Development of quality indicators of nosocomial infection control.

OBJECTIVES: To study the rates of catheter associated urinary tract infection (CAUTI), Ventilator-associated pneumonia (VAP), Central venous catheter blood stream infection (CVCBSI) and surgical site infection (SSI) in Thai hospitals. The rates of the infections will be used as quality indicators. MATERIAL AND METHOD: Active surveillance in 38 hospitals in Thailand during 2003-2004. Risk stratification of NI rates and utilization of devices were calculated. RESULTS: The rates of CAUTI, VAP, CVCBSI and SSI were obtained. Pooled means, and rates of NI at 10, 25, 50, 75 and 90 percentiles were calculated for CAUTI, VAP, CVCBSI. The infection rates were also presented for each type of hospital. The above NI rates were comparable to those reported by the National Nosocomial Infection Surveillance System (NNIS) in the United States. Surgical site infection was studied in 21 procedures with risk index categories 0-2. The rates of SSI in the present study was lower than those in the U.S. study due to different methods of study. CONCLUSION: The risk stratified rates of CAUTI, VAP, CVCBSI and SSI were obtained. They were similar to a larger scale of study in the United States. The NI rates could be used for evaluating the efficacy of NI control in Thai hospitals.

Skin flora of patients in Thailand.

BACKGROUND: Studies taken from different hospitalized patient populations, environments, and geographic regions reveal differences in the numbers and species of organisms colonizing the skin. Our aim was to determine the types and amounts of skin flora, and examine the factors associated with variations in microbial skin flora in patients in Thailand. METHOD: We studied 350 outpatients and 500 inpatients at Siriraj Hospital in Bangkok, Thailand. The skin at the forearm and the sternum of each patient was cultured by contact plate technique. RESULTS: The number of skin flora colony-forming units (CFUs) were correlated to the site of sampling. There was a significant correlation of CFUs between samples from the forearm and the sternum in patients who were hospitalized (r = 0.6; P <.001) and in outpatients (r = 0.5; P <.001). The numbers of micro-organisms on the sternum was significantly greater than the number cultured from the forearm for all patients. Inpatients had significantly more organisms on the the forearm and sternum compared with outpatients. High counts (CFUs > 600) were found more frequently in patients who were hospitalized; had chronic obstructive pulmonary disease, diabetes mellitus, or autoimmune diseases; and were undergoing operation and receiving antibiotics. Acinetobacter spp and methicillin-resistant Staphyloccoccus aureus were found more frequently in patients who were hospitalized. CONCLUSION: Skin flora of patients in tertiary care hospitals in Thailand has higher CFUs, and A baumannii is prevalent, especially in patients who are hospitalized.