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Ecological effects of selective oral decontamination on multidrug-resistance bacteria acquired in the intensive care unit: a case-control study over 5 years. Intensive Care Med 2022; 48:1165-1175. [PMID: 35953676 PMCID: PMC9463265 DOI: 10.1007/s00134-022-06826-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 07/12/2022] [Indexed: 11/17/2022]
Abstract
Purpose This case–control study investigated the long-term evolution of multidrug-resistant bacteria (MDRB) over a 5-year period associated with the use of selective oropharyngeal decontamination (SOD) in the intensive care unit (ICU). In addition, effects on health care-associated infections and ICU mortality were analysed. Methods We investigated patients undergoing mechanical ventilation > 48 h in 11 adult ICUs located at 3 campuses of a university hospital. Administrative, clinical, and microbiological data which were routinely recorded electronically served as the basis. We analysed differences in the rates and incidence densities (ID, cases per 1000 patient-days) of MDRB associated with SOD use in all patients and stratified by patient origin (outpatient or inpatient). After propensity score matching, health-care infections and ICU mortality were compared. Results 5034 patients were eligible for the study. 1694 patients were not given SOD. There were no differences in the incidence density of MDRB when SOD was used, except for more vancomycin-resistant Enterococcus faecium (0.72/1000 days vs. 0.31/1000 days, p < 0.01), and fewer ESBL-producing Klebsiella pneumoniae (0.22/1000 days vs. 0.56/1000 days, p < 0.01). After propensity score matching, SOD was associated with lower incidence rates of ventilator-associated pneumonia and death in the ICU but not with ICU-acquired bacteremia or urinary tract infection. Conclusions Comparisons of the ICU-acquired MDRB over a 5-year period revealed no differences in incidence density, except for lower rate of ESBL-producing Klebsiella pneumoniae and higher rate of vancomycin-resistant Enterococcus faecium with SOD. Incidence rates of ventilator-associated pneumonia and death in the ICU were lower in patients receiving SOD. Supplementary Information The online version contains supplementary material available at 10.1007/s00134-022-06826-7.
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Hachenberg J, Acis E, Auer-Schmidt MM, Warm M, Malter W, Thangarajah F, Eichler C. Preoperative Octenidine Application in Breast Reconstruction Surgery. In Vivo 2021; 35:549-554. [PMID: 33402508 DOI: 10.21873/invivo.12290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/21/2020] [Accepted: 11/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Postoperative infection in implant-based reconstructive breast surgery is a common problem. The preoperative application of a disinfecting washing agent may reduce postoperative infection rates. This retrospective analysis aimed to evaluate whether preoperative Octenisan® application yields a reduction in postoperative complications or infection rates in breast reconstructive surgery. PATIENTS AND METHODS Between 2016 and 2019, 127 women received implant-based breast reconstruction at the municipal hospital of Cologne, Holweide, Germany. A total of 197 treatments were performed. After giving consent, patients were asked to use Octenisan® wash lotion for five days before breast reconstructive surgery. All patients were asked by a simple questionnaire whether they performed showering and washing according to the proposed protocol. In 96 cases patients did adhere to the protocol. In 101 cases they did not. Patient cohorts were then divided into patients who had applied Octenisan® wash lotion and patients who had not. Endpoints were defined as minor complications with no implant loss and major complications with consecutive implant loss. RESULTS Patient adherence to the application regimen was 48.7%. Overall minor complications occurred in 34.4% with preoperative Octenidine usage and 36.6% without preoperative Octenidine usage. Major complications happened in 7% with preoperative Octenidine and 5% without Octenidine. Overall, there was no significant difference concerning minor or major complication rates. CONCLUSION Preoperative washing protocols involving the Octenisan® wash lotion is relatively cheap and easy to follow. There is evidence that washing protocols result in a reduction of S. aureus infections leading to a better perioperative outcome. Octenisan® is safe to use in implant-based breast reconstructive surgery and is not associated with higher risks for patients. Our study did not yield any significant reduction in perioperative and postoperative complication and infection rates. This is attributed to a relatively low study population. Wash lotion compliance was only 48.7%. Proper patient education is crucial. With those preliminary data, it is now possible to design a larger analysis since patient adherence to washing protocol with Octenisan® wash lotion has been established.
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Affiliation(s)
- Jens Hachenberg
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany;
| | - Ellen Acis
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | | | - Mathias Warm
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany
| | - Wolfram Malter
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Faculty of Medicine and University Hospital Cologne, The University of Cologne, Cologne, Germany
| | - Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany
| | - Christian Eichler
- Department of Gynecology and Obstetrics, University of Cologne, Cologne, Germany.,Department of Gynecology and Obstetrics, Frauenklinik Holweide, Kliniken der Stadt Köln, Cologne, Germany.,German Center for Material Science in Gynecology and Senology (DZMGS), Cologne, Germany
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3
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Wandhoff B, Schröder C, Nöth U, Krause R, Schmidt B, David S, Scheller EE, Jahn F, Behnke M, Gastmeier P, Kramer TS. Efficacy of universal preoperative decolonization with Polyhexanide in primary joint arthroplasty on surgical site infections. A multicenter before-and after-study. Antimicrob Resist Infect Control 2020; 9:188. [PMID: 33256845 PMCID: PMC7708093 DOI: 10.1186/s13756-020-00852-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Surgical site infections (SSI) are rare but severe complications after total joint arthroplasty (TJA). Decolonization measures prior to elective orthopedic surgeries have shown to reduce the risk of SSI with Staphylococcus aureus (S. aureus). Objective To determine the efficacy of universal decolonization with Polyhexanide on SSI rates with a focus on Staphylococcus aureus in patients with TJA. Methods Patients scheduled for elective hip or knee TJA in 5 participating certified orthopedic centers were included between 2015 and 2018 into this before and after study. Data on patients, surgeries and infections were prospectively collected. CDC-criteria were used to define and categorize Infections within 90 days after surgery. From January 2017 on, patients received decolonization sets containing Polyhexanide. Patients performed a 5 day decolonization regimen starting 4 days prior to surgery which included wipes, nasal decontamination and oral solution. Results Thirteen thousand, three hundred fifteen patients received TJA. During intervention 4437 decolonization sets were distributed among 7175 patients. Overall SSI rates increased from 0.68 /100 surgeries to 0.91/ 100 surgeries after implementation of the intervention (IRR 1.32; 95% CI 0.90–1.96). Time series analysis identified an increasing trend of SSI prior to the intervention. After implementation overall SSI rates plateaued. Regression analysis revealed surgery during intervention period to be an independent risk factor for developing a SSI (OR 1.34; 95%CI 1.18–1.53). Initial SSI rates due to S. aureus were 0.24/100 surgeries and decreased to 0.14/100 surgeries (IRR 0.57; 95% CI 0.25–1.22) after introduction of decolonization. Regression analysis revealed surgery during intervention period to be an independent protective factor for developing a SSI with S. aureus (OR 0.57, 95% CI: 0.33–0.99). Overall deep S. aureus SSI decreased significantly from 0.22/100 surgeries to 0.00/100 surgeries in patients adherent to protocol (IRR 0.00, 95% CI 0.00–.85). Conclusion Universal decolonization with Polyhexanide did not reduce overall surgical site infections, but was effective in reducing Staphylococcus aureus - surgical site infections following elective joint arthroplasty. Polyhexanide could extend the list of alternatives to already established decolonization strategies. Trial registration The trial was registered at the German Registry for clinical studies www.drks.de (DRKS00011505).
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Affiliation(s)
- Björn Wandhoff
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany.,Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße, 555, Berlin, Germany
| | - Christin Schröder
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Ulrich Nöth
- LADR MVZ GmbH Neuruppin, Zur Mesche 20, 16816, Neuruppin, Germany
| | - Robert Krause
- Oberlinklinik-Orthopädische Fachklinik, Rudolf-Breitscheid-Straße 24, 14482, Potsdam, Germany
| | - Burkhard Schmidt
- Oberlinklinik-Orthopädische Fachklinik, Rudolf-Breitscheid-Straße 24, 14482, Potsdam, Germany
| | - Stephan David
- Evangelisches Krankenhaus Paul Gerhardt Stift, Paul-Gerhardt-Straße 42-45, 06886, Lutherstadt Wittenberg, Germany
| | - Eike-Eric Scheller
- Evangelisches Krankenhaus Hubertus, Spanische Allee 10-14, 14129, Berlin, Germany
| | - Friedrich Jahn
- Evangelische Elisabeth Klinik, Lützowstraße 26, 10785, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Tobias Siegfried Kramer
- Institute of Hygiene and Environmental Medicine, Charité-Universitätsmedizin Berlin, Hindenburgdamm 27, 12203, Berlin, Germany. .,National Reference Center for Surveillance of Nosocomial Infections, Hindenburgdamm 27, 12203, Berlin, Germany. .,Evangelisches Waldkrankenhaus Spandau, Stadtrandstraße, 555, Berlin, Germany. .,LADR MVZ GmbH Neuruppin, Zur Mesche 20, 16816, Neuruppin, Germany.
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Hardtstock F, Heinrich K, Wilke T, Mueller S, Yu H. Burden of Staphylococcus aureus infections after orthopedic surgery in Germany. BMC Infect Dis 2020; 20:233. [PMID: 32192436 PMCID: PMC7082972 DOI: 10.1186/s12879-020-04953-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 03/09/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This study assessed incidence, risk factors, and outcomes of Staphylococcus aureus infections (SAI) following endoprosthetic hip or knee, or spine surgeries. METHODS Adult patients with at least one of the selected surgeries from 2012 to 2015 captured in a German sickness fund database were included. SAI were identified using S. aureus-specific ICD-10 codes. Patients with certain prior surgeries and infections were excluded. Cumulative incidence and incidence density of post-surgical SAI were assessed. Risk factors, mortality, healthcare resource utilization and direct costs were compared between SAI and non-SAI groups using multivariable analyses over the 1 year follow-up. RESULTS Overall, 74,327 patients who underwent a knee (28.6%), hip (39.6%), or spine surgery (31.8%) were included. The majority were female (61.58%), with a mean age of 69.59 years and a mean Charlson Comorbidity Index (CCI) of 2.3. Overall, 1.92% of observed patients (20.20 SAI per 1000 person-years (PY)) experienced a SAI within 1 year of index hospitalization. Knee surgeries were associated with lower SAI risk compared with hip surgeries (Hazard Ratio (HR) = 0.8; p = 0.024), whereas spine surgeries did not differ significantly from hip surgeries. Compared with non-SAI group, the SAI group had on average 4.4 times the number of hospitalizations (3.1 vs. 0.7) and 7.7 times the number of hospital days (53.5 vs. 6.9) excluding the index hospitalization (p < 0.001). One year post-orthopedic mortality was 22.38% in the SAI and 5.31% in the non-SAI group (p < 0.001). The total medical costs were significantly higher in the SAI group compared to non-SAI group (42,834€ vs. 13,781€; p < 0.001). Adjusting for confounders, the SAI group had nearly 2 times the all-cause direct healthcare costs (exp(b) = 1.9; p < 0.001); and 1.72 times higher risk of death (HR = 1.72; p < 0.001). CONCLUSIONS SAI risk after orthopedic surgeries persists and is associated with significant economic burden and risk of mortality. Hence, risk reduction and prevention methods are of utmost importance.
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Affiliation(s)
| | | | | | | | - Holly Yu
- Pfizer, Inc., Collegeville, PA, USA
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5
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von Lengerke T, Ebadi E, Schock B, Krauth C, Lange K, Stahmeyer JT, Chaberny IF. Impact of psychologically tailored hand hygiene interventions on nosocomial infections with multidrug-resistant organisms: results of the cluster-randomized controlled trial PSYGIENE. Antimicrob Resist Infect Control 2019; 8:56. [PMID: 30962918 PMCID: PMC6434638 DOI: 10.1186/s13756-019-0507-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 03/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background Professional hand hygiene compliance represents a multifaceted behaviour with various determinants. Thus, it has been proposed to apply psychological frameworks of behaviour change to its promotion. However, randomized controlled trials of such approaches, which also assess nosocomial infections (NIs), are rare. This study analyses data of the PSYGIENE-trial (PSYchological optimized hand hyGIENE promotion), which has shown improvements in compliance after interventions tailored based on the Health Action Process Approach (HAPA), on rates of NIs with multidrug-resistant organisms (MDROs). Methods A parallel-group cluster-randomized controlled trial was conducted on all 10 intensive care units and two hematopoietic stem cell transplantation units at Hannover Medical School, a German tertiary care hospital. Educational training sessions for physicians and nurses (individual-level intervention) and feedback discussions with clinical managers and head nurses (cluster-level) were implemented in 2013. In the “Tailoring”-arm (n = 6 wards), interventions were tailored based on HAPA-components, which were empirically assessed and addressed by behaviour change techniques. As active controls, n = 6 wards received untailored educational sessions of the local “Clean Care is Safer Care”-campaign (Aktion Saubere Hände: “ASH”-arm). From 2013 to 2015 compliance was assessed by observation following the World Health Organization, while alcohol-based hand rub usage (AHRU) and NIs with multidrug-resistant gram-negative bacteria, Methicillin-resistant Staphylococcus aureus or Vancomycin-resistant Enterococcus were assessed following national surveillance protocols. Data were analysed at cluster-level. Results In the “Tailoring”-arm, interventions led to a decrease of 0.497 MDRO-infections per 1000 inpatient days from 2013 to 2015 (p = 0.015). This trend was not found in the “ASH”-arm (− 0 . 022 infections; p = 0.899). These patterns corresponded inversely to the trends in compliance but not in AHRU. Conclusions While interventions tailored based on the HAPA-model did not lead to a significantly lower incidence rate of MDRO-infections compared to control wards, a significant reduction, compared to baseline, was found in the second follow-up year in the “Tailoring”- but not the "ASH"-arm. This indicates that HAPA-tailored hand hygiene interventions may contribute to the prevention of NIs with MDRO. Further research should focus on addressing compliance by interventions tailored not only to wards, but also leaders, teams, and individuals. Trial registration German Clinical Trials Register/International Clinical Trials Registry Platform, DRKS00010960. Registered 19 August 2016-Retrospectively registered, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00010960. http://apps.who.int/trialsearch/Trial2.aspx?TrialID=DRKS00010960. Electronic supplementary material The online version of this article (10.1186/s13756-019-0507-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Thomas von Lengerke
- Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, 30625 Hannover, Germany
| | - Ella Ebadi
- 2Hannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Carl-Neuberg-Str. 1, OE 5214, 30625 Hannover, Germany
| | - Bettina Schock
- Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, 30625 Hannover, Germany.,Leipzig University Hospital - AöR, Department for Diagnostics, Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Johannisallee 34, 04103 Leipzig, Germany
| | - Christian Krauth
- 4Hannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, OE 5410, 30625 Hannover, Germany
| | - Karin Lange
- Hannover Medical School, Centre for Public Health and Healthcare, Department of Medical Psychology, Carl-Neuberg-Str. 1, OE 5430, 30625 Hannover, Germany
| | - Jona T Stahmeyer
- 4Hannover Medical School, Centre for Public Health and Healthcare, Institute of Epidemiology, Social Medicine and Health Systems Research, Carl-Neuberg-Str. 1, OE 5410, 30625 Hannover, Germany
| | - Iris F Chaberny
- 2Hannover Medical School, Centre for Laboratory Medicine, Institute of Medical Microbiology and Hospital Epidemiology, Carl-Neuberg-Str. 1, OE 5214, 30625 Hannover, Germany.,Leipzig University Hospital - AöR, Department for Diagnostics, Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Johannisallee 34, 04103 Leipzig, Germany
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Bourigault C, Birgand G, Lakhal K, Bretonnière C. Quelle surveillance des infections associées aux soins en réanimation en 2018 ? MEDECINE INTENSIVE REANIMATION 2018. [DOI: 10.3166/rea-2018-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
La surveillance des infections associées aux soins (IAS) est prioritaire en réanimation, secteur à haut risque du fait de l’état critique des patients et de leur exposition aux dispositifs invasifs. Elle présente un triple objectif : décrire l’épidémiologie et l’incidence des IAS ; évaluer l’impact des actions de prévention ou de contrôle et alerter face à une épidémie ou des phénomènes émergents. Cette surveillance des IAS peut être réalisée selon une méthodologie interne, définie par l’établissement, ou intégrée à un réseau de surveillance. L’intérêt de la surveillance pour la prévention des IAS en réanimation n’est plus à démontrer, mais la surveillance manuelle reste chronophage pour les cliniciens et les équipes d’hygiène, limitant ainsi le temps dédié à la prévention de ces infections. La surveillance automatisée apparaît aujourd’hui comme un outil intéressant, tant par ses performances que par le gain de temps qu’elle représente pour les équipes. Plusieurs éléments sont primordiaux pour obtenir des résultats fiables : la nécessité d’une harmonisation des définitions et des méthodes de surveillance ; la mise à disposition d’outils informatiques performants pour faciliter le suivi des patients ; le leadership des réanimateurs dans la surveillance. Cet article fait le point sur les méthodes de surveillance des IAS utilisées aujourd’hui en réanimation, l’intérêt de la mise en place de cette surveillance épidémiologique ainsi que la fiabilité des données recueillies et, enfin, les avantages du développement d’une surveillance semi-automatisée ou automatisée des IAS dans ce secteur.
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Dettenkofer M, Frank U, Just HM, Lemmen S, Scherrer M. Epidemiologische Grundlagen nosokomialer Infektionen. PRAKTISCHE KRANKENHAUSHYGIENE UND UMWELTSCHUTZ 2018. [PMCID: PMC7123496 DOI: 10.1007/978-3-642-40600-3_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Viele Faktoren tragen zu erhöhten nosokomialen Infektionsraten bei. Der Anteil alter Patienten mit chronischen Krankheiten und Immunsupprimierter steigt. Fortschritte in Diagnostik und Therapie resultieren immer häufiger in invasiven Eingriffen. Antibiotikaresistenzen und Folgen nosokomialer Infektionen erfordern daher eine verlässliche Epidemiologie. Konsequenzen nosokomialer Infektionen betreffen einerseits Patienten (Morbidität und Letalität), aber auch das Gesundheitswesen, dem zusätzliche, teilweise vermeidbare finanzielle Belastungen entstehen.
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Affiliation(s)
- Markus Dettenkofer
- Gesundheitsverbund Landkreis Konstanz, Institut für Krankenhaushygiene & Infektionsprävention, Radolfzell, Germany
| | - Uwe Frank
- Sektion Krankenhaus- und Umwelthygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | | | - Sebastian Lemmen
- Zentralbereich für Krankenhaushygiene, Universitätsklinikum Aachen, Aachen, Germany
| | - Martin Scherrer
- Stabsstelle Techn. Krankenhaushygiene, Universitätsklinikum Heidelberg, Heidelberg, Germany
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Kumpf O, Braun JP, Brinkmann A, Bause H, Bellgardt M, Bloos F, Dubb R, Greim C, Kaltwasser A, Marx G, Riessen R, Spies C, Weimann J, Wöbker G, Muhl E, Waydhas C. Quality indicators in intensive care medicine for Germany - third edition 2017. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2017; 15:Doc10. [PMID: 28794694 PMCID: PMC5541336 DOI: 10.3205/000251] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Indexed: 12/29/2022]
Abstract
Quality improvement in medicine is depending on measurement of relevant quality indicators. The quality indicators for intensive care medicine of the German Interdisciplinary Society of Intensive Care Medicine (DIVI) from the year 2013 underwent a scheduled evaluation after three years. There were major changes in several indicators but also some indicators were changed only minimally. The focus on treatment processes like ward rounds, management of analgesia and sedation, mechanical ventilation and weaning, as well as the number of 10 indicators were not changed. Most topics remained except for early mobilization which was introduced instead of hypothermia following resuscitation. Infection prevention was added as an outcome indicator. These quality indicators are used in the peer review in intensive care, a method endorsed by the DIVI. A validity period of three years is planned for the quality indicators.
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Affiliation(s)
- Oliver Kumpf
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jan-Peter Braun
- Department of Anesthesiology and Intensive Care Medicine, Martin-Luther Krankenhaus, Berlin, Germany
| | - Alexander Brinkmann
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Heidenheim, Germany
| | - Hanswerner Bause
- Department of Anaesthesiology and Intensive Care Medicine, Asklepiosklinikum Altona, Hamburg, Germany
| | - Martin Bellgardt
- Department of Anaesthesiology and Intensive Care Medicine, St. Josef-Hospital, Klinikum der Ruhr-Universität Bochum, Germany
| | - Frank Bloos
- Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Rolf Dubb
- Kreiskliniken Reutlingen, Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF), Germany
| | - Clemens Greim
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum Fulda, Germany
| | - Arnold Kaltwasser
- Kreiskliniken Reutlingen, Deutsche Gesellschaft für Fachkrankenpflege und Funktionsdienste (DGF), Germany
| | - Gernot Marx
- Department of Intensive Care Medicine, Universitätsklinikum RTWH Aachen, Germany
| | - Reimer Riessen
- Zentralbereich des Departments für Innere Medizin, Internistische Intensivmedizin, Universitätsklinikum Tübingen, Germany
| | - Claudia Spies
- Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jörg Weimann
- Department of Anesthesiology and Interdisciplinary Intensive Care Medicine, Sankt Gertrauden-Krankenhaus, Berlin, Germany
| | - Gabriele Wöbker
- Department of Intensive Care Medicine, Helios-Klinikum Wuppertal, Germany
| | - Elke Muhl
- Department of Surgery, Medical University of Schleswig Holstein, Kiel, Germany
| | - Christian Waydhas
- Department of Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany.,Medical Faculty of the University Duisburg-Essen, Germany
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:171-206. [DOI: 10.1007/s00103-016-2487-4] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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10
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Prävention von Infektionen, die von Gefäßkathetern ausgehen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2017; 60:216-230. [DOI: 10.1007/s00103-016-2485-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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Tacconelli E, Müller NF, Lemmen S, Mutters NT, Hagel S, Meyer E. Infection Risk in Sterile Operative Procedures. DEUTSCHES ARZTEBLATT INTERNATIONAL 2016; 113:271-8. [PMID: 27159141 PMCID: PMC4985522 DOI: 10.3238/arztebl.2016.0271] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 01/18/2016] [Accepted: 01/18/2016] [Indexed: 12/31/2022]
Abstract
BACKGROUND The main objective of hospital hygiene and infection prevention is to protect patients from preventable nosocomial infections. It was recently stated that the proper goal should be for zero infection rates in sterile surgical procedures. In this article, we attempt to determine whether this demand is supported by the available literature. METHODS We systematically searched the Medline and EMBASE databases for studies published in the last 10 years on the efficacy of infection control measures and carried out a meta-analysis according to the PRISMA tool. We used the following search terms: "aseptic surgery," "intervention," "surgical site infection," "nosocomial infection," "intervention," and "prevention." RESULTS 2277 articles were retrieved, of which 204 were acquired in full text and analyzed. The quantitative analysis included 7 prospective cohort studies on the reduction of nosocomial infection rates after aseptic surgery. The measures used included training sessions, antibiotic prophylaxis, and operative-site disinfection and cleaning techniques. These interventions succeeded in reducing postoperative wound infections (relative risk (RR] 0.99 [0.98; 1.00]). Subgroup analyses on antibiotic prophylaxis (RR 0.99 [0.98; 1.01]) and noncontrolled trials (RR 0.97 [0.92; 1.02]) revealed small, insignificant effects. CONCLUSION A multimodal approach with the participation of specialists from various disciplines can further reduce the rate of postoperative infection. A reduction to zero is not realistic and is not supported by available evidence.
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Affiliation(s)
- Evelina Tacconelli
- German Center for Infection Research (DZIF), Department of Internal Medicine I, Medical University Hospital Tübingen
| | - Niklas F. Müller
- Division of Gastroenterology and Rheumatology, Department of. Internal Medicine, Neurology and Dermatology, University Hospital of Leipzig
| | - Sebastian Lemmen
- Central Department of Hospital Hygiene and Infectiology, Aachen University Hospital
| | - Nico T. Mutters
- Heidelberg University Hospital, Department of Infectious Diseases, Medical Microbiology and Hygiene
| | - Stefan Hagel
- Center for Infectious Diseases and Infection Control, Jena University Hospital
| | - Elisabeth Meyer
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin
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12
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Verstraete EH, De Coen K, Vogelaers D, Blot S. Risk Factors for Health Care-Associated Sepsis in Critically Ill Neonates Stratified by Birth Weight. Pediatr Infect Dis J 2015; 34:1180-6. [PMID: 26244835 DOI: 10.1097/inf.0000000000000851] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Health care-associated bloodstream infection (HABSI) is a frequent complication in neonatal intensive care. Research on risk factors stratified by birth weight and adjusted for severity of illness and comorbidities is limited. Our objective is to describe independent risk factors for HABSI in critically ill neonates with emphasis on risk variation between birth weight groups. METHODS We performed a single-center historical cohort study in a tertiary referral center. A neonatal intensive care-audit system was used to identify eligible neonates admitted for ≥72 hours (2002-2011). HABSI is defined according to National Institute of Child Health and Human Development criteria. Risk factors for HABSI were assessed by univariate and logistic regression analysis for the total cohort and for birth weight subgroups, that is, neonates ≤1500 g and >1500 g. RESULTS A total of 342 neonates developed HABSI in 5134 admissions of ≥72 hours (6.7%). Very low birth weight, total parenteral nutrition (TPN), mechanical ventilation, gastrointestinal disease, surgery (cardiac and other type), and renal insufficiency are independent risk factors for the total cohort. Gastrointestinal disease and cardiac surgery are independent risk factors in both birth weight groups; mechanical ventilation (odds ratio [OR]: 2.6; confidence interval [CI]: 1.6-4.0) and other type of surgery (OR: 4.3; CI: 2.1-8.8) are solely independent risk factors in the ≤1500-g cohort; TPN is exclusively an independent risk factor (OR: 7.9; CI: 3.9-16.2) in the >1500-g cohort. CONCLUSIONS In our neonatal intensive care unit, risk stratification by birth weight revealed some difference. Special attention concerning infection control practices is for neonates receiving TPN, mechanical ventilation, cardiac surgery, and with a gastrointestinal disease.
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Affiliation(s)
- Evelien Hilde Verstraete
- From the *Department of Internal Medicine, Ghent University, Belgium; †Department of Neonatal Medicine, ‡Department of General Internal Medicine, Infectious Diseases and Psychosomatic Disorders, Ghent University Hospital, Belgium; and §Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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13
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Langelotz C, Mueller-Rau C, Terziyski S, Rau B, Krannich A, Gastmeier P, Geffers C. Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System. VISZERALMEDIZIN 2015; 30:114-7. [PMID: 26288585 PMCID: PMC4513817 DOI: 10.1159/000362100] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Background Surgical site infections (SSI) are among the most frequent healthcare-associated infections. They impose a substantial burden with increased morbidity and exceeding healthcare costs. Risk factors such as age, diabetes, and smoking status are commonly accounted for in the literature, but few studies address gender differences. Methods Data from the German Nosocomial Infections Surveillance System (Krankenhaus-Infektions-Surveillance-System (KISS)) from 2005 to 2010 were analysed for cardiac, vascular, visceral, and orthopaedic surgery, with a total of 438,050 surgical procedures and 8,639 SSI. Rates of SSI and isolated pathogens were analysed for gender. Results Women had a lower rate of SSI (SSI/100 procedures) in abdominal surgery than men (2.92 vs. 4.37; p < 0.001). No gender-specific differences were found in orthopaedic and vascular surgery, while women had a higher risk for SSI in cardiac surgery (5.50 vs. 3.02; p < 0.001). Isolated pathogens showed differences for sensitive Staphylococcus aureus and Pseudomonas aeruginosa, which were more frequent in women (both p = 0.007), while coagulase-negative staphylococci occurred more often in men (18.8 vs. 14.0%; p < 0.001). Conclusion Gender differences in SSI exist and are procedure-specific. The underlying mechanisms need to be further elucidated so that targeted measures for the prevention of SSI can be developed.
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Affiliation(s)
- Corinna Langelotz
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Carolin Mueller-Rau
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Stoil Terziyski
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Beate Rau
- Klinik für Allgemein-, Viszeral-, Gefäß- und Thoraxchirurgie, Charité - Universitätsmedizin Berlin, Campus Mitte, Berlin, Germany
| | - Alexander Krannich
- Abteilung Biostatistik, Koordinierungszentrum für Klinische Studien, Charité - Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
| | - Petra Gastmeier
- Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Berlin, Germany ; Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
| | - Christine Geffers
- Nationales Referenzzentrum für die Surveillance von nosokomialen Infektionen, Berlin, Germany ; Institut für Hygiene und Umweltmedizin, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany
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14
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Verstraete EH, Blot K, Mahieu L, Vogelaers D, Blot S. Prediction models for neonatal health care-associated sepsis: a meta-analysis. Pediatrics 2015; 135:e1002-14. [PMID: 25755236 DOI: 10.1542/peds.2014-3226] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/27/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Blood culture is the gold standard to diagnose bloodstream infection but is usually time-consuming. Prediction models aim to facilitate early preliminary diagnosis and treatment. We systematically reviewed prediction models for health care-associated bloodstream infection (HABSI) in neonates, identified superior models, and pooled clinical predictors. DATA SOURCES LibHub, PubMed, and Web of Science. METHODS The studies included designed prediction models for laboratory-confirmed HABSI or sepsis. The target population was a consecutive series of neonates with suspicion of sepsis hospitalized for ≥ 48 hours. Clinical predictors had to be recorded at time of or before culturing. Methodologic quality of the studies was assessed. Data extracted included population characteristics, total suspected and laboratory-confirmed episodes and definition, clinical parameter definitions and odds ratios, and diagnostic accuracy parameters. RESULTS The systematic search revealed 9 articles with 12 prediction models representing 1295 suspected and 434 laboratory-confirmed sepsis episodes. Models exhibit moderate-good methodologic quality, large pretest probability range, and insufficient diagnostic accuracy. Random effects meta-analysis showed that lethargy, pallor/mottling, total parenteral nutrition, lipid infusion, and postnatal corticosteroids were predictive for HABSI. Post hoc analysis with low-gestational-age neonates demonstrated that apnea/bradycardia, lethargy, pallor/mottling, and poor peripheral perfusion were predictive for HABSI. Limitations include clinical and statistical heterogeneity. CONCLUSIONS Prediction models should be considered as guidance rather than an absolute indicator because they all have limited diagnostic accuracy. Lethargy and pallor and/or mottling for all neonates as well as apnea and/or bradycardia and poor peripheral perfusion for very low birth weight neonates are the most powerful clinical signs. However, the clinical context of the neonate should always be considered.
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Affiliation(s)
| | - Koen Blot
- Ghent University, Belgium, Ghent, Belgium
| | - Ludo Mahieu
- University of Antwerp, Belgium, Antwerp, Belgium; Antwerp University Hospital, Antwerp, Belgium
| | - Dirk Vogelaers
- Ghent University, Belgium, Ghent, Belgium; Ghent University Hospital, Ghent, Belgium; and
| | - Stijn Blot
- Ghent University, Belgium, Ghent, Belgium; Burns, Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, Australia
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Habbe N, Hannes S, Liese J, Woeste G, Bechstein WO, Strey C. The use of purse-string skin closure in loop ileostomy reversals leads to lower wound infection rates--a single high-volume centre experience. Int J Colorectal Dis 2014; 29:709-14. [PMID: 24407267 DOI: 10.1007/s00384-013-1822-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/31/2013] [Indexed: 02/04/2023]
Abstract
PURPOSE Wound infections affect not only the individual patient but lead to an increase in medical costs. After ileostomy reversal, surgical site infections are a common problem. The objective of the study was to compare the infection rates of purse-string and conventional skin closure techniques in a high volume setting. METHODS Patients undergoing ileostomy reversal at the Goethe University Hospital between January 2009 and August 2012 were retrospectively analysed regarding surgical site infections and associated risk factors. Patients received either conventional skin closure (running, interrupted or stapled suturing; group C) or subcuticular purse-string suture (group PS). RESULTS In total, 114 patients have been analysed. Conventional wound closure was performed in 81 patients and 33 patients received purse-string skin closure. The groups did not differ regarding age, gender, indication for ileostomy, previous chemotherapy, and operation time. Median hospital stay was 7 days (3-34) in group PS and 8 (3-53) in group C (p = 0.15). Wound infections only occurred in groups C (n = 10, 12 %) compared to group PS (n = 0; 0 %; p = 0.034), and the wound closure technique was the only significant factor associated with surgical site infection. Surgery performed by a resident under supervision was not a risk factor for complications compared to the procedure done by a senior surgeon (p = 0.73). CONCLUSION This study reveals an advantage of the purse-string skin closure technique in ileostomy reversals analysing a large cohort of patients. Therefore, we recommend the use of the purse-string skin closure in ileostomy reversals as one way to lower wound infection rates.
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Affiliation(s)
- Nils Habbe
- Department of General and Visceral Surgery, Hospital of the Johann Wolfgang Goethe-University Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Germany,
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16
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Behnke M, Hansen S, Leistner R, Diaz LAP, Gropmann A, Sohr D, Gastmeier P, Piening B. Nosocomial infection and antibiotic use: a second national prevalence study in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2013; 110:627-33. [PMID: 24133543 PMCID: PMC3796357 DOI: 10.3238/arztebl.2013.0627] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2013] [Accepted: 05/29/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND In 2011, seventeen years after the first national study on the prevalence of nosocomial infections and antibiotic use in German hospitals, a second national prevalence study was carried out according to the specifications of the European Centre for Disease Prevention and Control (ECDC). METHODS The ECDC protocol, containing uniform surveillance definitions and ascertainment methods, was implemented. The only infections counted were those that were active or under treatment with antibiotics on the day of the study. In addition to the representative sample required by the ECDC, which consisted of 46 hospitals, further hospitals participated on a voluntary basis. RESULTS Data on 41 539 patients in 132 hospitals were analyzed. The prevalence of infections that had arisen during the current hospital stay was 3.8% in the overall group and 3.4% in the representative sample of 9626 patients in 46 hospitals. The prevalence of all nosocomial infections, including those acquired before the current hospital stay and still present upon admission, was 5.1% in both the overall group and the representative sample. The prevalence of antibiotic use on the day of the study was 25.5% and 23.3% in the two groups, respectively. CONCLUSION The prevalence of nosocomial infection has not changed since 1994, but the prevalence of antibiotic use has increased. In interpreting these findings, one should bear in mind that confounders may have influenced them in different directions: The mean length of hospital stay is now shorter than in 1994, but the mean age of hospitalized patients is higher.
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Affiliation(s)
- Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Sonja Hansen
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Rasmus Leistner
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | | | - Alexander Gropmann
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Dorit Sohr
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
| | - Brar Piening
- Institute of Hygiene and Environmental Medicine, Charité – Universitätsmedizin Berlin
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Gehring S, Zepp F. Nosokomiale Infektionen in Kinderkliniken. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-013-2881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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