ObjectiveTo monitor occurrence trends and identify clusters of nosocomial infection (NI) using statistical process control (SPC) charts. MethodsBetween January 1998 and December 2000 nosocomial infection occurrence was evaluated in a cohort of 460 patients admitted to the Pediatric Intensive Care Unit of a university hospital, according to the concepts and criteria proposed by the National Nosocomial Infection Surveillance System of the Centers for Disease Control, in the United States. Graphs were plotted using Poisson statistical distribution, including three horizontal lines: center line (CL), upper warning limit (UWL) and upper control limit (UCL). CL was the arithmetic mean NI rate calculated for the studied period; UWL and Rev Saúde Pública 2003; 37(6) Endemic nosocomial infection graphs www.fsp.usp.br/rsp Arantes A et al UCL were drawn at 2 and 3 standard deviations above average NI rates, respectively. Clusters were identified when NI rates remained above UCL. ResultsMean NI incidence was 20 per 1,000 patient days. One urinary tract infection cluster was identified in July 2000, with an infection rate of 63 per 1,000 patient days, exceeding UCL and characterizing a period of epidemic. ConclusionsThe use of SPC charts for controlling endemic levels of NI, through both global and site-specific evaluation, allowed for the identification of uncommon variations in NI rates, such as outbreaks and epidemics, and for their distinction from the natural variations observed in NI occurrence rates, without the need for calculations and hypothesis testing.

We studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.

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In order to assess the level of knowledge of screening for carcinoma of the cervix among women presenting with this condition, a survey of a consecutive series of patients was undertaken. AH 266 patients presenting at this hospital during 1988 for the treatment of carcinoma of the cervix completed a structured questionnaire about cervical câncer screening. A percentage of 68.8% patients had never been screened. Those patients who had not previously had a cervical smear test were more likely to be in the older age groups (over 45 years) and to come from low income groups with poor educatlon and poor access to medicai facilities. Even among patients who had previousiy had contacts with the medicai profession, only a minority (approximately 40%) had undergone cervical screening at any time. Since carcinoma of the cervix is currently the commonest malignant neoplasm in women in Brazil, it is evident that an urgent campaign is necessary to educate both the public and the medical profession in cervical screening, hopefully to reduce the very high rate of Invasive carcinoma of the cervix in this country.