BACKGROUND: In this report, we present the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2008 through June 2009. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 101 ICUs in 57 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: We identified 3,287 NIs during the study period: 1,787 UTIs (1,772 cases were urinary catheter-associated), 917 BSIs (797 were central line-associated), and 583 PNEUs (335 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.80 cases per 1,000 device-days (95% confidence interval, 4.58-5.03) and urinary catheter utilization ratio was 0.85 (0.849-0.851). Although the urinary catheter utilization ratios were lower in the hospitals with 400-699 beds than in the hospitals with 700-899 beds and more than 900 beds, the rates of urinary catheter-associated UTIs were higher in hospitals with 400-699 beds than in the larger ones. The rate of central line-associated BSIs was 3.27 (3.05-3.51) and the utilization ratio was 0.56 (0.559-0.561). The rate of ventilator-associated PNEUs was 1.86 (1.67-2.07) and the utilization ratio was 0.41 (0.409-0.411). The rate of ventilator-associated PNEUs was lower in July 2008-June 2009 than in July 2007-June 2008 and July 2006-December 2006. CONCLUSION: It appears that the KONIS influences the reduction in the rate of device-associated infections, especially ventilator-associated PNEU; therefore, ongoing targeted surveillance and infection control strategies are needed to control device-associated infections.
Cross Infection ; Gossypol ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Urinary Catheters ; Urinary Tract Infections

Urinary tract infections frequently affect pregnant mothers. This problem causes significant morbidity and healthcare expenditure. Three common clinical manifestations of UTIs in pregnancy are: asymptomatic bacteriuria, acute cystitis and acute pyelonephritis. Escherichia coli remains the most frequent organism isolated in UTIs. All pregnant mothers should be screened for UTIs in pregnancy and antibiotics should be commenced without delay. Urine culture and sensitivity is the gold standard in diagnosing UTIs. Without treatment, asymptomatic bacteriuria in pregnancy is associated with preterm delivery, intrauterine growth retardation, low birth weight, maternal hypertension, pre-eclampsia and anaemia. Acute pyelonephritis can lead to maternal sepsis. Recurrent UTIs in pregnancy require prophylactic antibiotic treatment.
Pregnancy ; Urinary tract infection ; Asymptomatic bacteriuria ; Acute ; therapeutic aspects

BACKGROUND: Urinary tract is the most common site of nosocomial infections, accounting for 35% of all nosocomial infections. About 80-90% of these urinary tract infections are associated with urethral catheter insertion. Recently, we experienced an outbreak of nosocomial UTI (urinary tract infection) caused by Candida spp. in the surgical ICU (SICU) and we investigated the cause of UTI outbreak. METHODS: We collected data from clinical records and observed the current methods of care of urethral catheters in the SlCU. During the outbreak, we investigated the current procedures and maintenance care of urethral catheter insertion and educated the staff on the correct methods of the catheter insertion and care. We performed surveillance cultures of unused new urine bags, RESULTS: Between May 2000 and June 2000, 17 Candida spp. strains were isolated from urines of 17 patients hospitalized in the SICU of National Health Insurance Corporation Ilsan Hospital. All infections were attributed to the care of urethral catheter insertion and contaminated bags. We identified that routine bladder irrigation and emptying urine to a common urinal have been done incorrectly during the outbreak period. Rodotorula spp. was isolated from 4 urine bags (50% contamination rate) out of 8 unused new urine bags by surveillance cultures. CONCLUSION: The causes of the UTI outbreak caused by Candida spp. was terminated by outbreak investigation and change of contaminated urine bag.
Candida* ; Catheters ; Cross Infection ; Humans ; National Health Programs ; Urinary Bladder ; Urinary Catheters ; Urinary Tract Infections* ; Urinary Tract*

BACKGROUND: Laboratory-based surveillance is an effective method' to detect nosocomial infections with limited personnel and time, and also can be used to identify clusters of organisms by unit and site. However it will fail to detect a significant number of infections because of cultures being negative or not submitted at all. This study was performed to determine the sensitivity of laboratory-based surveillance method in detecting nosocomial infections. METHODS: Four nursing units, two each of medical and surgical units, of Asan Medical Center were chosen and surveillance for nosocomial infections was performed with the total surveillance method for the 6-month period from July to December of 1995 by an infection control nurse. Proportion of the nosocomial infections that would have been detected by culture results alone was identified to determine the sensitivity of the laboratory-based surveillance method. RESULTS: A total of 164 cases of nosocomial infections were identified by the total surveillance method. Of these, 119 (72.6%) cases would have been detected by the laboratory-based surveillance method alone. Sensitivities were 100% in urinary tract infection and bacteremia, and 44.7%, 52.6% and 54.8% in lower respiratory tract, surgical site and other site infections, respectively. The 45 cases of infections that would have been undetected by microbiology data alone included 30 cases with culture negatives and 15 cases in which cultures were not submitted. CONCLUSIONS: The laboratory-based surveillance revealed different sensitivities depending on the sites of infections and patient services. The method is efficient with an acceptable level of sensitivities, but infection control teams should be aware of its shortcoming by a periodic monitoring of its sensitivity in the detection of nosocomial infections at their own hospitals.
Bacteremia ; Chungcheongnam-do ; Cross Infection* ; Humans ; Infection Control ; Nursing ; Respiratory System ; Urinary Tract Infections

BACKGROUND: Laboratory-based surveillance is an effective method' to detect nosocomial infections with limited personnel and time, and also can be used to identify clusters of organisms by unit and site. However it will fail to detect a significant number of infections because of cultures being negative or not submitted at all. This study was performed to determine the sensitivity of laboratory-based surveillance method in detecting nosocomial infections. METHODS: Four nursing units, two each of medical and surgical units, of Asan Medical Center were chosen and surveillance for nosocomial infections was performed with the total surveillance method for the 6-month period from July to December of 1995 by an infection control nurse. Proportion of the nosocomial infections that would have been detected by culture results alone was identified to determine the sensitivity of the laboratory-based surveillance method. RESULTS: A total of 164 cases of nosocomial infections were identified by the total surveillance method. Of these, 119 (72.6%) cases would have been detected by the laboratory-based surveillance method alone. Sensitivities were 100% in urinary tract infection and bacteremia, and 44.7%, 52.6% and 54.8% in lower respiratory tract, surgical site and other site infections, respectively. The 45 cases of infections that would have been undetected by microbiology data alone included 30 cases with culture negatives and 15 cases in which cultures were not submitted. CONCLUSIONS: The laboratory-based surveillance revealed different sensitivities depending on the sites of infections and patient services. The method is efficient with an acceptable level of sensitivities, but infection control teams should be aware of its shortcoming by a periodic monitoring of its sensitivity in the detection of nosocomial infections at their own hospitals.
Bacteremia ; Chungcheongnam-do ; Cross Infection* ; Humans ; Infection Control ; Nursing ; Respiratory System ; Urinary Tract Infections

BACKGROUND: This study was purposed to identify the knowledge and performance level of the infection control guidelines and to improve their performance level of infection control for those nurses who care patients directly. METHODS: This study was based on the survey questionnaires about infection control guidelines with the total 626 nurses in Seoul and Kyunggi areas for the period between May 26, 2003 and July 14, 2003. RESULTS: The average knowledge level of infection control was 0.84 +/-0.07 (score range 0-1) and the average performance level of the infection control was 4.44+/-10.27 (score range 0-5). The correlation between knowledge and performance of the infection control showed positive correlation (r=.39; P<.001). The knowledge and performance level of the 'Prevention of the central catheter infection' were higher than other infection control guidelines. The performance levels of the 'Prevention of the surgical site infection' were lower than other infection control guidelines. The correlation between knowledge and performance of the 'Prevention of the nosocomial pneumonia' (r=.389; P<.001). 'Prevention of the urinary tract infection' (r=.325; P<.001), 'Prevention of the central catheter infection (r=.290; P<.001) and 'Intravascular infection control' (r=.446; P<.001) showed positive correlation. CONCLUSION: The study demonstrated that the nurses' knowledge and performance of infection control guidelines showed positive correlation. So the education on the infection control is required indispensably and it would contribute to reduce the hospital infection rate by performing the right treatment on the infection control with the basis of accurate knowledge.
Catheters ; Cross Infection ; Education ; Gyeonggi-do ; Humans ; Infection Control* ; Seoul ; Urinary Tract ; Surveys and Questionnaires

BACKGROUND: We present here the annual data of the intensive care unit (ICU) module of the Korean Nosocomial Infections Surveillance System (KONIS) from July 2010 through June 2011. METHODS: We performed a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 130 ICUs in 72 hospitals using KONIS. Nosocomial infection (NI) rates were calculated as the number of infections per 1,000 patient-days or device-days. RESULTS: A total of 3,757 NIs were found: 1,978 UTIs (1,949 cases were urinary catheter-associated), 1,092 BSIs (with 932 being central line-associated), and 687 PNEUs (410 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 3.87 cases per 1,000 device-days (95% confidence interval, 3.70-4.05), and the urinary catheter utilization ratio was 0.86 (0.859-0.861). The rate of central line-associated BSIs was 3.01 per 1,000 device-days (2.82-3.21), and the utilization ratio was 0.53 (0.529-0.531). The rate of ventilator-associated PNEUs (VAPs) was 1.75 per 1,000 device-days (1.59-1.93), and the utilization ratio was 0.40 (0.399-0.401). Although both the ventilator utilization ratiosand the urinary catheter utilization ratios were lower in hospitals with 400-699 beds than thosein hospitals with 700-899 beds ormore than 900 beds, the rates of VAPsand CAUTIs were higher in hospitals with 400-699 beds than thosein hospitals with 700-899 beds or more than 900 beds. CONCLUSION: The risk of acquiring VAP and CAUTI is higher in the ICUs of 400-699 bed hospitals than in ICUs oflarger hospitals. Therefore, ongoing targeted surveillance and implementation of proven infection control strategies are needed especially for hospitals having fewer than 700 beds.
Benzamides ; Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

BACKGROUND: This is the first annual data on the surveillance of intensive care unit (ICU) module by the Korean Nosocomial Infections Surveillance System (KONIS) from July 2007 through June 2008. METHODS: The KONIS performed a prospective surveillance for nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 96 ICUs in 56 hospitals. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days. RESULTS: A total of 2,637 NIs were found during the study period; 1,391 UTIs (1,365 cases were urinary catheter-associated), 667 BSIs (563 were central line-associated), and 579 PNEUs (357 were ventilator-associated). The rate of urinary catheter-associated UTIs was 4.43 cases per 1,000 device-days (95% confidence interval, 4.20-4.67) and urinary catheter utilization ratio was 0.84 (0.839-0.841). The rate of central line-associated BSIs was 2.83 (2.61-3.07) and the utilization ratio was 0.54 (0.538-0.542). The rate of ventilator-associated PNEUs was 2.49 (2.25-2.76) and the utilization ratio was 0.39 (0.388-0.392). Although the ventilator utilization ratios were lower in the hospitals with less than 900 beds than in the hospitals with more than 900 beds, the rates of ventilator-associated PNEUs were higher in the smaller hospitals than in the larger ones. CONCLUSION: This result suggests that ongoing targeted surveillance and implementation of proven infection control strategies are needed.
Cross Infection ; Infection Control ; Critical Care ; Intensive Care Units ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections ; Ventilators, Mechanical

BACKGROUND: The Korean Society for Nosocomial Infection Control (KOSNIC) ran a surveillance system, called as Korean Nosocomial Infections Surveillance (KONIS), since July 2006. Here, we report the annual data of the intensive care unit (ICU) module of the system from July 2012 through June 2013. METHODS: This is a prospective surveillance of nosocomial urinary tract infections (UTI), bloodstream infections (BSI), and pneumonia (PNEU) at 161 ICUs in 91 hospitals using the KONIS system. The nosocomial infection (NI) rate was calculated as the number of infections per 1,000 patient days or device days. RESULTS: A total of 3,042 NIs were reported during the study period: 877 UTIs (854 cases were urinary catheter-associated), 1,272 BSIs (1,096 were central line-associated), and 893 PNEUs (526 cases were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTIs) was 1.26 cases per 1,000 device days (95% confidence interval; 1.18-1.34) and urinary catheter utilization ratio was 0.78 (0.779-0.781). The rate of central line-associated BSIs was 2.57 (2.42-2.72) and the utilization ratio was 0.49 (0.489-0.491). The rate of ventilator-associated PNEUs was 1.64 (1.50-1.78) and the utilization ratio was 0.37 (0.369-0.371). The urinary catheter utilization ratio was lower in the ICUs of hospitals with 400-699 beds than in those of hospitals with more than 900 beds; nevertheless, CAUTIs were more common in the hospitals with 400-699 beds. The central line-associated BSI (CLABSI) rate was lower in the study period than in the previous period of July 2011-June 2012 [2.57 (2.42-2.72) vs. 3.01 (2.84-3.19)]. CONCLUSION: The CLABSI rates were lower in the study period than those in the previous years. CAUTIs were more common in the ICUs of hospitals with 400-699 beds than in those of larger hospitals.
Cross Infection* ; Humans ; Intensive Care Units* ; Critical Care* ; Pneumonia ; Prospective Studies ; Urinary Catheters ; Urinary Tract Infections

PURPOSE: We developed a norfloxacin hydrogel coated urethral catheters, and evaluated its efficacy in a rabbit model. Our goal was to create a catheter that would prevent the development of catheter associated nosocomial urinary tract infections. MATERIALS AND METHODS: We inserted either an untreated, a polyurethane hydrogel coated or a polyurethane hydrogel with norfloxacin coated 8Fr Foley, catheter into the bladders of New Zealand White rabbits. Urine cultures were examined daily for 7 days. Scanning electron microscopy of the catheter surface was performed to structurally analyze the biofilm. RESULTS: There was a significant improvement (p=0.002) in the average time to a positive urine culture, from 3.1 to 5.7 days, and the rate of bacteriuria of the norfloxacin coated catheters was 70% lower than that of the untreated catheters. Scanning electron microscopy showed the formation of a bacterial biofilm on the surface of the untreated catheters, but deterioration of the biofilm was visible throughout the norfloxacin hydrogel coated catheters. CONCLUSIONS: A significant benefit was realized by coating the catheter surface with a norfloxacin impregnated hydrogel. This in vivo study suggests that this procedure may provide a significant clinical advantage, and reduce health care costs, for nosocomial infections.
Bacteriuria ; Biofilms ; Catheters* ; Cross Infection ; Health Care Costs ; Hydrogel* ; Microscopy, Electron, Scanning ; Norfloxacin* ; Polyurethanes ; Rabbits ; Urinary Bladder ; Urinary Catheterization ; Urinary Catheters* ; Urinary Tract Infections* ; Urinary Tract*