RESUMEN
OBJECTIVE: To know the trend of nosocomial infections rates at a third level hospital since the beginning of the infection control program until the present and to evaluate the impact in mortality and length of hospital stay. MATERIAL AND METHODS: A study descriptive, retrospective and retrolective was done in a reference hospital providing tertiary care in Mexico City. Recorded data included rates, type of nosocomial infections and distribution of nosocomial infections from the database of Hospital Epidemiology Division between 1991 to 1996. In every patient the degree of severity disease was evaluated according to the McCabe-Jackson's scale, we also collected age and the length of stay. Statistical analysis was done with chi 2 test for tendencies of different evaluated parameters. This study was divided in three periods: before remodel (1991-1993), to remodel (1994-1995) and after remodel (1996). Compared the before remodel period against after remodel period. RESULTS: In the study period, mean nosocomial infections ratio was of 8.6 by 100 discharges, showing a decrease of 20% (p < 0.01). Hospital area with the highest infections rate was ICU (26.9 by 100 discharge), followed by general ward of hospitalization with shared rooms (9.47) and private rooms (7.5). Urinary tract infections was the most frequent (26.6%), followed by surgical wound infection (24.4%), pneumonia (12.1%) and primary bacteremia (9.5%). Rates of urinary tract infections and primary bacteremias had decreased significantly (p < 0.05 and p < 0.00001 respectively), while surgical wound infections and pneumonias increased (p < 0.005 and p < 0.00001 respectively). Associated mortality diminished in 36% (p < 0.00001). The length of stay diminished 42.8%. There was not differences in the severity of disease along this period. CONCLUSIONS: Since the establishment of the nosocomial infections surveillance and control program at the INNSZ on 1985, nosocomial infections rate (56%) and the associated mortality (36%) have diminished. These changes are consequence of the establishment of a nosocomial infections control program and the decrease of length of stay and does not seems to be related to the age or to the severity of the disease of the hospitalized patients.
Asunto(s)
Infección Hospitalaria/prevención & control , Factores de Edad , Distribución de Chi-Cuadrado , Infección Hospitalaria/mortalidad , Humanos , Unidades de Cuidados Intensivos , Tiempo de Internación , México , Persona de Mediana Edad , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVE: To describe an outbreak of Salmonella gastroenteritis among employees of the National Institute of Nutrition (INNSZ) of Mexico City during July, 1994. METHODS: Employees who developed diarrhea or fever associated with gastrointestinal symptoms starting on July 14th were included for study as well as 50 healthy controls. A questionnaire was applied to all, and they also provided a stool sample, along with other 80 asymptomatic people (included the kitchen workers) in whom only stool culture was done. RESULTS: Ninety-seven employees that ate regularly at the Hospital's cafeteria were affected by the outbreak, and 67 of them (69%) could be evaluated. Most of them were nurses (34%), and handymen (27%). Most common symptoms were abdominal pain (97%), diarrhea (95%), nausea (91%), and fever (89%). Cultures from suspicious food items were all negative, but stool cultures from 10/70 cases were positive for Salmonella enteritidis vs. 0/133 in the controls. The ten S. enteritidis isolates resulted identical either by serotyping and by rapid amplified polymorphic DNA (RAPD) analysis. Cultures from all kitchen employees were negative for S. enteritidis. Breakfast meal on July 14th was associated with the development of gastroenteritis (61/67 cases vs 26/50 controls, p < 0.001), and particularly with an egg-covered meat plate (61/62 vs 13/26 controls, p < 0.0001). CONCLUSIONS: This outbreak was probably caused by eggs contaminated with Salmonella, since no one of the kitchen personnel was found to be an asymptomatic carrier, and the implicated recipe allows for inappropriate cooking. Recommendations to improve cooking procedures must be added to the usual regulations to diminish the frequency of foodborne disease outbreaks in hospitals.