Nosocomial infection prevention practices in Belgian intensive care units

Background

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.

Objectives

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).

Results

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%).

Conclusions

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.