title: Surveillance and infection control in an intensive care unit.
abstract: OBJECTIVE
  To evaluate the effect of an infection control program on the incidence of hospital-acquired infection (HAI) and associated mortality.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  A 2000-bed, university-affiliated hospital in Italy.
  
  
  METHODS
  All patients admitted to the general intensive care unit (ICU) for more than 48 hours between January 2000 and December 2001.
  
  
  METHODS
  The infection control team (ICT) collected data on the following from all patients: demographics, origin, diagnosis, severity score, underlying diseases, invasive procedures, HAI, isolated microorganisms, and antibiotic susceptibility.
  
  
  METHODS
  Regular ICT surveillance meetings were held with ICU personnel. Criteria for invasive procedures, particularly central venous catheters (CVCs), were modified. ICU care was restricted to a team of specialist physicians and nurses and ICU antimicrobial therapy policies were modified.
  
  
  RESULTS
  Five hundred thirty-seven patients were included in the study (279 during 2000 and 258 in 2001). Between 2000 and 2001, CVC exposure (82.8% vs 71.3%; P < .05) and mechanical ventilation duration (11.2 vs 9.6 days) decreased. The HAI rate decreased from 28.7% in 2000 to 21.3% in 2001 (P < .05). The crude mortality rate decreased from 41.2% in 2000 to 32.9% in 2001 (P < .05). The most commonly isolated microorganisms were nonfermentative gram-negative organisms and staphylococci (particularly MRSA). Mortality was associated with infection (relative risk, 2.11; 95% confidence interval, 1.72-2.59; P < .05).
  
  
  CONCLUSIONS
  Routine surveillance for HAI, coupled with new measures to prevent infections and a revised policy for antimicrobial therapy, was associated with a reduction in ICU HAls and mortality.
authors.affiliation: Department of Public Health Sciences, University La Sapienza Rome, Rome, Italy. giovanni.orsi@uniroma1.it
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Orsi
authors.forename: Massimiliano
authors.initials: M
authors.lastname: Raponi
authors.forename: Cristiana
authors.initials: C
authors.lastname: Franchi
authors.forename: Monica
authors.initials: M
authors.lastname: Rocco
authors.forename: Carlo
authors.initials: C
authors.lastname: Mancini
authors.forename: Mario
authors.initials: M
authors.lastname: Venditti
mesh_terms: D000328:Adult; D000368:Aged; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000453:epidemiology / Q000517:prevention & control*; D002176:Candida albicans / Q000302:isolation & purification; D003428:Cross Infection / Q000382:microbiology* / Q000401:mortality / Q000517:prevention & control; D005260:Female; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D007362:Intensive Care Units; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate