Epidemiology of Infections Related to Assistance in Patients of Psychiatric Hospitals

Background: Studies on infection in long-term care facilities (LTCFs) have been released and published over the last two decades, mainly the ones related to Nursing Home residents. However, the epidemiology of infections related to assistance in patients of psychiatric hospital remains little known.

Objective: To identify the epidemiological aspects of infections that occur in psychiatric hospital inpatients.

Methods: The prospective epidemiological surveillance was performed in Instituto Raul Soares (IRS), a public psychiatric hospital with 109 beds, in the period ranging from October 2008 to October 2009, by utilizing the definitions of infection for surveillance in long-term care facilities published in 1991; it was analyzed in an automated system for hospital infection control adapted to LTCFs.

Results: During the 12 months under surveillance, 55 infections were related to assistance. The registered rates ranged from 1.03 to 2.60 nosocomial infection per 1,000 patients-day. The stratified analysis per topography showed 32.7% of  respiratory tract infection (RTI), 27.3% of skin and solf-tissue infection (SST), 25.5% of eye, ear nose and mouth infection (EENT) and 14.5% of other infections. The three most utilized antimicrobials were amoxicillin-clavulanic acid, caphalexin and amoxicillin. Odontological approaches, venous periphery punctures and electroconvulsotherapy were the invasive procedures most frequently utilized. The inpatients that showed infections were 60% male and 40% female with an average age of 42.8 years. The main psychiatric diagnoses registered were 35.5% F20 - F29 – schizophrenia, schizotypal and delusional disorders, 25.8% F30 – F39 mood (affective) disorders,  and 24.2% F10 – F19 - mental and behavioral disorders due to the use of  psychoactive substances (ICP 10 Classification of Mental and Behavioral Disorders). No death was registered.

Conclusions: The epidemiological aspects identified in a psychiatric hospital are different from the ones present in other long term care facilities. The treatments carried out were simple and similar to the ones utilized in community-acquired infections. The recommendations for infection prevention and control may need to be adapted for this different population and the relationship among psychiatric diagnosis, risk factors and invasive procedures must also be utilized as a reference.