Device-associated nosocomial infection rates in Turkish medical-surgical intensive care units

Abstract

Objective: To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates.

Design: Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions.

Setting: Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey.

Patients: All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission.

Results: Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter-days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line-days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases).

Conclusion: We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.