[Nosocomial infections in head and neck surgery. 2. A prospective study]

Nosocomial infections are defined as infections that occur during hospitalization but were not present at admission. Nosocomial infections have been found to occur in 6% of all hospitalizations and are present mainly in intensive care units and surgical wards. These infections extend the time of hospitalization and therefore increase the cost of care. Between July and December 1993, all nosocomial infections occurring in 304 patients of the surgical ward of the University ENT Department, Cologne, were recorded prospectively. These were classified into wound, implant, urinary tract, respiratory, skin or mucosal infections, nosocomial bacteremias and gastrointestinal infections. The overall prevalence of nosocomial infections was 15.4%. Of these, 9.2% were postoperative wound infections, 2.6% respiratory infections, and 2.3% infections of the skin and mucosa. The incidence of urinary tract infections was 0.7%, while bacteremias occurred in 0.3%. No implant or gastrointestinal infections occurred. Microbial analysis demonstrated 9 gram-positive and 15 gram-negative bacterial and 8 candidal infections. Nineteen cultures were negative. Among the bacteria cultured three were methicillin-resistant. The time of hospitalization was extended from a normal average of 9.52 days to 25.7 days. The distinct risk of a nosocomial infection in the treatment of hospitalized patients requires and accurate documentation of all acquired infections. Determination of the source of infection, the method of spread and microbial analysis including the spectrum of organism resistance is necessary in order to decrease the infection rate and to prevent establishment of a nosocomial infection. These requirements at the least are an important part of quality control in the surgical disciplines.