In-hospital deaths attributable to healthcare-associated infections. / Helsetjenesteassosiert infeksjon som årsak til død i sykehus.

BACKGROUND: It is estimated that approximately one-third of in-hospital deaths in Norway are attributable to adverse events, while the proportion caused by infection is unknown. Oslo University Hospital provides a full range of medical specialties on a national and regional level while serving as a local hospital for a population of approximately 300 000. We wished to investigate in-hospital deaths associated with fatal adverse events, and healthcare-associated infections in particular. MATERIAL AND METHOD: The study is based on a review of the medical records for all patients who died in Oslo University Hospital's somatic units in 2011. Infections were classified according to the criteria of the Centers for Disease Control and Prevention, USA. RESULTS: Out of a total of 82 341 admitted patients, 1 126 died while in hospital. We identified life-shortening adverse events in 128 (11.4 %) of these. The 87 patients at Ullevål hospital had a mean age of 73 years, while the 41 patients at Rikshospitalet/the Norwegian Radium Hospital had a mean age of 62 years. A total of 108 patients (9.6 %) died from a healthcare-associated infection, 49 of whom had a predicted survival of more than four weeks (4.4 % of the fatalities). Fifty-eight patients had pneumonia. INTERPRETATION: The proportion of deaths that were attributable to adverse events was lower than previously estimated in Norway. Oslo University Hospital, with its combined functions and broad patient base, can provide representative figures for healthcare-associated infections with fatal outcome in Norwegian hospitals.

Impact of a single plain finger ring on the bacterial load on the hands of healthcare workers.

OBJECTIVE: To investigate the impact of a single plain finger ring on the number and types of bacteria on the hands of healthcare workers (HCWs). DESIGN: Nonequivalent control groups, posttest only (preexperimental). METHODS: A total of 121 HCWs wearing 1 plain ring and 113 HCWs wearing no rings had both hands sampled by the "glove juice" technique. Quantitative culture of the samples was performed and microorganisms were identified. SETTING: Two Norwegian acute care hospitals. PARTICIPANTS: A total of 234 HCWs who had physical contact with patients. RESULTS: Total bacterial counts did not differ when hands with rings and hands without rings were compared, both according to nonpaired analysis (which compared the ring-bearing hands of ring-wearing HCWs to the hands of HCWs who did not wear rings [P=.661]) and according to paired analysis (which compared the ring-bearing and ring-free hands of ring-wearing HCWs [P=.071]). Staphylococcus aureus was recovered from 18.6% of the hands sampled, belonging to 26.9% of the HCWs, but neither paired nor nonpaired analysis showed any association with ring wearing. Gram-negative bacteria were recovered from 20.3% of the hands sampled, belonging to 28.6% of the HCWs. Ring-wearing HCWs were significantly more likely to be carriers of Enterobacteriaceae (P=.006), but paired comparison of the ring-bearing and ring-free hands of these HCWs did not show significant differences (P=.180). Carriage of nonfermentative gram-negative rods did not differ between the 2 groups, by either paired or nonpaired analysis. CONCLUSIONS: Wearing a single plain finger ring did not increase the total bacterial load on the hands, nor was it associated with an increased rate of carriage of S. aureus or nonfermentative gram-negative rods. However, plain rings were associated with an increased rate of Enterobacteriaceae carriage.