Hostname: page-component-78c5997874-94fs2 Total loading time: 0 Render date: 2024-11-13T00:58:32.720Z Has data issue: false hasContentIssue false

Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

Published online by Cambridge University Press:  21 June 2016

François L'Hériteau
Affiliation:
C-CLIN Paris Nord, Paris VI University, Paris, France
Corinne Alberti
Affiliation:
Public Health Department, Robert Debré Hospital, Paris VII University, Paris, France
Yves Cohen
Affiliation:
Medical-Surgical ICU, Avicenne Teaching Hospital, Bobigny, France
Gilles Troché
Affiliation:
Surgical ICU, Antoine Béclère Teaching Hospital, Clamart, France
Pierre Moine
Affiliation:
Surgical ICU, Lariboisière Teaching Hospital, Paris, France
Jean-François Timsit*
Affiliation:
Medical ICU, Bichat Teaching Hospital, Paris, France
*
réanimation médicale, Hôpital Michallon et département d'épidemiologie INSERM U578, Grenoble, FranceJFTimsit@chu-grenoble.fr

Abstract

Objectives:

To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.

Design:

A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.

Participants:

Three hundred ninety-five responder ICUs (69%) in France.

Results:

In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.

Conclusion:

This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Monitoring hospital-acquired infections to promote patient safety. MMWR Recomm Rep 2000;49:149153.Google Scholar
2.Comité Technique National des Infections Nosocomiales. 100 Recommendations for Surveillance and Prevention of Nosocomial Infections, Paris: Ministère de l'Emploi et de la Solidarité; 1999.Google Scholar
3.Misset, B, Timsit, JF. Dumay, MF, et al.A continuous quality-improvement program reduces nosocomial infection rates in the ICU. Intensive Care Med 2004;30:395400.Google Scholar
4.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128140.Google Scholar
5.Astagneau, P, Brucker, G. Organization of hospital-acquired infection control in France. J Hosp Infect 2001;47:8487.Google Scholar
6.Mermel, LA, Farr, BM, Sherertz, RJ, et al.Guidelines for the management of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2001;22:222242.CrossRefGoogle ScholarPubMed
7.Hubmayr, RD, Burchardi, H, Elliot, M, et al.Statement of the 4th International Consensus Conference in Critical Care on ICU-Acquired Pneumonia: Chicago, Illinois, May 2002. Intensive Care Med 2002;28:15211536.CrossRefGoogle ScholarPubMed
8.Greenacre, M. Correspondence analysis in medical research. Stat Methods Med Res 1992;1:97117.Google Scholar
9.Leclerc, A, Luce, D, Lert, F, Chastang, JF, Logeay, P. Correspondence analysis and logistic modelling: complementary use in the analysis of a health survey among nurses. Stat Med 1988;7:983995.Google Scholar
10.Sax, H, Pittet, D. Interhospital differences in nosocomial infection rates: importance of case-mix adjustment. Arch Intern Med 2002;162:24372442.CrossRefGoogle ScholarPubMed
11.Fagon, JY, Chastre, J. Management of suspected ventilator-associated pneumonia. Ann Intern Med 2000;133:1009.Google Scholar
12.Chastre, J, Fagon, JY. Ventilator-associated pneumonia. Am J Respir Crit Care Med 2002;165:867903.Google Scholar
13.Suetens, C, Savey, A, Labeeuw, J, Morales, I. The ICU-HELICS programme: towards European surveillance of hospital-acquired infections in intensive care units. European Surveillance 2002;7:127128.Google Scholar
14.Suetens, C, Savey, A, Lepape, A, Morales, I, Carlet, J, Fabry, J. Surveillance of nosocomial infections in intensive care unit: toward a consensual approach in Europe. Réanimation 2003;12:205213.CrossRefGoogle Scholar
15.Souweine, B, Veber, B, Bedos, JP, et al.Diagnostic accuracy of protected specimen brush and bronchoalveolar lavage in nosocomial pneumonia: impact of previous antimicrobial treatments. Crit Care Med 1998;26:236244.Google Scholar
16.Timsit, J-F. Updating of the 12th consensus conference of the Société de Réanimation de Langue Française (SRLF): catheter-related infections in intensive care unit. Réanimation 2003;12:258265.CrossRefGoogle Scholar
17.Gastmeier, P, Sohr, D, Geffers, C, Nassauer, A, Daschner, F, Ruden, H. Are nosocomial infection rates in intensive care units useful benchmark parameters? Infection 2000;28:346350.Google Scholar
18.Eggimann, P, Pittet, D. Infection control in the ICU. Chest 2001;120:20592093.CrossRefGoogle ScholarPubMed
19.Eggimann, P, Hugonnet, S, Sax, H, Touveneau, S, Chevrolet, JC, Pittet, D. Ventilator-associated pneumonia: caveats for benchmarking. Intensive Care Med 2003;3:3.Google Scholar
20.Moro, ML, Jepsen, OB. Infection control practices in intensive care units of 14 European countries: The EURO.NIS Study Group. Intensive Care Med 1996;22:872879.CrossRefGoogle ScholarPubMed
21.Hails, J, Kwaku, F, Wilson, AP, Bellingan, G, Singer, M. Large variation in MRSA policies, procedures and prevalence in English intensive care units: a questionnaire analysis. Intensive Care Med 2003;29:481483.Google Scholar