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How Many Nosocomial Infections are Associated with Cross-Transmission? A Prospective Cohort Study in A Surgical Intensive Care Unit

Published online by Cambridge University Press:  02 January 2015

Klaus Weist ,
Kathrin Pollege ,
Ines Schulz ,
Henning Rüden  and
Petra Gastmeier
Klaus Weist*
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Kathrin Pollege
Affiliation:
Department of Anaesthesiology and Intensive Care Medicine, Hospital Ernst von Bergmann, Potsdam, Germany
Ines Schulz
Affiliation:
Department of Microbiology, Hospital Ernst von Bergmann, Potsdam, Germany
Henning Rüden
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
Petra Gastmeier
Affiliation:
Institute of Hygiene, Free University Berlin, Berlin, Germany
*
Institute of Hygiene, University Hospital Benjamin Franklin, Free University Berlin, Hindenburgdamm 27, 12203 Berlin, Germany
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Abstract

Objective:

To determine the percentage of cross-transmissions in an intensive care unit (ICU) with high nosocomial infection (NI) rates according to the data of the German Nosocomial Infection Surveillance System.

Setting:

A 14-bed surgical ICU of a 1,300-bed, tertiary-care teaching hospital.

Method:

Prospective surveillance of NIs during a period of 9 months. If an NI was present, the isolates of the following indicator pathogens were stored and typed by species: Staphylococcus aureus, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter species. Pulsed-field gel electrophoresis was performed for typing of S. aureus strains and arbitrarily primed polymerase chain reaction was applied for the other pathogens. The presence of two indistinguishable strains in two patients was considered as one episode of cross-transmission.

Results:

Two hundred sixty-two patients were observed during a period of 2,444 patient-days; 96 NIs were identified in 59 patients and the overall incidence density of NI was 39.3 per 1,000 patient-days. For 104 isolates, it was possible to consider typing results. Altogether, 36 cross-transmissions have lead to NIs in other patients. That means at least 37.5% of all NIs identified were due to cross-transmissions.

Conclusion:

Because of the method of this study, the percentage of NIs due to cross-transmission identified for this ICU is an “at least number”. In reality, the number of cross-transmissions, and thus the number of avoidable infections, may have been even higher. However, it is difficult to assess whether the percentage of NIs due to cross-transmission determined for this ICU may be the crucial explanation for the relatively high infection rate in comparison to other surgical ICUs.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 23 , Issue 3 , March 2002 , pp. 127 - 132
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2002

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