Nosocomial infections in elderly patients in the United States, 1986-1990

Article Abstract:

Over the last several decades, the number of hospitalized elderly patients has increased. It is well recognized that old age increases the risk of infection, and nosocomial (hospital-acquired) infections are a serious concern in this group. Unless effective infection control programs are developed and implemented, the rate of nosocomial infections (NIs) among elderly patients will increase. In order to design an effective NI control program, the risk factors associated with NIs, and rates, types, and causes of infections need to be identified. In an attempt to provide this information, the case reports of 101,479 NIs reported by 89 hospitals to the National Nosocomial Infections Surveillance system between 1986 and 1990 were reviewed. Fifty-four percent of these infections occurred in patients over the age of 65. The most common NIs in elderly patients were urinary tract infections (44 percent), pneumonia (18 percent), surgical wound infections (11 percent), and blood infections (8 percent). Urinary tract infections were more common in the elderly patients, while surgical wound infections were more common in younger patients. The most common causes of infection were Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus. Medical devices that were associated with NIs included catheters used for removing urine from the bladder, mechanical ventilators used to assist breathing, and intravenous catheters for giving medications or nutrients. Twelve percent of the patients with NIs died, and 54 percent of the deaths were caused by the infection. Pneumonia and blood infections were the most common causes of death. It is concluded that NIs are more common in elderly patients than younger patients. Infection control should focus on preventing infections related to the use of medical devices, poor hygiene and poor nutrition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Aged patients, Elderly patients

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Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989

Article Abstract:

Infections that are acquired during hospitalization (nosocomial infections) are a major health concern. It has been estimated that between 3 and 5 percent of all patients who become hospitalized develop an infection during their stay. Infections occurring in the bloodstream (BSIs) account for approximately 8 percent of all nosocomial infections. BSIs can be very serious and can cause significant illness and even death. In addition, they can increase the length of time spent in the hospital and the cost to the patient. A study was performed to estimate the prevalence of BSIs over the last decade. The medical reports from 124 acute care hospitals that reported BSIs to the National Nosocomial Infectious Surveillance System between 1980 and 1989 were reviewed. During this time period, a total of 25,269 BSIs and 9,027,541 patient discharges were reported to the Centers for Disease Control. Large teaching hospitals reported the greatest number of cases of BSIs, followed by small teaching hospitals, large nonteaching hospitals and small nonteaching hospitals. Bacteria called coagulase-negative staphylococci (CNS) were the most common cause of BSIs. Between 1980 and 1989, the incidence of BSIs increased by 70 percent in large teaching hospitals, by 124 percent in small teaching hospitals, by 196 percent in large nonteaching hospitals, and by 279 percent in small nonteaching hospitals. The increase in BSIs can be attributed to an increase in infections caused by CNS, Candida species, Staphylococcus aureus, and enterococci. The percentage of BSIs caused by CNS in large teaching hospitals increased by 754 percent during the study period. It is concluded that the number of BSIs occurring in hospitals is increasing, and that more effective methods of preventing BSIs are needed. (Consumer Summary produced by Reliance Medical Information, Inc.)

Infection, Bacterial infections, Blood

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Year 2000 objectives for preventing nosocomial infections: how do we get there?

Article Abstract:

The first report containing national objectives for the control and prevention of disease was prepared by the United States Public Health Service (PHS) in the late 1970s. The national objectives for the years 1990 and 2000 include plans for controlling and preventing nosocomial infections, namely those that occur during hospitalization. The 1990 objectives called for a 20 percent reduction in the incidence of nosocomial infections and requested that 95 percent of all licensed patient care facilities use the recommended procedures for controlling nosocomial infections. The objectives for controlling and preventing nosocomial infections outlined in the PHS report for the year 2000 include plans for protecting health care workers and patients. Objectives for protecting workers include regulations to prevent exposure to infections that are transmitted in blood, such as hepatitis B and the human immunodeficiency virus (HIV, the virus that causes AIDS), and providing immunization for 90 percent of the workers exposed to hepatitis B. Educational training regarding HIV infections and methods of preventing HIV infection should be provided every three years. The PHS Year 2000 objectives for the patient include a 10 percent reduction in the incidence of infection in intensive care patients and surgery patients. A system is needed for monitoring the compliance of medical care facilities with the recommended procedures for controlling infections, and for estimating nosocomial infection rates. More educational programs should be developed to provide information about the treatment and prevention of infectious diseases. (Consumer Summary produced by Reliance Medical Information, Inc.)

Standards, Public health

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