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How Outbreaks Can Contribute to Prevention of Nosocomial Infection: Analysis of 1,022 Outbreaks

  • Petra Gastmeier (a1), Sabine Stamm-Balderjahn (a2), Sonja Hansen (a2), Frauke Nitzschke-Tiemann (a2), Irina Zuschneid (a2), Katrin Groneberg (a2) and Henning Rüden (a2)...

To describe the epidemiology of nosocomial outbreaks published in the scientific literature.


Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002.


Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied.


Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period).


Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.

Corresponding author
Institut für Medizinische Mikrobiologie und Krankenhaushygiene, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover,
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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

. . ;:–.2.National Nosocomial Infections Surveillance (NNIS) SystemNational Nosocomial Infections Surveillance (NNIS) System report: data summary from January 1992 to June 2002, issued August 2002 Am J Infect Control 2002 30 458475

, , , . ;:–.4. P Gastmeier G Kampf N Wischnewski et al.Prevalence of nosocomial infections in representatively selected German hospitals J Hosp Infect 1998 38 3749

, . . ;:–.5. C Richards W Jarvis Lessons from recent nosocomial epidemics Curr Opin Infect Dis 1999 12 327334

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Infection Control & Hospital Epidemiology
  • ISSN: 0899-823X
  • EISSN: 1559-6834
  • URL: /core/journals/infection-control-and-hospital-epidemiology
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