PubMed · 9767013
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T Ronchetti. Cleaning up our practice.. https://pubmed.ncbi.nlm.nih.gov/9767013/
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The authors argue that accidental patient deaths are a significant public health concern and that public health professionals are well positioned to contribute to ongoing efforts to protect the public from unintended injuries in the hospital.
Prevalence surveys have been part of the Danish infection control programme since 1974. Nationwide surveys were carried out in 1978, 1979, 1980, 1991 and 1999. The results indicate a net reduction of approximately 25%, mainly due to a reduction of urinary tract infections (UTIs) in medical patients. Results from the nationwide surveys are validated by results of occasional independent surveys performed in regions or single hospitals. The reduction coincides with preventive programmes focused on catheter policy and UTI. We conclude that the prevalence survey is an important part of our strategic programme for infection control in hospitals.
Seven patients developed Pseudomonas aeruginosa urinary tract infections following urodynamic studies, over a two-month period. One patient developed septicaemia and meningitis and died following rupture of a berry aneurysm. Two others required hospital admission for intravenous antibiotic treatment. Pseudomonas aeruginosa was isolated from a pressure dome which covered the pressure transducer of the urodynamic system used for assessing bladder pressure. The device packaging carried the symbol designating this as a 'single use' product, but as an economy measure, a local decision had been taken to change the device monthly.