Objective: To characterize the infrastructure and HAI surveillance and control methods of existing ICP in Porto Alegre, a city with 1,453,077 inhabitants and 25 hospitals in Southern Brazil.
Methods: Cross-sectional study. Between March and June, 2008, all 25 city hospitals where visited by the researchers using semi-structured questionnaires through interviews with ICP coordinators.
Results: Seven (25%) hospitals were public (government owned), all were classified as general acute care facilities, and 23 (92%) had intensive care units. Hospitals comprise 7,701 beds (Min 20/Max 1,027) and performed 76,256 surgical and 53,922 clinical admissions in 2007. All but one studied hospitals demonstrated the existence of a structured ICP. Twelve hospitals (48%) had the minimum legally required number of personnel working on ICP (1 staff member per 200 beds). Comparing to institutions with unsatisfactory ICP staff/bed ratio, hospitals with satisfactory staff/bed ratio were more frequently able to identify HAI-related risk factors (respectively, 58% vs 38%) and outbreaks (75% vs 61%). Three hospitals adopt hospital-wide (global) HAI active surveillance, 19 perform device-associated HAI active surveillance, and three reported only passive surveillance methods. None of the hospitals that do not adopt hospital-wide active HAI surveillance perform any kind of point-prevalence HAI estimative on a regular basis. On average, less than 50% of ICP staff available time was spent on HAI surveillance. The hospitals that perform routine active surveillance of ventilator-associated pneumonia, central line-associated primary bloodstream infections (BSI) and urinary catheter-associated urinary tract infections corresponded to, respectively, 76%, 20% and 20%. Amongst the surgical hospitals, few perform surgical site-related infection and BSI HAI surveillance, respectively 30% and 20%. Hospitals that estimate their HAI rates on a monthly basis and have specific goals for them corresponded to, respectively, 19 (76%) and 12 (48%).
Conclusions: Most studied hospitals have understaffed ICP which lack focus on surveillance of the most prevalent HAI according to the characteristics of the institution. More emphasis on HAI surveillance is needed and may represent the best way to demonstrate the impact of ICP programs.