ISSN:
1432-055X
Keywords:
Schlüsselwörter Nosokomiale Infektionen
;
Intensivstationen
;
NIDEP
;
Bundesweite Prävalenzstudie
;
Key words Nosocomial infections
;
Intensive care unit
;
NIDEP
;
Nationwide prevalence survey
Source:
Springer Online Journal Archives 1860-2000
Topics:
Medicine
Description / Table of Contents:
Abstract In a large, multicenter survey in 1994, the prevalence of nosocomial infections in German hospitals was examined, predominant pathogens were identified, and possible risk factors evaluated. In this paper the results from the intensive care units (ICUs) are presented. Methods. Seventy-two representative hospitals in Germany were selected by randomisation and divided into four different groups according to their size (〈200 beds; 200–400 beds; 400–600 beds; 〉600 beds). During 10 months four especially trained doctors documented the patients clinical and laboratory data and possible endogenous and exogenous risk factors for nosocomial infections. For better evaluation, they discussed the cases with the responsible senior officers and health care workers and visited the patients. Diagnosis of nosocomial infection was based on CDC criteria. Results. In 515 patients in 89 ICUs, 78 hospital-acquired infections were documented (15.3%). The most common were pneumonia (5.9%), bronchitis (2.7%), urinary tract infections (2.4%), and septicaemia (2.2%). Possible exogenous risk factors included: peripheral venous catheters (65.6%); catheterisation of the urinary tract (64.5%); central venous catheters (60.4%); gastric tubes (38.0%); wound drainage (28.6%) and artificial ventilation (27.6%). The most frequent concomitant diseases were cardiovascular (61.9%), diabetes (20.2%), malignancies (18.8%), pre-existing infections (15.3%), and chronic respiratory disease (14.0%). The prevalence of nosocomial infections was higher in hospitals with more than 600 beds than in smaller ones (28.3% versus 12.9%, P〈0.001). Predominant pathogens were Pseudomonas aeruginosa, enterococci, Staphylococcus aureus, Candida spp., Escherichia coli, and Klebsiella spp.. Fifty per cent of the ICUs changed ventilation tubes and 66.3% changed infusion sets daily; 34.8% of patients received drugs for the prevention of stress ulcers that neutralise or decrease production of gastric acid; only 7.6% received sucralfate. Routine microbiological surveillance of tracheal aspirates and urine was done by 25.9% and 24.6% of the ICUs, respectively. Discussion. Nosocomial infections are seen far more often in ICUs than on normal wards due to the immunosuppressed state of many ICU patients and the continuous use of invasive diagnostic and therapeutic procedures. Most of these infections are of endogenous origin. Other prevalence surveys have shown results comparable to ours. Daily changing of ventilation tubes is no longer necessary, but is still routine in many hospitals. Infusion sets were also changed more often than required. The use of selective decontamination of the digestive tract for the prevention of pneumonia is still controversial; in our study it was practised in only 1.5% of the cases. The most commonly used drugs for the prevention of stress ulcers were H2-receptor blocking agents, although it has been shown that sucralfate is the better choice, as it can help prevent nosocomial pneumonia. Routine microbiological surveillance of tracheal aspirates and urine was done in 25.9% and 24.6% of the ICUs. No study so far has shown that routine cultures of tracheal secretions and urine have a preventive effect regarding infection.
Notes:
Zusammenfassung Im Auftrag des Bundesgesundheitsministeriums wurde von Januar bis Oktober 1994 eine für Deutschland repräsentative Prävalenzstudie mit insgesamt 14966 Patienten an 72 nach Größenklassen ausgewählten Kliniken mit dem Ziel durchgeführt, nosokomiale Infektionen, potentielle Risikofaktoren und Hygienemaßnahmen zu erfassen (NIDEP: Nosokomiale Infektionen in Deutschland – Erfassung und Prävention). Auf 89 Intensivstationen hatten von 515 Patienten 78 (15,3%) mindestens eine nosokomiale Infektion. Die häufigsten Infektionen waren Pneumonie (5,9%), Tracheobronchitis (2,7%), Harnwegsinfektion (2,4%) und primäre Sepsis (2,2%). Die häufigsten potentiellen endogenen Risikofaktoren für Krankenhausinfektionen waren Herz-Kreislauferkrankungen (61,9%), Diabetes mellitus (20,2%), Malignome (18,8%), vorbestehende Infektionen (15,3%) und chronische Atemwegserkrankungen (14,0%). Für die potentiell exogenen Risikofaktoren ergaben sich folgende Prävalenzen: Periphere Venenkatheter (65,6%), Harndrainagen (64,5%), zentrale Venenkatheter (60,4%), Magensonden (38,0%), Wunddrainagen (28,6%), und kontrollierte Beatmung (27,6%). 50,0% der Intensivstationen wechselten die Beatmungsschläuche und 66,3% die Infusionssysteme immer noch täglich. Bei 34,8% der Patienten wurde eine säurehemmende Streßulkusprophylaxe durchgeführt, lediglich 17,6% der Patienten erhielten Sucralfat. Die Mehrzahl der Intensivstationen führte kein routinemäßiges mikrobiologisches Monitoring durch. Einige Intensivstationen untersuchten jedoch Urin und Trachealsekret täglich. Die häufigsten Erreger nosokomialer Infektionen auf Intensivstationen waren in absteigender Reihenfolge Pseudomonas aeruginosa, Enterokokken, Staphylococcus aureus, Candida spp., Escherichia coli, Klebsiella spp.
Type of Medium:
Electronic Resource
URL:
http://dx.doi.org/10.1007/s001010050356
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