Nosocomial infection following cardiovascular surgery: Comparison of two periods, 1987 vs. 1992

Objective: To evaluate whether changes have occurred at our center in the rate of nosocomial infections and in the infectious organisms consequent to changes in policy and procedure as of 1987. Setting: Multidisciplinary pediatric intensive care unit (PICU) in a major tertiary care center. Design: Prospective comparative study. Patients: Four-hundred and fifty-five consecutive patients who underwent cardiac surgery within a 10-month period. Interventions: Changes related to antibiotic use and invasive device management were introduced after the 1987 survey. To determine the effect of these changes, all patients undergoing cardiac surgery between July 1991 and April 1992 were followed daily from PICU admission to 2 months after hospital discharge for signs of infection. Each infectious episode was reviewed by the nosocomial infection control committee. A weighted scoring system was used to determine risk. Measurements and Main Results: In the 1987 study, 40 of 310 patients had 78 infections for a nosocomial infection ratio (NIR) of 25.2. Of the 455 patients surveyed in 1992, 72 had 91 episodes of infection. The nosocomially infected patient rate was 15.8 and the NIR was 20. The frequency of wound infection decreased from 7% in 1987 to 4.3% in this study, and no episode of mediastinitis was observed. In the bacteriological spectrum, the absence of candidal infection was significant, and there was a decrease in the proportional frequency of pseudomonas infection from 21% to 15%. Conclusion: The comparison between the two time periods demonstrates that an aggressive approach to managing intravascular catheters and urinary catheters and limiting the use of antibiotics probably affects the spectrum of nosocomial infections.