Surveillance nosokomialer Infektionen: Prospektive gezielte Erfassung von nosokomialen Infektionen auf einer pädiatrischen Intensivstation

Zusammenfassung:

Hintergrund, Patienten und Methodik: Von November 1997 bis Mai 1998 wurde am Zentrum für Kinderheilkunde der Universität Bonn in einer prospektiven Surveillance-Studie die Inzidenz nosokomialer Infektionen auf einer interdisziplinären pädiatrischen Intensivpflege- und Überwachungsstation untersucht. Die Erfassung erfolgte nach einem standardisierten Konzept (SEKI), das sich an den Vorgaben des U.S.-amerikanischen National Nosocomial Infections Surveillance [NNIS] Systems der Centers for Disease Control and Prevention orientiert. Die Definitionen der einzelnen nosokomialen Infektionen wurden an die aktuelle Situation in der pädiatrischen Intensivmedizin in Deutschland angepasst. Infektionsraten wurden auf die Patientenzahl, auf Patiententage und Risikofaktoren, insbesondere auf den Gebrauch bestimmter intensivmedizinischer Devices (zentrale Venenkatheter, Beatmung, Harnwegskatheter) bezogen. Ergebnisse: Bei 201 neu aufgenommenen Patienten wurden im Verlauf von 1035 Patiententagen 15 nosokomiale Infektionen erfasst, entsprechend 7,4 pro 100 Patienten bzw. 14,5/1000 Patiententage. Die durchschnittlichen Liegedauer betrug 5,1 Tage. Die Rate der Harnwegskatheter-assoziierten Harnwegsinfektionen lag ebenso wie die Rate der Beatmungs-assoziierten Pneumonien mit 7,2/1000 Anwendungstage zwischen der 25. - 75. Percentile der zum Vergleich herangezogenen NNIS Daten von 1986 - 1998. Die Rate der ZVK-assoziierten Bakteriämien bzw. Sepsen lag mit 10,7/1000 Anwendungstage über der 75. NNIS Percentile (10,1/1000 Anwendungstage). Schlussfolgerung: Durch den Bezug auf stationseigene Basisdaten, wie Patiententage und Anwendungsraten intensivmedizinischer Devices ergaben sich valide, international vergleichbare Ergebnisse, die die Grundlage für eine qualitätsgesicherte Hygienepraxis darstellen. SEKI erfüllt in der hier vorgestellten Studie die Zielvorstellungen einer praxisnahen, prospektiven und standardisierten Surveillance. Der Aufwand ist bei enger Kooperation aller beteiligten Berufsgruppen im Interesse der Patienten zumutbar. Nach internationalen Standards entworfene, gezielte Surveillance-Systeme zur prospektiven Erfassung nosokomialer Infektionen sollten auch in der Bundesrepublik Deutschland fester Bestandteil interner und externer Qualitätskontrollen der pädiatrischen Intensivmedizin werden.

Background, Patients and Methods: From November 1997 through May 1998, the incidence of nosocomial infections was studied prospectively in a 10-bed multidisciplinary pediatric intensive care unit in Germany. A standardized surveillance [SEKI] system based on the National Nosocomial Infection Surveillance [NNIS] System of the Centers for Disease Control and Prevention [CDC] was used. The CDC definitions for nosocomial infections were adapted to the current practice of pediatric intensive care in Germany. Infection rates were calculated as infections per 100 patients, per 1000 patient-days, and per 1000 device-days (central venous catheters, urinary-catheters, and mechanical ventilation). Results: Fifteen nosocomial infections were recorded in 201 patients during 1035 patient-days. The overall nosocomial infection rates were 7.5/100 patients and 14.5/1000 patient-days. Device-associated nosocomial infection rates for urinary-catheters and mechanical ventilation were 7.2/1000 utilization-days and thus below the 75^th percentile of the last NNIS report. Central line infection rates were 10.7/1000 utilization days and therefore above the 75^th percentile of the NNIS data (10.2/1000). The median length-of-stay was 5.1 days. Conclusions: Surveillance data are indispensable for internal and external quality control, and prospective surveillance of nosocomial infections should become an essential component of hospital infection control programs in pediatric intensive care in Germany. The standardized calculation of (device utilization ratios and) device-specific infection rates yields results which can be compared with national and international surveillance data. SEKI meets the criteria of a practice oriented, prospective and standardized surveillance system. Considerable efforts for collecting and interpreting the required data should be balanced against the benefit of prevention of nosocomial infections in this population of critically ill persons.

Schlüsselwörter:

Dyskeratosis congenita - Immundefekt - Panzytopenie - Knochenmarksinsuffizienz

Key words:

Dyskeratosis congenita - immunodeficiency - pancytopenia - bone marrow failure

Literatur

01 SEKI = System zur Erfassung von Krankenhausinfektionen (Medizinische Einrichtungen der Rheinischen Friedrich-Wilhelms-Universität Bonn)

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