Infection control practices in intensive care units of 14 European countries

Objective: To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). Design: European descriptive survey by questionnaire mailed to all the directors of ICUs. Patients and participants: A total of 1642 general ICUs with more than three beds in 14 countries were contacted: 1005 units participated in the study (overall response rate of 61.2%). Measurements and results: Data on the general characteristics of the hospital and of the ICU, surveillance activities, and patient-care practices relevant to the control of HAIs were collected. Compliance varied significantly by the type of practice evaluated. Comprehensive programs adopting all the recommended preventive practices for specific infections were maintained in a very low proportion of units, ranging from 18% for antibiotic policy to 39% for urinary tract infections. Moreover, 14% of the units claimed to adopt three or more practices that are clearly unsafe, and only 35% of the units claimed not to adopt any risky practice. The presence of an infection control nurse was significantly associated with a lower frequency of substandard care. A great variability was observed by country in the adoption of 29 patient-care practices, mostly for practices for which clear-cut guidelines are lacking. Conclusion: Interpretation of data is made difficult by the lack of consensus among experts with respect to some of the practices investigated. Nevertheless, the implementation of standard practices for preventing HAIs is far from satisfactory in the hospitals surveyed, even in a high priority hospital area such as intensive care. Documented European guidelines could be worthwhile in increasing awareness of the ICU staff. The availability of at least one infection control nurse in each hospital should be strongly advocated.