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Impact of an Infection Control Program in an Intensive Care Unit in France

Published online by Cambridge University Press:  21 June 2016

Régis Verdier ,
Sylvie Parer ,
Hélène Jean-Pierre ,
Pierre Dujols  and
Marie-Christine Picot
Régis Verdier*
Affiliation:
Department of Medical Information, University Hospital of Montpellier, Montpellier, France
Sylvie Parer
Affiliation:
Intensive Care Unit A, University Hospital of Montpellier, Montpellier, France
Hélène Jean-Pierre
Affiliation:
Department of Bacteriology, University Hospital of Montpellier, Montpellier, France
Pierre Dujols
Affiliation:
Department of Medical Information, University Hospital of Montpellier, Montpellier, France
Marie-Christine Picot
Affiliation:
Department of Medical Information, University Hospital of Montpellier, Montpellier, France
*
CETAF, 67-69 Avenue de Rochetaillée, 42012 Saint Etienne Cedex 02, France (verdier_regis@yahoo.fr)
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Abstract

Objective.

To evaluate the impact of an infection control program in an intensive care unit (ICU).

Design.

Prospective before-after study. Two 6-month study periods were compared; between these periods, an infection control program based on isolation was implemented.

Setting.

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.

Main Outcome Measures.

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.

Results.

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 significandy 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).

Conclusions.

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.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 1 , January 2006 , pp. 60 - 66
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1.Haley, RW, White, JW, Culver, DH, Hughes, JM. The financial incentive for hospitals to prevent nosocomial infections under the prospective payment system: an empirical determination from a nationally representative sample. JAMA 1987; 257:1611–1614.CrossRefGoogle ScholarPubMed
2.Nosocomial Infection National Technical Committee. Infections nosocomiales: constats et objectifs. Hygiène 1997; 621:15–16.Google Scholar
3.Bueno-Cavanillas, A, Delgado-Rodriguez, M, Lopez-Luque, A, Schaffino-Cano, S, Galvez-Vargas, R. Influence of nosocomial infection on mortality rate in an intensive care unit. Crit Care Med 1994; 22:55–60.CrossRefGoogle Scholar
4.Fagon, JY, Chastre, J, Vuagnat, A, Trouillet, JL, Novara, A, Gibert, C. Nosocomial pneumonia and mortality among patients in intensive care units. JAMA 1996; 275:866–869.CrossRefGoogle ScholarPubMed
5.Girou, E, Stephan, F, Novara, A, Safar, M, Fagon, JY. Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients. Am J Respir Crit Care Med 1998; 157:1151–1158.CrossRefGoogle ScholarPubMed
6.Jarvis, WR. Selected aspects of the socioeconomic impact of nosocomial infections: morbidity, mortality, cost, and prevention. Infect Control Hosp Epidemiol 1996; 17:552–557.CrossRefGoogle ScholarPubMed
7.Rello, J, Torres, A, Ricart, M, et al. Ventilator-associated pneumonia by Staphylococcus aureus: comparison of methicillin-resistant and methicillin-sensitive episodes. Am J Respir Crit Care Med 1994; 150:1545–1549.CrossRefGoogle ScholarPubMed
8.Romero-Vivas, J, Rubio, M, Fernandez, C, Picazo, JJ. Mortality associated with nosocomial bacteremia due to methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1995; 21:1417–1423.CrossRefGoogle ScholarPubMed
9.Abramson, MA, Sexton, DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999; 20:408–411.CrossRefGoogle ScholarPubMed
10.French Noscomial Infection National Technical Committee Working Group. 100 Recommandations pour la surveillance et la prévention des infections nosocomiales. 2nd ed. Paris: Ministère de l'Emploi et de la Solidarité-Secrétariat d'Etat à la Santé et à l'action sociale; 1999.Google Scholar
11.Weist, K, Pollege, K, Schulz, I, Ruden, H, Gastmeier, P. How many nosocomial infections are associated with cross-transmission? A prospective cohort study in a surgical intensive care unit. Infect Control Hosp Epidemiol 2002; 23:127–132.CrossRefGoogle Scholar
12.LeGall, JR. Evaluation en réanimation—risque de décès hospitalier. L'évaluation en réanimation. Paris: Masson; 1990.Google Scholar
13.Dupont, H, Mentec, H, Sollet, JP, Bleichner, G. Impact of appropriateness of initial antibiotic therapy on the outcome of ventilator-associated pneumonia. Intensive Care Med 2001; 27:355–362.CrossRefGoogle Scholar
14.Geissler, A, Gerbeaux, P, Granier, I, Blanc, P, Façon, K, Durand-Gasselin, J. Rational use of antibiotics in the intensive care unit: impact on microbial resistance and costs. Intensive Care Med 2003; 29:49–54.CrossRefGoogle ScholarPubMed
15.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacillii, Clostridium difficile, and Candida. Ann Intern Med 2002; 136:834–844.CrossRefGoogle Scholar
16.Eggiman, P, Pittet, D. Infection control in the ICU. Chest 2001; 120:2059–2093.CrossRefGoogle Scholar
17.Appelgren, P, Hellstrom, I, Weitzberg, E, Soderlund, V, Bindslev, L, Ransjo, U. Risk factors for nosocomial intensive care infection: a long-term prospective analysis. Acta Anaesthesiol Scand 2001; 45:710–719.CrossRefGoogle ScholarPubMed
18.Farinas-Alvarez, C, Carmen Farinas, M, Llorca, J, Delgado Rodriguez, M. Risk factors for nosocomial sepsis: a case-control study. Med Clin (Barc) 2001; 116:765–769.CrossRefGoogle ScholarPubMed
19.McCusker, ME, Perisse, A, Roghmann, MC. Severity-of-illness markers as predictors of nosocomial infection in adult intensive care unit patients. Am J Infect Control 2002; 30:139–144.CrossRefGoogle ScholarPubMed
20.Tejada Artigas, A, Bello Dronda, S, Chacon Valles, E, et al. Risk factors for nosocomial pneumonia in critically ill trauma patients. Crit Care Med 2001; 29:304–309.CrossRefGoogle ScholarPubMed
21.Vanhems, P, Lepape, A, Savey, A, Jambou, P, Fabry, J. Nosocomial pulmonary infection by antimicrobial-resistant bacteria of patients hospitalized in intensive care units: risk factors and survival. J Hosp Infect 2000;45:98–106.CrossRefGoogle ScholarPubMed