Alarming Baseline Rates of Nosocomial Infection and Surgical Prophylaxis Errors in a Small Teaching Hospital in Argentina

Abstract

A hospitalwide survey was conducted to estimate baseline rates in order to design a specific infection control programme. On 13 August 1999, all patients hospitalized in a small teaching hospital in Argentina were examined for the presence of hospital-acquired infection. Of 126 inpatients who were eligible for evaluation, 36 had nosocomial infection (overall point prevalence, 28.6%; 95% confidence interval (CI), 20.2-36.9%). The respective lengths of stay for infected and uninfected patients were 33.6+or-36 and 11.2+or-9.1 days (P<0.0001). Although a high prevalence of nosocomial infection was observed in all the units, the most worrisome infection frequencies were those found in the surgery, trauma and intensive care units. The 90 uninfected patients were followed until discharge (5 patients undergoing surgery, other than prosthetic implant, were followed for 30 days after discharge for detection of surgical-site infection); 14 patients became infected (cumulative incidence, 15.6%; CI, 7.5-23.6%) for an incidence density of 8 per 1000 patient-days. A simple linear regression analysis showed a close relation between the incidence of infection and the length of stay (r 2 =0.91, P=0.05). Staphylococcus aureus (22.4%) and Pseudomonas aeruginosa (11.1%) were among the most prevalent organisms. Methicillin resistance was displayed by 46% of the S. aureus strains and imipenem resistance by 10% of the P. aeruginosa isolates. During 1998-99, consumption of vancomycin and carbapenem increased in this hospital by 30 and 300%, respectively.