Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-20T04:23:46.269Z Has data issue: false hasContentIssue false
  • English
  • Français

Selective Surveillance for Nosocomial Infections in a Brazilian Hospital

Published online by Cambridge University Press:  21 June 2016

Noelia L. Lima ,
Claudia R.B. Pereira ,
Isabel C. Souza ,
Monica C. Facanha ,
Aldo A.M. Lima ,
Richard L. Guerrant  and
Barry M. Farr
Noelia L. Lima
Affiliation:
Universidade Federal do Ceará, Charlottesville, Virginia
Claudia R.B. Pereira
Affiliation:
Universidade Federal do Ceará, Charlottesville, Virginia
Isabel C. Souza
Affiliation:
Universidade Federal do Ceará, Charlottesville, Virginia
Monica C. Facanha
Affiliation:
Universidade Federal do Ceará, Charlottesville, Virginia
Aldo A.M. Lima
Affiliation:
Universidade Federal do Ceará, Charlottesville, Virginia
Richard L. Guerrant
Affiliation:
University of Virginia, Charlottesville, Virginia
Barry M. Farr*
Affiliation:
University of Virginia, Charlottesville, Virginia
*
University of Virginia, Health Sciences Center, Box 473, Charlottesville, VA 22908
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To devise a system for surveying the frequency of nosocomial infections in a tertiary care hospital in a developing country.

Design:

Prospective selective surveillance by nurses of the charts of patients at high risk for nosocomial infections, as identified by a form completed by resident physicians. The sensitivity, specificity, and predictive value of this method of selective surveillance were compared with those for total prospective chart review by two infectious disease specialists.

Setting:

A university hospital in northeastern Brazil.

Patients:

All patients hospitalized for more than 72 hours with an identified risk factor for nosocomial infection.

Results:

The ratio of nosocomial infections to 100 discharges was 13.4 and the incidence density was 11.2/1,000 patient days. The surveillance method demonstrated a sensitivity of 74% and a specificity of 99.7%. Positive predictive value was 93%, negative predictive value was 99%, and overall accuracy was 98%.

Conclusions:

This method of selective surveillance for nosocomial infections based on risk factors identified by physicians demonstrated excellent predictive value and overall accuracy and may be of use to other hospitals that lack a nursing care plan book such as the Kardex. The relative frequency of nosocomial infections significantly exceeded the rates reported from hospitals in developed countries.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 14 , Issue 4 , April 1993 , pp. 197 - 202
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1993

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. Haley, RW, Culver, DH, White, JW, Morgan, WM, Emori, TG. The nationwide nosocomial infection rate: a new need for vital statistics. Am J Epidemiol. 1985;121:159–167.Google Scholar
2. Haley, RW, Schaberg, DR, Von Allmen, SD, et al. Extra charges and prolongation of stay attributable to nosocomial infections: a prospective interhospital comparison. Am J Med. 1981;70:51–58.Google Scholar
3. Freeman, J, Rosner, BA, McGowan, JE Jr. Adverse effects of nosocomial infections, J Infect Dis. 1979;140:732–740.Google Scholar
4. Lolekha, S, Ratanaubol, B, Manu, R Nosocomial infection in a teaching hospital in Thailand. Philippines Soc Microbiol J Infect Dis. 1981;10:103–114.Google Scholar
5. Caceres, JAM, Sotello, Y. Infection control in El Salvador: the Hospital Rosales experience. Infect Control. 1987;8:495–500.Google Scholar
6. Western, KA, St John, RK, Shearer, LA. Hospital infection control: an international perspective. Infect Control. 1983:453–455.Google Scholar
7. Ponce de Leon, RS, Garcia Garcia, ML, Volkow Fernandez, R et al. Resultados iniciales de un programa de vigilancia de infecciones nosocomiales en los institutos nacionales de salud. Salud Publica Mex. 1986;28:583–592.Google Scholar
8. Ferraz, EM, Porfirio, L, Vasconcelos, MDMM, Gusmao, MEN. Controle de Infeccao Hospitalar. Resultados de urn estudo prospectivo de 10.254 pacientes de urn hospital universitario. MEDNEWS. 1985;3:5–26.Google Scholar
9. Bermudez, LE, Vidal, E, Panza, M, Velasco, E, Nascimento, MC, Vaz, AMM. Controle de Infeccao Hospitalar. Experiencia de dos anos. Revista Brasileira de Cancerologia. 1984;30:6–13.Google Scholar
10. Evora, YDM, Almeida, ECS. Comissao de Controle de Infecao Hospitalar de urn Hospital-Escola. Reuista Paulista de Hospitais. 1983;31:70–73.Google Scholar
11. Cavalcante, MDA, Braga, OB, Teofilo, CH, Oliviera, EN, Alves, A. Cost improvements through the establishment of prudent infection control practices in a Brazilian general hospital, 1986-1989. Infect Control Hosp Epidemiol. 1991;12:649–653.Google Scholar
12. Haley, RW. Managing Hospital Infection Control for Cost Effectiveness. Chicago, IL: American Hospital Association; 1986.Google Scholar
13. Ministério da Saúde. Portaria número 196. Diario Oficial de June 28,1983. Seçao 1,11.319 Brazilia DC.Google Scholar
14. Cardo, DM. Validacao de Métodoa Ativo de Coleta de Dados e Análise dos Principais Indicios para Deteccao de Infeccao Hospitalar em Hospital de Ensino Nacional. Sao Paulo 1989 (Tese de Doutorado [doctoral thesis]-Escola Paulista de Medicina).Google Scholar
15. Zanon, U. Incidencia, letalidade e mortalidade de infeccoes hospitalates em alguns hospitais brasileiros. Etstudo multicentrical, 1987. Arquivos Brasileiros de Medicina. 1990:64:323–330.Google Scholar
16. Wenzel, RR Osterman, CA, Hunting, KJ, Gwaltney, JM Jr. Hospital acquired infections, I: surveillance in a university hospital. Am J Epidemiol. 1976;103:251–259.Google Scholar
17. Garner, JS, Wiliam, RJ, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections 1988. Am J Infect Control. 1988;16:128–140.Google Scholar
18. Lima, NL, Guerrant, RL, Kaiser, DL, Germanson, T; Farr, BM. A retrospective cohort study of nosocomial diarrhea as a risk factor for nosocomial infection. J Infect Dis. 1990;161:948–952.Google Scholar
19. Fletcher, RH, Fletcher, SW, Wagner, EH. Clinical Epidemiology: the Essentials. 2nd ed. Baltimore, MD: Williams and Wilkins; 1988.Google Scholar
20. Eickhoff, TC, Brachman, PS, Bennett, TV, Brown, JE Surveillance of nosocomial infections in community hospitals, I: surveillance methods, effectiveness, and initial results. J Infect Dis. 1969;120:305–317.Google Scholar
21. Hambraeus, A, Malmborg, AS. Surveillance of hospital infections: at the bed side or at the bacteriological laboratory? Scand J Infect Dis. 1977;9:289–292.Google Scholar
22. Haley, RW, Schaberg, DR, McClish, DK, et al. The accuracy of retrospective chart review in measuring nosocomial infections rates: results of validation studies in pilot hospitals. Am J Epidemiol. 1980;111:516–533.Google Scholar
23. Glenister, H, Taylor, L, Bartlett, C, Cooke, M, Sedgwick, J, Leigh, D. An assessment of selective surveillance methods for detecting hospital-acquired infection. Am J Med. 1991;91(Suppl 38):121S–124S.Google Scholar
24. Freeman, J, McGowan, JE Jr. Methodologic issues in hospital epidemiology, I: rates, case-finding, and interpretation. Rev Infect Dis. 1981;4:658–667.Google Scholar
25. Rosenblatt, MR, Zizza, F, Beck, L. Nosocomial infections. Bull NY AcadMed. 1969;45:10–21.Google Scholar
26. McGuckin, MB. An innovative approach to surveillance of nosocomial outbreaks. QRB. 1979;54:13–18.Google Scholar
27. Weinstein, RA, Mallison, GE The role of the microbiology laboratory in surveillance and control of nosocomial infections. Am J Clin Pathol. 1978;69:130–136.Google Scholar