Improvement of the ventilator associated pneumonia rate with infection control practices in an Italian ICU.

BACKGROUND: To assess the impact of an intervention to improve respiratory infection control practices and reduce the ventilator associated pneumonia (VAP) rate in an intensive care unit, at the request of the ICU staff. DESIGN: prospective surveillance before-after study. Baseline VAP rates were determined over a 4-month period of active surveillance without an infection control program (period 1) and compared to VAP rates following implementation of an infection control program (period 2). The ICU staff requested the implementation of infection control practices. SETTING: Intensive Care Unit (ICU) at a university teaching hospital in Italy. PATIENTS: A total of 185 patients admitted to the ICU were included in the study. RESULTS: PATIENTS assessed during period 1 were similar to patients assessed during period 2 with regard to age, sex, origin, type of admission and mortality. PATIENTS who were admitted during period 2 had significantly lower simplified acute physiology scores (SAPS) II and acute physiology and chronic health evaluation (APACHE) II scores than patients admitted during period 1 (P<0.05). During period 1, there were 27 cases of VAP, and the incidence rate was 36.9/1000 MV-days. During period 2, the VAP rate decreased significantly (P=0.049): there were only 17 cases of VAP, and the incidence rate was 22.5/1,000 MV-days, with a rate-ratio of 0.61. CONCLUSION: Despite our short study period, the results appear to be encouraging and show a measurable impact on the incidence of VAP.

Surveillance for surgical site infection after hospital discharge: a surgical procedure-specific perspective.

OBJECTIVE: To estimate the rate of surgical site infection (SSI) occurring after hospital discharge, to evaluate whether limiting surveillance to inpatients underestimates the true rate of SSI, and to select surgical procedures that should be included in a postdischarge surveillance program. DESIGN: Prospective surveillance study. SETTING: A surgical ward at a university teaching hospital in Italy. PATIENTS: A total of 264 surgical patients were included in the study. RESULTS: The global SSI rate was 10.6% (28 patients); 17 (60.2%) of patients with an SSI developed the infection after hospital discharge. The overall mean length of postoperative stay (+/-SD) for patients who acquired a postdischarge SSI was 4.9+/-3.7 days, and SSI was diagnosed a mean duration (+/-SD) of 11.5+/-4.5 days after surgery. Among procedures with postdischarge SSIs, those classified by the National Nosocomial Infections Surveillance system (NNIS) as herniorrhaphy, mastectomy, other endocrine system, and other integumentary system were associated with a mean postoperative stay that was less than the mean time between the operation and the onset of SSI. Four (36%) of in-hospital SSIs occurred after procedures with an NNIS risk index of 0, and 7 (64%) occurred after procedures with an NNIS risk index of 1 or higher. Of the 17 SSIs diagnosed after discharge, 14 procedures (82%) had an NNIS risk index of 0, compared with 3 procedures (18%) with an NNIS risk index of 1 or higher. CONCLUSIONS: Our results revealed an increased risk of postdischarge SSI after some types of surgical procedures and suggest that there is an important need to change from generalized to NNIS operative category-directed postdischarge surveillance, at least for procedures locally considered to be high-risk.