 and aquaporin 5 in rat after bleomycin inhalation

Measurement of indocyanine green plasma disappearance rate by two different dosages