Efficacy of nosocomial infection control in urological patients: building benchmarking through active surveillance

Abstract number: 1133_99

Agodi A., Barchitta M., Anzaldi A., Marchese F., Bonaccorsi A., Bellocchi P., Cantaro P., Motta M.

Objectives:  

Many studies have suggested that disseminating Nosocomial infections (NI) risk-adjusted reliable infection rates obtained through surveillance to healthcare personnel (HCP) and establishing a link with prevention efforts is essential for successful control. Our study goals were: i) to evaluate the efficacy of feeding back NI surveillance data to HCP of a Urologic Clinic and ii) to provide indicators useful for benchmarking within and between surgical wards.

Methods:  

Active surveillance was performed at the Urologic Clinic of an Italian University Hospital, in accordance with the methods, protocols and definitions of the National Nosocomial infections Surveillance (NNIS) System, USA. A first 1 month-surveillance survey was conducted in June-July 2002 and data recorded and analyzed. Diagnosis was based on CDC definitions for NI. Each suspected infection was discussed and validated by the epidemiologists, infection control personnel and surgeons. Indicators were calculated including site specific NI incidence and incidence density rates. At the end of the study a feedback session was held and results were communicated and discussed with the staff. A second study was planned and performed as a 4 months-surveillance survey from April to July 2004. Surveillance data were analyzed and compared.

Results:  

The cumulative incidence of NI decreased from 8.0% patients in 2002 to 2.3% in 2004 and incidence density from 11.5‰ patient-days to 3.2‰ (p < 0.05, chi square test). Symptomatic urinary tract infections were not detected in 2002 while in 2004 their incidence was 1.4‰ patient-days, 13.04‰ catheterized patients and 3.04‰ patient-days of catheterization. Surgical site infections (SSI) incidence and incidence density decreased respectively from 5.4% patients to 1.3% and from 7.7‰ patient-days to 1.8‰ (p < 0.05). SSI rates by operative procedure and NNIS risk index category decreased from values above the 90th percentile of NNIS distribution to values between the 75th and the 90th percentile.

Conclusions:  

Few surveillance data have been published on NI rates in urological patients. Our study represents a contribution to building specific benchmarking and an example of successful control of NI in a urology ward. Several explanation may be suggested to have prevented infections, but the role of feeding back information to ‘those who need to know’, changing personnel behaviour and improving the quality of patient care is shown to have been critical.