Surveillance of nosocomial infections in a neurology intensive care unit

To identify overall and site-specific nosocomial infection (NI) rates in pa tients receiving neurological intensive care therapy, a prospective study w as started in 1997 in the ten-bed neurological intensive-care unit (NICU) o f the University Hospital of Freiburg, Germany. Case records and microbiolo gy reports were reviewed twice a week, and ward staff were consulted. NI we re defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Within 30 months , 505 patients with a total of 4,873 patient days were studied (mean length of stay: 9.6 days). 122 NI were identified in 96 patients (74 patients wit h one, 18 with two and 4 with three infections. An incidence of 24.2/100 pa tients and incidence density of 25.0/1,000 patient days of NI in the neurol ogical ICU were documented. Site-specific incidence rates and incidence den sities were: 1.4 bloodstream infections per 100 patients (1.9 central line- associated BSIs per 1,000 central line-days), 11.7 pneumonias per 100 patie nts (20.4 ventilator-associated pneumonias per 1,000 ventilator-days), 8.7 urinary tract infections per 100 patients (10.0 urinary catheter-associated urinary track infections (UTIs) per 1,000 urinary catheter-days). Addition ally, 0.4 cases of meningitis, 0.8 ventriculitis, and 1.2 other infections (catheter-related local infection, diarrhea) were documented per 1,000 pati ent days. 15 % of nosocomial pathogens were A. baumannii (due to a outbreak of an nosocomial pneumonia with A. baumannii),13 % S. aureus, 10 % E. coli ,7 % CNS, 7 % Bacteroides spp., 7 % Enterobacter spp., 6, 5 % Klebsiella sp p., 5.9 % enterococci, 5.9 streptococci, and 4.7 Pseudomonas spp. In eight cases of NI no pathogen could be isolated. in future, data on NI in NICUs s hould be assessed in greater detail, both to improve the quality of care an d serve as a basis for identification and implementation of the most effect ive measures by which to prevent these infections in patients receiving int ensive neurological care.