Nadzór nad zakażeniami w polskich szpitalach w roku 1999 i w latach 2002-2003 na przykładzie szpitalnego zapalenia płuc w oddziałach intensywnej terapii

Jadwiga Wójkowska-Mach, Małgorzata Bulanda, Anna Różańska, Mirosław Jawień, Piotr B. Heczko

Summary
Background. Nosocomial infections remain a major problem in health care all over the world. Almost 50% of all hospital-occurring complications are related to various nosocomial infections, with ICU pneumonias playing a major role. Methods. The purpose of the study was to register all cases of nosocomial respiratory tract infections among patients treated in ICU´s of 93 hospitals during the year 1999, and in 33 hospitals over the years 2002-2003. Infection rates were calculated by using a denominator of the number of patients infected in relation to all patients hospitalised over the analyzed period. The incidence of pneumonia among all ventilated patients, and mortality (number of deaths among ventilated patients with pneumonia) was calculated. Frequencies of mechanical ventilation and its effect on the occurrence of ventilator-associated pneumonia (VAP) were noted. Results. The cumulative incidence of pneumonia among the ICU patients was 4.2% in 1999 and 5.6% over the years 2002-2003. Mortality decreased in the 2002-2003 surveillance. Mean lengths of stay in ICU of the non-infected patients were 6.5 days (1999) and 5.8 days (2002-2003). Patients with nosocomial pneumonia were treated for 14.6 and 35.2 days, respectively. The incidence of VAP was directly related to the incidence of mechanical ventilation (R² =0.7675, p=0.0043), and it was higher than reported in previously published data of other multicenter trials. Discussion and conclusion. The results are preliminary and cover only 5% of Polish ICU patients. Modern methods of infection control, which are just being more widely introduced, allow for better detection of nosocomial infections. Nevertheless, the vast majority of Polish ICU´s are not properly standardized to be compared, therefore the results should be regarded as preliminary only. The higher incidence of VAP indicates an urgent need for a multicenter trial and for the introduction of a better infection control system.

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