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Surveillance of ICU-acquired infections: intensive care unit characteristics, practices in prevention and surveillance methodology

Introduction

The characteristics and practices of ICUs participating in the Belgian national surveillance program were reviewed within the validation study. The main objective was to better understand the hospital practices for nosocomial infection prevention and the methodology used for the collection of surveillance data.

Methods

Forty-five ICUs were randomly selected through systematic random sampling from a list of 1997–2001 participation-quarters (3 months). The number of patients admitted to the hospital and to the ICU was provided by the hospital administration as well as the number of hospitalization-days. Data were collected, through a questionnaire, from those responsible for data collection at each institution.

Results

Data from 44 ICUs were analyzed. The average participation was six surveillance quarters (range 1–22). The ICUs belong to hospitals admitting on average 2676 patients per quarter. The average ICUs have 10.5 beds on average, and 88.6% of them are medical/surgical ICUs. The average number of ICU admissions was 217 patients per quarter (927 patient-days). The mean length of stay within the ICU was 4.3 days. Specific guidelines for pneumonia prevention were available in 75% of ICUs; and for catheter-related bacteremia in 85.4%. A total 86.4% of ICUs had specific guidelines for hemoculture procedures. Systematic culture of sputum (surveillance cultures) was performed by 77.3% ICUs, but with different periodicity. Catheter tip culture was performed by 73.8% of the ICUs (2/3 systematically). Guidelines for the use of antibiotics were available at 64% of ICUs while 15.8% of them allowed antibiotic use at the doctor's appreciation. Almost 70% of respondents prefer a patient-based rather than a unit-based surveillance. On average two persons are involved in surveillance (44% ICU doctor, 26% ICU nurse, 6% infection control doctor and 18% IC nurse). It takes 20 min per patient.

Conclusions

The study allowed identifying methodological problems and areas for targeted training in order to improve the quality of the data collected in the national surveillance.

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Morales, I., Suetens, C., Versporten, A. et al. Surveillance of ICU-acquired infections: intensive care unit characteristics, practices in prevention and surveillance methodology. Crit Care 9, P22 (2005). https://doi.org/10.1186/cc3085

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Keywords

  • Specific Guideline
  • National Surveillance
  • Systematic Random Sampling
  • Surveillance Culture
  • Average ICUs