lOS Press Safety and risk in practice

Nosocomial bloodstream infections represent a most important threat to patients admitted to hospital. It is believed that in the USA every year 62,500 hospitalized patients die of septicemia. Despite efforts for decades to prevent hospital-acquired infections the situation has not improved; indeed, both the overall incidence and the population-attributable risk of death among patients with nosocomial bloodstream infections has actually increased progressively during the last decade. This is the alarming conclusion of a 12-year retrospective study performed at the University of Iowa Hospitals and Clinics (Iowa City, USA). In the University's main 902-bed hospital (with 213 beds reserved for all kind of critical care patients) a nosocomial infection surveillance programme has existed since 1976. The study covers all the 260,834 patients (representing 2.4 million days of care) admitted to the hospital between 1980 and 1992. A total of 3464 nosocomial bloodstream infections 0.3%) were identified in 3077 patients (1.1 %). A subdivision was made into primary bloodstream infections with an extracorporeal source and secondary bloodstream infections, caused by a diagnosed nosocomial infection at another site in the body (pneumonia, urinary tract infection). The overall bloodstream infection rate increased from 0.7 % in 1981 to 1.8 % in 1992, with