title: How many nosocomial infections are associated with cross-transmission? A prospective cohort study in a surgical intensive care unit.
abstract: OBJECTIVE
  To determine the percentage of cross-transmissions in an intensive care unit (ICU) with high nosocomial infection (NI) rates according to the data of the German Nosocomial Infection Surveillance System.
  
  
  METHODS
  A 14-bed surgical ICU of a 1,300-bed, tertiary-care teaching hospital.
  
  
  METHODS
  Prospective surveillance of NIs during a period of 9 months. If an NI was present, the isolates of the following indicator pathogens were stored and typed by species: Staphylococcus aureus, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter species. Pulsed-field gel electrophoresis was performed for typing of S. aureus strains and arbitrarily primed polymerase chain reaction was applied for the other pathogens. The presence of two indistinguishable strains in two patients was considered as one episode of cross-transmission.
  
  
  RESULTS
  Two hundred sixty-two patients were observed during a period of 2,444 patient-days; 96 NIs were identified in 59 patients and the overall incidence density of NI was 39.3 per 1,000 patient-days. For 104 isolates, it was possible to consider typing results. Altogether, 36 cross-transmissions have lead to NIs in other patients. That means at least 37.5% of all NIs identified were due to cross-transmissions.
  
  
  CONCLUSIONS
  Because of the method of this study, the percentage of NIs due to cross-transmission identified for this ICU is an "at least number." In reality, the number of cross-transmissions, and thus the number of avoidable infections, may have been even higher. However, it is difficult to assess whether the percentage of NIs due to cross-transmission determined for this ICU may be the crucial explanation for the relatively high infection rate in comparison to other surgical ICUs.
authors.affiliation: Institute of Hygiene, Free University Berlin, Germany.
authors.forename: Klaus
authors.initials: K
authors.lastname: Weist
authors.forename: Kathrin
authors.initials: K
authors.lastname: Pollege
authors.forename: Ines
authors.initials: I
authors.lastname: Schulz
authors.forename: Henning
authors.initials: H
authors.lastname: Rüden
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
mesh_terms: D001419:Bacteria / Q000145:classification / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D016521:Electrophoresis, Gel, Pulsed-Field; D005858:Germany / Q000453:epidemiology; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016133:Polymerase Chain Reaction; D011159:Population Surveillance; D011446:Prospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*