Prevalence of nosocomial infections in a teaching hospital: distribution, predisposing factors and diagnostic pointers

Nosocomial infections are a major challenge for modern medicine and contrib ute to increased resource use in health care systems. The first hospital-wi de prevalence survey of nosocomial infections was conducted at the Universi ty of Geneva Hospitals in 1994. At the time of the study, 16.9% of admitted patients had nosocomial infections (168/994). Leading infection sites were : urinary tract (30%), respiratory tract (17%), surgical wounds (12%) and b loodstream (9.6%). Rates of infection varied between hospital wards: intens ive care (21%), surgery (19%), rehabilitation (18%), internal medicine (13% ). However, the distribution of nosocomial infections varied according to s urveillance and attribution rules. Optimal detection of nosocomial infectio ns requires ward surveillance, including revision of microbiology, nursing (Kardex) and medical records; the combination of fever above 38 degrees C, prescription of antimicrobial agent(s), and positive microbiological record s suggested the diagnosis of nosocomial infections in 95% of situations. Pr iorities for infection control were derived from these results.