title: Is there an association between nosocomial infection rates and bacterial cross transmissions?
abstract: OBJECTIVE
  Surveillance data of nosocomial infection rates are increasingly used for public reporting and interhospital comparisons. Approximately 15% of nosocomial infections on intensive care units are the result of patient-to-patient transmissions of the causative organisms. These exogenous infections could be prevented by adherence to basic infection control measures. The association between bacterial cross transmissions and nosocomial infection rates was analyzed.
  
  
  METHODS
  Prospective cohort study during 24 months.
  
  
  METHODS
  Eleven intensive care units from two university hospitals.
  
  
  METHODS
  All inpatients.
  
  
  METHODS
  None.
  
  
  RESULTS
  Primary isolates of six indicator organisms (Acinetobacter baumannii, Enterococcus faecalis and E. faecium, Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus) cultured from clinical samples or methicillin-resistant S. aureus surveillance testing of all inpatients were genotyped. Indistinguishable isolates in > or =2 patients defined potential episodes of transmissions. Surveillance of nosocomial infection rates was performed according to the German nosocomial infection surveillance system, Krankenhaus Infektions Surveillance System. Transmission events and nosocomial infection rates were pooled by intensive care unit to calculate Spearman's rank-correlation test. During 100,781 patient days, 100,829 microbiological specimens from 24,362 patients were sampled (average investigation density: 1.0 sample per patient and day) and 3419 primary indicator organisms were cultured. Altogether, 462 transmissions (incidence density of 4.6 transmissions per 1000 patient days; range, 1.4-8.4 days) and 1216 nosocomial infections (incidence density of 12.1 per 1000 patient days; range, 6.2-16.6 days) were discerned. Correlation analysis was unable to reveal any association between the incidence of cross transmissions and nosocomial infections, duration of hospitalization, or device use.
  
  
  CONCLUSIONS
  Differences in nosocomial infection rates between study intensive care units are not explained solely by cross transmissions. Other factors, like the severity of the patient's underlying diseases, the patient's endogenous flora, or invasive procedures, likely have a dominant effect on the magnitude of nosocomial infection rates.
authors.affiliation: Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany. axel.kola@charite.de
authors.forename: Axel
authors.initials: A
authors.lastname: Kola
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Sina
authors.initials: S
authors.lastname: Bärwolff
authors.forename: Tim
authors.initials: T
authors.lastname: Eckmanns
authors.forename: Klaus
authors.initials: K
authors.lastname: Weist
authors.forename: Elke
authors.initials: E
authors.lastname: Dinger
authors.forename: Ingo
authors.initials: I
authors.lastname: Klare
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Witte
authors.forename: Henning
authors.initials: H
authors.lastname: Ruden
authors.forename: Petra
authors.initials: P
authors.lastname: Gastmeier
mesh_terms: D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology / Q000635:transmission*; D002408:Catheters, Indwelling / Q000009:adverse effects; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000635:transmission*; D018562:Disease Transmission, Infectious / Q000517:prevention & control / Q000706:statistics & numerical data*; D004866:Equipment Contamination; D005260:Female; D005858:Germany / Q000453:epidemiology; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000706:statistics & numerical data*; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D011336:Probability; D011446:Prospective Studies; D012307:Risk Factors