Surveillance and infection control in an intensive care unit

OBJECTIVE: To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality. DESIGN: Prospective study. SETTING: A 2000-bed, university-affiliated hospital in Italy. PATIENTS: All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001. METHODS: The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility. INTERVENTIONS: Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified. RESULTS: Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P < .05). CONCLUSION: Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAls and mortality.