title: Variation in nosocomial infection prevalence according to patient care setting:a hospital-wide survey.
abstract: A study was performed to estimate the prevalence of nosocomial infections (NI) and assess differences between medical care settings in one hospital complex. A seven-day period-prevalence survey was conducted in May 1998 in a large primary and tertiary healthcare centre in Geneva, Switzerland, that included all patients in acute, sub-acute and chronic care settings. Variables included demography, exposure to invasive devices and antibiotics, surgical history, and patients' localization. Overall prevalence of NI was 11.3% (acute, 8.4%; sub-acute, 11.4%; chronic care setting, 16.4%) in the 1928 patients studied, and ranged from 0% in ophthalmology to 23% in critical care units. Odds of infection in sub-acute and chronic care settings were significantly higher than in the acute care setting even after adjustment for case-mix [OR, 2.59; 95% confidence interval (CI(95)) 1.53-4.41; and OR, 2.34; Cl(95)1.38-3.95, respectively]. As a distinct group, patients in the geriatric location (belonging to the sub-acute care setting) showed a significant proportion of urinary (39%) and respiratory (21%) tract infections, contrasting with a relatively low exposure to urinary catheters (6.1%) and orotracheal intubation (0%). In conclusion, sub-acute and chronic care settings are associated with high infection prevalence even after case-mix adjustment. Prevalence studies are an easy surveillance tool that can be exploited further by analysing data according to hospital care settings to identify high-risk areas.
authors.affiliation: Infection Control Program, University of Geneva Hospitals, Geneva, Switzerland
authors.forename: H
authors.initials: H
authors.lastname: Sax
authors.forename: S
authors.initials: S
authors.lastname: Hugonnet
authors.forename: S
authors.initials: S
authors.lastname: Harbarth
authors.forename: P
authors.initials: P
authors.lastname: Herrault
authors.forename: D
authors.initials: D
authors.lastname: Pittet
mesh_terms: D000208:Acute Disease / Q000628:therapy*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology*; D002177:Candidiasis / Q000453:epidemiology / Q000209:etiology*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease / Q000628:therapy*; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology*; D003953:Diagnosis-Related Groups / Q000145:classification / Q000706:statistics & numerical data; D006757:Hospital Units; D006784:Hospitals, Teaching; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D017053:Infection Control; D007902:Length of Stay / Q000706:statistics & numerical data; D016015:Logistic Models; D008134:Long-Term Care; D008875:Middle Aged; D015995:Prevalence; D012307:Risk Factors; D019467:Subacute Care; D013557:Switzerland / Q000453:epidemiology