Assessing the effectiveness of 3 surveillance methods for nosocomial infections in psychiatry

Methodological data concerning nosocomial infection surveillance in psychia tric institutions are scarce. Methods used in Ether type of hospitals are p robably not adjusted to psychiatry because risk groups are different. Our p urpose was to assess retrospectively the effectiveness of 3 surveillance me thods in our hospital. We studied the results of a prevalence study, the re sults of surveillance according to clinical microbiology data, and accordin g to prescriptions of antimicrobial agents. The prevalence survey gave poor information because of a low number of infections (n = 5; prevalence rate = 0.9 %). The 2 other methods can not be used separately. Surveillance acco rding to clinical microbiology data showed a lack of sensitivity. Indeed, d uring the 6 months of the study, 38 nosocomial infections were detected by clinical microbiology data, whereas our hospital physicians wrote out 88 an tibiotic prescriptions. Moreover, antimicrobial agent prescription data sho wed a lack of sensitivity and a lack of specificity. Indeed, on one hand, a mong 32 urinary tract infections detected by laboratory work, only 14 led t o a prescription. On the other hand, it was not easy to consider as nosocom ial, 20 rhino-pharyngeal infections and 25 cases of bronchopneumonia that l ed to a prescription. These 3 methods gave different but probably complemen tary results. According to us and with great care accorded to the quality o f data collection and to the pertinence of infection diagnosis, a prospecti ve study of incidence associating these 2 methods could allow to detect mos t nosocomial infections in our hospital. Such a study would be long and tim e-consuming. Regular sensitization and motivation of all concerned hospital staff would be necessary (environmental microbiology analysis, regular inf ormation in various wards).