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434 HOSPITAL-WIDE SURVEILLANCE OF HEALTH-ACQUIRED INFECTION. IS IT WORTH?

Saturday, March 20, 2010
Grand Hall (Hyatt Regency Atlanta)
Ricardo S. Kuchenbecker, PhD , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Loriane Konkewicz , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Marcia Pires , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Nadia Kuplich , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Rodrigo Santos , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Helena Santos , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Suzi Camey , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Mario Wagner , Graduate Studies Program in Epidemiology, and Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
Background: Hospital-wide surveillance of healthcare-acquired infection (HAI) was progressively substituted by more specific (e.g. targeted) surveillance methods by most hospitals, although few studies addressed comparatively the benefits and limitations of those approaches.

Objective: To compare between surveillance coverage achieved by comprehensive hospital wide (HW) surveillance to the surveillance coverage obtained with Centers for Disease Control and Prevention (CDC)-recommended approach which focus on intensive care units (ICUs) and emphasizes device-related infections (HAI associated with central venous catheters, ventilators and/or urinary catheters).

Methods: Review of prospectively obtained comprehensive HW surveillance data from Jan/2002 to Dec/2008 at the Hospital de Clínicas de Porto Alegre (HCPA), Southern Brazil, a public, university-affiliated general hospital with 749 beds (27,000 admissions/year). HCPA has three Intensive Care Units (ICUs): An adult medical and surgical ICU, a Pediatric, and a Neonatal with, respectively 34, 13 and 20 beds. Surveillance HAI data was obtained by trained infection control nurses using standard CDC criteria.

Results: From the 15,644 HAI detected in the seven-year study period detected by HW surveillance, 5,387 (34%) were detected at the 3 ICU using CDC-recommended surveillance, and the remaining 10,257 HAI occurred at surgical and clinical non-critical wards and were detected by HW surveillance. CDC-recommended ICU surveillance for central line-associated primary bloodstream infections (BSI), urinary catheter-associated urinary tract infections (UTI) and ventilator-associated pneumonia would have detected only 413 (27%) of 1,528 catheter-related BSIs, 956 (97%) of 984 VAP and 725 (27%) of 2,875 urinary catheter-associated urinary tract infections that occurred in the medical and surgical wards. BSI and UTI rates at non-critical wards were consistently higher than ICUs rates, respectively, 5,2 vs 3,8 infections/1,000 catheter-days; and 12,2 vs 9,5 infections/1,000 catheter-days.

Conclusions:

In the study period, CDC-recommended device-associated surveillance detected one-third of the HAI detected using a HW surveillance approach. The present findings may be useful for comparative studies such as cost-effectiveness approaches addressing different global versus targeted HAI surveillance methods.