Nosocomial infection prevention practices in Belgian intensive care units
© Current Science Ltd 1997
Published: 1 March 1997
In January 1996, a multicentric surveillance of nosocomial infections in Belgian Intensive Care Units (ICUs) was initiated, proposing to all ICUs of the country a voluntary quarterly registration (pneumonia and bacteraemia acquired in the ICU). Besides this continuous registration, a questionnaire survey was conducted, investigating prevailing practices for the prevention of bacteraemia and pneumonia. Results are compared to the European EURONIS A study of 1990.
To describe prevailing preventive practices in use among the ICUs participating in the national surveillance programme (90 units from 72 hospitals).
Method and population
In January 1996, a two-page questionnaire was mailed to all 90 participating units; 62 responded (68.9%). Mean size of the units was 8.7 beds. Response rate was higher among university hospitals (53.8% of all Belgian university hospitals).
On average 2.2 nurse full time equivalents per ICU bed were available, slightly more than the Belgian figure in the 1990 Euronis survey (1.9 FTE/bed).
Nosocomial pneumonia. For aspiration of ventilated patients, 71.2% of the units use sterile gloves: 37.3 use non-sterile gloves. In 61.4% of the units, the respiratory circuit is only changed between even patient. This figure was 42% in 1990. Use of humidification equipment varies widely; heat and moisture exchanger (50%) are the most commonly used. A filter on the expiration tube is used systematically in 61.4% of the units.
Nosocomial bacteraemia. At insertion of a central venous catheter 97% of the respondents systematically use sterile gloves and 89.8% perform handwashing with an antiseptic. Masks, caps and aprons are used less frequently and in various combinations. For skin disinfection 81.3% of the units use alcoholic solutions, versus 15.2% using aqueous solutions. Once the catheter is in place, dressings are changed daily in 37.3% and every other day in 42.4%. Catheter replacement was generally only performed at symptoms of infection: 64.4% (versus 69% in 1990). In the other units, replacement was systematic every week (20.3%), or more (11.9%).
During the last 5 years, preventive practices in Belgian ICUs have converged towards existing guidelines, but a greater variability in practices is observed where no consensus recommendations are available. The relatively low numbers of health care personnel remains a structural risk factor.