METHOD: A prospective cohort-targeted comprehensive surveillance study on NI associated with usage of devices was conducted in three ICUs in Malaysia using a developed NI surveillance form. Patients who developed infection outside an ICU were excluded from the study.
RESULTS: The device associated NI was 21.1%. The mean duration for development of NI was 10.0 +/- 7.44 days in ICU. The major device-associated infections were nosocomial pneumonia (18.7%) followed by bacteremia (8.5%) and urinary tract infections (4.7%) respectively. NI incidence density rate was 20.6 per 1,000 patient-days. Bacteremia, urinary tract infection (UTI) and nosocomial pneumonia (NP) rates were 8.9, 4.7 and 20.5 per 1,000 patient-days, respectively. Acinetobacter species, Klebseilla pneumoniae, Pseudomonas aeruginosa and Methicillin-resistant Staphylococcus aureus were the predominant pathogens isolated from the NIs subjects during the study period in the three ICUs.
CONCLUSION: Analysis of the rate of the NIs associated with usage of devices in the three ICUs showed that it is highly correlated with the use of mechanical ventilation devices, followed by intravascular devices and usage of indwelling urinary catheters.
METHODOLOGY: Staff members were observed during patient contacts, and their hand washing techniques and hand hygiene practices were monitored. Five contact periods were observed for staff members while they cared for their assigned patients. Hand hygiene practices before and after patient contacts were categorized as clean uncontaminated, clean recontaminated, new gloves, and unchanged contaminated gloves. Compliance to hand-washing steps and time taken for hand washing were analyzed. Appropriate use of gloves based on CDC criteria also was assessed.
RESULTS: Compliance to hand hygiene practices was 70% before each patient contact. Staff members did not completely adhere to the hand-washing steps. The average time taken to wash hands was 20 seconds, and the necessary steps (rubbing palm over dorsum; rubbing fingers interlaced, and rotational rubbing of thumbs) were practiced minimally by all staff. Hand washing protocol was generally followed by all staff (100%). Alcohol hand rubs were available but were used moderately (60%); when used, staff members did not wait for the alcohol to dry. Only 4% of staff changed contaminated gloves between patients.
CONCLUSIONS: Hand hygiene compliance by ICU staff members needs to be improved. Improving adherence to correct hand hygiene techniques will require effective education programs and behavioral modification techniques. Moreover, hand hygiene guidelines must be incorporated into new staff orientation programs and the continuing education curriculum in the two hospitals studied.