Sorveglianza delle infezioni ospedaliere: osservazioni presso il Presidio Ospedaliero di Penne (Pescara)

Healthcare-associated infection is one of the major challenges to providing high quality healthcare. Faced with expectations to improve patient safety and contain costs, the health care system is under increasing pressure to comprehensively and objectively account for nosocomial infections. Laboratory records represent the main surveillance method for evaluation of healthcare-associated infections and antimicrobial drug resistance. Object:We review the occurrence, microbiology, risk factors for healthcare-associated infections, particularly antimicrobial drug resistance and diffusion of Staphylococcus aureus methicillin-resistant (MRSA) among healthcare workers. Methods: Records from biological materials in the period January 1st 2000 and December 31st 2004 were considered. Isolated microrganisms, antibiotic assay (Vitek system, bioMérieux) were analysed. 92 health care workers attending surgical theatre (surgical dept, ICU and anaesthesiology dept.) were screened for MRSA. Results: 1754 bacteria were isolated. Escherichia coli was the more common bacteria (38%), followed by S. aureus, Enterococcus faecalis, Pseudomonas aeruginosa, Proteus mirabilis, Klebsiella pneumoniae, coagulase-negative staphylococci, and Enterobacter spp.The oxacillin resistance was 71% in coagulase-negative staphylococci, and 32% in S. aureus. Among the Enterobacteriaceae the more resistant has been the Enterobacter spp. Imipenem has demonstrated the highest antimicrobial activity (sensibility 82%) in P. aeruginosa infections. Nasal plugs from healthcare workers demonstrated 40% colonized by S. aureus, and none of them carrier of MRSA. Conclusion: Laboratory chart review represent the mainstay for preventing of Nosocomial Infections. Prudent prescribing of antimicrobial drugs to hospital in patients may reduce incidences of antimicrobial drug resistance and healthcare-associated infections.The reservoirs for antibiotic-resistant organisms are colonized patients, and the vectors are often healthcare workers.