Skip to main content
SpringerLink
Log in

Preventing Nosocomial Infections to Improve Outcomes of Intensive Care

  • Conference paper
Surviving Intensive Care

Part of the book series: Update in Intensive Care Medicine ((UICMSOFT,volume 39))

  • 100 Accesses

Abstract

There are few topics that have been subjected to such controversy as the question of the influence of nosocomial infections on outcomes, especially mortality, of critically ill patients. The topic is indeed of importance, since nosocomial infection (similarly to other iatrogenic* events) is a frequent event [1–3] and probably the most frequent drawback of intensive care, and determining outcomes attributable to nosocomial intensive care unit (ICU)-acquired infections is going to bear heavily on the design and interpretation of studies aimed at prevention or treatment of such infections. Therefore, the question whether prevention of nosocomial infection will result, or not, in improved outcome from intensive care is undermined by the uncertainty surrounding the consequences of infection on outcome. For example, it is apparent that if nosocomial infections do not influence mortality, there is no point in attempting to show a difference in mortality through implementation of a preventive or therapeutic intervention. In this circumstance, the impact of the intervention on other end-points such as length of stay or antibiotic use will be examined, and this has important imphcations in terms of study design and sample size needed. In this chapter, we shall examine the available data for the most common nosocomial infections occurring in ICU patients, in terms of their impact on mortality, length of stay and resource use, including antibiotics when available. Most such studies have focused on specific sites of infection, and these will be examined separately, after a brief overview of the problem. We shall then examine the evidence, if any, regarding to what extent preventing nosocomial infection may impact on outcome of critically ill patients, and the indicators that may be used for the purpose of quality improvement processes and follow-up.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Richards MJ, Edwards JR, Culver DH, Gaynes RP (2000) Nosocomial infections in combined medical-surgical intensive care units in the United States Infect Control Hosp Epidemiol 21510–515

    Article  PubMed  CAS  Google Scholar 

  2. Richards MJ, Edwards JR, Culver DH, Gaynes RP (1999) Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System Crit Care Med 27887–892

    Article  PubMed  CAS  Google Scholar 

  3. CDC. Nosocomial Infections Surveillance Activity, Hospital Infection Program, National Center for Infectious Diseases (2000) Monitoring hospital-acquired infections to promote patient safety — United States, 1990–1999 Morbidity and Mortality Weekly Report MMWR 49149–153

    Google Scholar 

  4. Vincent JL, Bihari D, Suter PM, et al (1995) The prevalence of nosocomial infection in intensive care in Europe. Results of the European prevalence of infection in intensive care (EPIC) study JAMA 274639–644

    Article  PubMed  CAS  Google Scholar 

  5. Kauffman CA, Vazquez JA, Sobel JD, et al (2000) Prospective multicenter study of funguria in hospitalized patients Clin Infect Dis 3014–18

    Article  PubMed  CAS  Google Scholar 

  6. Hanberger H, Garcia-Rodriguez J-A, Gobernado M, et al (1999) Antibiotic susceptibility among aerobic Gram-negative bacilli in intensive care units in 5 European countries JAMA 28167–71

    Article  PubMed  CAS  Google Scholar 

  7. Kollef MH, Sherman G, Ward S, Fraser VJ (1999) Inadequate antimicrobial treatment of infections: a risk factor for hospital mortality among critically ill patients Chest 115462–474

    Article  PubMed  CAS  Google Scholar 

  8. Le Gall JR, Klar J, Lemeshow S, et al (1996) The logistic organ dysfunction system: A new way to assess organ dysfunction in the intensive care unit JAMA 276802–810

    Article  PubMed  Google Scholar 

  9. Le Gall JR, Lemeshow S, Saulnier F (1993) A new simplified acute physiology score based on a European-North American multicenter study JAMA 2702957–2963

    Article  PubMed  Google Scholar 

  10. Brun-Buisson C, Doyon F, Carlet J, et al (1995) Incidence, risk factors, and outcome of severe sepsis and septic shock in adults. A multicenter prospective study in intensive care units JAMA 274968–974

    Article  PubMed  CAS  Google Scholar 

  11. Britt MR, Schleupner CJ, Matsumiya S (1978) Severity of underlying disease as a predictor of nosocomial infection. Utility in the control of nosocomial infection JAMA 2391047–1051

    Article  PubMed  CAS  Google Scholar 

  12. Gross PA, DeMauro PJ, van Antwerpen C, Wallenstein S, Chiang S (1988). Number of comorbidities as a predictor of nosocomial infection acquisition Infect Control Hosp Epidemiol 9497–500

    Article  PubMed  CAS  Google Scholar 

  13. Gross PA, van Antwerpen C (1983) Nosocomial infections and hospital deaths, A case-control study Am J Med 75658–662

    Article  PubMed  CAS  Google Scholar 

  14. Gross PA, Neu HC, Aswapokee P, van Antwerpen C, Aswapokee N (1980) Deaths from nosocomial infections: experience in a university hospital and a community hospital Am J Med 68219–223

    Article  PubMed  CAS  Google Scholar 

  15. Bueno-Cavanillas A, Delgado-Rodriguez M, Lopez-Luque A, Schaffmo-Cano S, Calvez-Vargas R (1994) Influence of nosocomial infection on mortality rate in an intensive care unit Crit Care Med 2255–60

    PubMed  CAS  Google Scholar 

  16. Bueno-Cavanillas A, Contreras RR, Lopez-Luque A, Delgado-Rodriguez M, Galves-Vargas R (1991) Usefulness of severity indices in intensive care medicine as a predictor of nosocomial infection risk Intensive Care Med 17336–339

    Article  PubMed  CAS  Google Scholar 

  17. Girou E, Stephan F, Novara A, Safar M, Fagon JY (1998) Risk factors and outcome of nosocomial infections: results of a matched case-control study of ICU patients Am J Respir Crit Care Med 1571151–1158

    PubMed  CAS  Google Scholar 

  18. Girou E, Pinsard M, Auriant I, Canonne M (1996) Influence of the severity of illness measured by the simplified acute physiology score (SAPS) on occurrence of nosocomial infections in ICU patients J Hosp Infect 34131–138

    Article  PubMed  CAS  Google Scholar 

  19. Digiovine B, Chenoweth C, Watts C, Higgins M (1999) The attributable mortality and costs of primary nosocomial bloodstream infections in the intensive care unit Am J Respir Crit Care Med 160976–981

    PubMed  CAS  Google Scholar 

  20. Soufir L, Timsit JF, Mahe C, Carlet J, Regnier B, Chevret S (1999). Attributable morbidity and mortality of catheter-related septicemia in critically ill patients: a matched, risk-adjusted, cohort study Infect Control Hosp Epidemiol 20396–401

    Article  PubMed  CAS  Google Scholar 

  21. Renaud B, Brun-Buisson C (2001) Outcomes of primary and catheter-related bacteremia. A cohort and case-control study in critically ill patients Am I Respir Crit Care Med 1631584–1590

    CAS  Google Scholar 

  22. Mermel LA (2000) Prevention of intravascular catheter-related infections Ann Intern Med 132391–402

    PubMed  CAS  Google Scholar 

  23. Wenzel RP (1998) Perspective: attributable mortality — the promise of better antimicrobial therapy Clin Infect Dis 178917–919

    CAS  Google Scholar 

  24. Leu HS, Kaiser DL, Mori M, Woolson RF, Wenzel RP (1989) Hospital-acquired pneumonia: attributable mortality and morbidity Am ] Epidemiol 1291258–1267

    CAS  Google Scholar 

  25. Fagon JY, Chastre J, Domart Y, Trouillet J-L, Gibert C (1996) Mortality due to ventilator-associated pneumonia or colonization with Pseudomonas or Acinetobacter species: assessment by quantitative culture of samples obtained by a protected specimen brush Clin Infect Dis 23538–542

    Article  PubMed  CAS  Google Scholar 

  26. Heyland DK, Cook DJ, Griffith L, Keenan SP, Brun-Buisson C, The Canadian Crifical Care Trials Group (1999) The attributable morbidity and mortality of ventilator-associated pneumonia in the critically ill patient Am J Respir Crit Care Med 1591249–1256

    Google Scholar 

  27. Bregeon F, Papazian L, Visconti A, Gregoire R, Thirion X, Gouin F (1997) Relafionship of microbiologic diagnostic criteria to morbidity and mortality in patients with ventilator-associated pneumonia JAMA 277655–662

    Article  PubMed  CAS  Google Scholar 

  28. Papazian L, Bregeon F, Thirion X, et al (1996) Effect of ventilator-associated pneumonia of mortality and morbidity Am J Respir Crit Care Med 15491–97

    PubMed  CAS  Google Scholar 

  29. Timsit JF, Chevret S, Valcke J, et al (1996) Mortality of nosocomial pneumonia in ventilated patients: influence of diagnostic tools Am J Respir Crit Care Med 154116–123

    PubMed  CAS  Google Scholar 

  30. Baker AM, Meredith JW, Haponik EF (1996) Pneumonia in intubated trauma patients. Microbiology and outcome Am J Respir Crit Care Med 153343–349

    PubMed  CAS  Google Scholar 

  31. Hsieh AHH, Bishop MJ, Kubihs PS, Newell DW, Pierson DJ (1992) Pneumonia following closed-head injury Am J Respir Crit Care Med 146290–294

    CAS  Google Scholar 

  32. Chastre J, Trouillet J-L, Vuagnat A, et al (1998) Nosocomial pneumonia in patients with acute respiratory distress syndrome Am J Respir Crit Care Med 1571165–1172

    PubMed  CAS  Google Scholar 

  33. Delclaux C, Roupie E, Blot F, Brochard L, Lemaire F, Brun-Buisson C (1997) Lower respiratory tract colonization and infection during severe acute respiratory distress syndrome. Incidence and diagnosis Am J Respir Crit Care Med 1561092–1098

    PubMed  CAS  Google Scholar 

  34. Markowicz P, Wolff M, Djedaini K, et al (2000) Multicenter prospective study of ventilatorassociated pneumonia during acute respiratory distress syndrome. Incidence, prognosis, and risk factors. ARDS Study Group Am J Respir Crit Care Med 1611942–1948

    PubMed  CAS  Google Scholar 

  35. D’Amico R, Pifferi S, Leonetti C, Torri V, Tinazzi A, Liberafi A (1998) Effectiveness of antibiotic prophylaxis in critically ill adult patients: systematic review of randomised controlled trials Br Med J 3161275–1285

    Article  CAS  Google Scholar 

  36. Nathens AB, Marshall JC (1999) Selective decontamination of the digestive tract in surgical patients. A systematic review of the evidence Arch Surg 134170–176

    Article  PubMed  CAS  Google Scholar 

  37. Nouira S, Marghli S, Belghith M, Besbes L, Elatrous S, Abroug F (2001 ) Once daily oral ofloxacin in chronic obstructive pulmonary disease exacerbation requiring mechanical ventilation: a randomised placebo-controlled trial Lancet 3582020–2025

    Article  PubMed  CAS  Google Scholar 

  38. Maki DG (1989) Risk factors for nosocomial infection in intensive care. “Devices vs. nature” and goals for the next decade Arch Intern Med 14930–35

    Article  PubMed  CAS  Google Scholar 

  39. Vieillard-Baron A, Girou E, Valente E, et al (2000) Predictors of mortality in acute respiratory distress syndrome. Focus On the role of right heart catheterization Am J Respir Grit Care Med 1611597–1601

    CAS  Google Scholar 

  40. Girou E, Schortgen F, Delclaux C, et al (2000) Association of non-invasive ventilation with nosocomial infections and survival in critically ill patients JAMA 2842361–2367

    Article  PubMed  CAS  Google Scholar 

  41. Eggimann P, Harbarth S, Constantin MN, Touveneau S, Chevrolet JC, Pittet D (2000) Impact of a prevention strategy targeted at vascular-access care on incidence of infections acquired in intensive care Lancet 3551864–1868

    Article  PubMed  CAS  Google Scholar 

  42. Pittet D, Mourouga P, Perneger TV (1999) Compliance with handwashing in a teaching hospital Ann Intern Med 130126–130

    PubMed  CAS  Google Scholar 

  43. Pittet D, Hugonnet S, Harbarth S, et al (2000) Effectiveness of a hospital-wide programme to improve compliance with hand hygiene Lancet 3561307–1312

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Dept of Intensive Care, Hôpital Henri Mondor, 94010, Créteil, France

    C. Brun-Buisson (Professor)

Authors
  1. C. Brun-Buisson
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Critical Care Medicine, University of Pittsburgh, 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Derek C. Angus MD, MPH, FCCM, FCCP (Associate Professor and Vice Chair for Research) (Associate Professor and Vice Chair for Research)

  2. Anaesthesiology and Emergency Department, Fondation Hôpital St Joseph, 185 rue Raymond Losserand, 75674, Paris Cedex 14, France

    Jean Carlet MD (Head of the Intensive Care Unit Coordinator of the Intensive Care) (Head of the Intensive Care Unit Coordinator of the Intensive Care)

Rights and permissions

Reprints and permissions

Copyright information

© 2003 Springer-Verlag Berlin Heidelberg

About this paper

Cite this paper

Brun-Buisson, C. (2003). Preventing Nosocomial Infections to Improve Outcomes of Intensive Care. In: Angus, D.C., Carlet, J. (eds) Surviving Intensive Care. Update in Intensive Care Medicine, vol 39. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-55733-0_20

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-55733-0_20

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-540-44149-6

  • Online ISBN: 978-3-642-55733-0

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation