Deaths from nosocomial infections: experience in a university hospital and a community hospital.

A prospective multicenter study concerning the incidence, onset time, risk factors and mortality of pneumonia was carried out by the Intensive Care Units Collaborative Group for Infection Control in Lombardy, Northern Italy Out of 1304 patients admitted over 3 months in 16 intensive care units (ICUs), 441 met the criteria for the protocol (no previous pulmonary infection or irreversible terminal illness, ICU stay greater than 48 h) The incidence of acquired pneumonia was 213% (94/441), with 542% of cases diagnosed within 4 days of admission (early onset pneumonia) Impairment of airway reflexes on admission and more than 24 h respiratory assistance were shown as significant risk factors (RR) for early onset pneumonia (respectively RR = 124, with 95% confidence interval (CI) = 53-289 and RR = 33, with 95% CI = 18-59) A suggested pathogenetic mechanism is aspiration of oropharyngeal contents at the onset of acute illness, due to depression of protective reflexes with delayed clearance of bacterial contamination No protection was offered by routinely applied prophylactic antibiotic therapy

Early onset pneumonia: a multicenter study in intensive care units

Colonization and infection with an endemic multiresistant strain ofAcinetobacter calcoaceticus varietyanitratus had been observed in the surgical intensive care unit of a university hospital since 1982. An outbreak of infection with this endemic, multiresistantAcinetobacter anitratus strain occurred between January and September, 1984. After initial attempts at identification of environmental reservoirs had been unsuccessful, risk factors for the acquisition ofAcinetobacter anitratus were investigated by comparing the epidemiological characteristics of patients who became colonized or infected with those of control patients without colonization. The results of this case-control study and of the ensuing specific cultures indicated that ventilators in use in the unit were the reservoirs ofAcinetobacter anitratus, resulting in frequent nosocomial respiratory tract infections. After modification of the mechanical ventilators, colonization and infection rates withAcinetobacter anitratus decreased. Since January 1985, no new cases of colonization or infection with this endemic strain ofAcinetobacter anitratus have been recorded.

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Endemic Acinetobacter anitratus in a surgical intensive care unit: mechanical ventilators as reservoir.

Risk factors for pneumonia were analysed in a large population of critically ill patients, collected in two prospective multicentre “pneumonia studies” in Italy. Twenty-three intensive care units were involved and the study time was 150 unit months. Only patients without previous pulmonary infection, with intensive care unit stay ≥ 48 hours and no rapidly irreversible illness at admission were included. The incidence of pneumonia in the 1475 selected patients was 15% (220 cases). 239 patients died in ICU; the mortality rate was significantly higher in patients developing pneumonia (p<0.0001); pneumonia was found to be an independent highly significant risk factor for death in critically ill patients (OR = 3.88; p<0.0001). Multivariate analysis of seven risk factors for pneumonia showed a significantly higher risk in patients with neuromuscular disease (OR = 3.8, p<0.002), impairment of airway reflexes at admission (OR = 2.93, p<0.0001), and ≥ 24h respiratory assistance (OR=3.05, p<0.0001). Impairment of airway reflexes at admission to the emergency room or intensive care unit identifies the population who will experience 3/4 of the overall lower respiratory tract infections. Rapid recognition of at-risk patients seems clinically important and may improve awareness programs and preventive approaches.

Epidemiology and risk factors of pneumonia in critically ill patients

Sterile water used for humidification in low-flow oxygen therapy: Is it necessary?

Inhalation therapy equipment is a potential vector of gram-negative bacilli. Small-volume Venturi nebulizers have a potential but are infrequently implicated in the dissemination of bacteria. Large volume nebulizers of all designs are the major source for aerosolized bacteria. Ventilators and humidifiers have minimal potential.Any system of decontamination requires the meticulous application of a procedure at least once every 24 hours. The degree of contamination should not exceed that of hospital air.

Jay P. Sanford

Papers

Infection control in critical care units.