Device-associated infection rates in adult intensive care units of Cuban university hospitals: International Nosocomial Infection Control Consortium (INICC) findings.

OBJECTIVES: To determine the rate of device-associated healthcare-associated infection (DA-HAI), microbiological profile, length of stay (LOS), extra mortality, and hand hygiene compliance in two intensive care units (ICUs) of two hospital members of the International Infection Control Consortium (INICC) of Havana, Cuba. METHODS: An open label, prospective cohort, active DA-HAI surveillance study was conducted on adults admitted to two tertiary-care ICUs in Cuba from May 2006 to December 2009, implementing the methodology developed by INICC. Data collection was performed in the participating ICUs, and data were uploaded and analyzed at the INICC headquarters on proprietary software. DA-HAI rates were registered by applying the definitions of the US Centers for Disease Control and Prevention National Healthcare Safety Network (CDC NHSN). We analyzed the mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI) rates, microorganism profile, extra length of stay (ELOS), extra mortality, and hand hygiene compliance. RESULTS: During 14 512 days of hospitalization, 1982 patients acquired 444 DA-HAIs, an overall rate of 22.4% (95% CI 20.6-24.3) or 30.6 (95% CI 27.8-33.5) DA-HAIs per 1000 ICU-days. The CLA-BSI rate was 2.0 (95% CI 1.2-3.1) per 1000 central line-days, the VAP rate was 52.5 (95% CI 47.2-58.3) per 1000 ventilator-days, and the CAUTI rate was 8.1 (95% CI 6.5-10.0) per 1000 catheter-days. LOS of patients was 4.9 days for those without DA-HAI, 23.3 days for those with CLA-BSI, and 23.8 days for those with VAP. CAUTI LOS was not calculated due to the lack of data. Extra mortality was 47% (relative risk (RR) 2.42; p=0.0693) for VAP and 17% (RR 1.52; p=0.5552) for CLA-BSI. The only patient with CAUTI died, but there was too little mortality data regarding this infection type to consider this significant. Escherichia coli was the most commonly isolated microorganism. The overall hand hygiene compliance was 48.6% (95% CI 42.8-54.3). CONCLUSIONS: DA-HAI rates, LOS, and mortality were found to be high, and hand hygiene low. It is of primary importance that infection control programs that include outcome and process surveillance are implemented in Cuba.

[Prevalence of nosocomial infections in University Hospital of Habana]. / Prevalencia de infección nosocomial en hospitales universitarios de La Habana, Cuba.

OBJECTIVE: Determine nosocomial infection (NI) prevalence in seven University Hospitals of Havana. METHOD: A cross sectional survey was carry out in university hospital with more than 100 beds. Presence of NI was determined by an active screening procedure in all patients admitted in hospitals. Technical statistics of frequency distribution was used. Rates of NI were estimated for each hospital and in the special case of procedure, Odds Ratio and its confidence interval at 95 % were calculated (CI 95 %). RESULTS: Prevalence of NI was 9.2 %. The most frequent localization were: cardiovascular system (55 patients), surgical site (50 patients) and urinary tract (42 patients ). The 19.7 % of studied patient showed intravascular device. All patients showed NI associated with procedures, the highest intensity was association with an endotracheal tube (OR 7.83, IC 95 % 3.32-11.52). CONCLUSION: Nosocomial infections in this hospital is a serious health problem; it is necessary to focus our medical work in this regard for the prevention and control of NI.

Prevalencia de infección nosocomial en hospitales universitario de La Habana, Cuba / Prevalence of nosocomial infections in university hospital of Havana

Objetivo: Determinar la prevalencia de infección nosocomial (IN) en siete Hospitales Clínico Quirúrgicos de Ciudad de La Habana. Método: Realizamos un estudio descriptivo de corte transversal de los hospitales universitarios con número de camas superior a 100. La presencia de IN, se determinó mediante la realización de pesquizaje activo en la totalidad de los pacientes ingresados. Se utilizó la técnica estadística de análisis de distribución de frecuencias. Fueron calculadas tasas de IN, por hospital y servicio de atención. También se calculó Odds Ratio puntual y por intervalos. Resultados: La prevalencia global de IN resultó ser de 9,2 por cada 100 pacientes. Las localizaciones más frecuentes correspondieron a: el sistema cardiovascular (55 casos), el sitio quirúrgico (50 casos) y el tracto urinario (42 casos). El 19,7 % de los pacientes estudiados, tenían algún dispositivo intravascular colocado. Todos ellos fueron encontrados asociados a la presencia de infección nosocomial. La mayor intensidad resultó ser con la entubación endotraqueal (OR 7.83 IC 95 % 3,32-11,52). Conclusión: La prevalencia de infecciones nosocomiales en los Hospitales Clínico Quirúrgicos de Ciudad de la Habana hacen necesario fortalecer las actividades de prevención y control, con especial énfasis en su vigilancia

Objective: Determine nosocomial infection (NI) prevalence in seven University Hospitals of Havana. Method: A cross sectional survey was carry out in university hospital with more than 100 beds. Presence of NI was determined by an active screening procedure in all patients admited in hospitals. Technical statistics of frequency distribution was used. Rates of NI were estimated for each hospital and in the special case of procedure, Odds Ratio and its confidence interval at 95 % were calculated (CI 95 %). Results: Prevalence of NI was 9.2 %. The most frequent localization were: cardiovascular system (55 patients), surgical site (50 patients) and urinary tract (42 patients ). The 19.7 % of studied patient showed intravascular device. All patients showed NI associated with procedures, the highest intensity was association with an endotracheal tube (OR 7.83, IC 95 % 3.32-11.52). Conclusion: Nosocomial infections in this hospital is a serious health problem; it is necessary to focus our medical work in this regard for the prevention and control of NI

Infección nosocomial en el Servicio de Geriatría del Hospital"Joaquín Albarrán", 1990-2001 / Nosocomial infection in Geriatric service of "Joaquín Albarrán" Hospital, 1990-2001

Los ancianos constituyen una proporción importante de los pacientes atendidos en instituciones de salud, y constituyen un grupo altamente susceptible de adquirir infecciones nosocomiales. Con el objetivo de describir el comportamiento de las infecciones nosocomiales en el servicio de geriatría del Hospital "Joaquín Albarrán" en el periodo de 1990 al 2001, realizamos un estudio observacional descriptivo. Se analizó la tendencia secular de la infección nosocomial mediante el método gráfico de suavizamiento de datos mediante medianas móviles y la localización y la etiología de las infecciones nosocomiales mediante la técnica estadística de análisis de distribución de frecuencias. En el Servicio de Geriatría se observó decremento marcado en la tasa de infección nosocomial a partir del año 1995, que se mantuvo hasta 1997, un predominio de las infecciones venosas (58,9 por ciento) sobre el resto de las localizaciones (tracto urinario (19,2 por ciento) y las del tracto respiratorio bajo (15,1 por ciento).Los principales gérmenes aislados resultaron ser: Klebsiella spp (34 por ciento), Pseudomona spp (23 por ciento), y con frecuencias bastante similares, Estafilococo spp (18,5 por ciento) y Proteus spp (17 por ciento). Se constata la magnitud e importancia que tienen las infecciones nosocomiales como problema de salud en los ancianos atendidos en el servicio de geriatría, y la necesidad de aplicar enfoques adecuados dirigidos a la prevención y control de estas infecciones (AU)