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Deniz A, Erhan ÖL, Bayar MK, Karatepe Ü, Demirel İ. Examination of Changes in Infection Rates in a Restructured Anaesthesia Intensive Care Unit: A Retrospective Study. Turk J Anaesthesiol Reanim 2017; 45:353-360. [PMID: 29359075 PMCID: PMC5772415 DOI: 10.5152/tjar.2017.68095] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 08/17/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE This retrospective study aimed to evaluate the effect of a restructured anaesthesia intensive care unit (ICU) on changes in infection rates and infections. METHODS Organisational restructuring was done in the anaesthesia ICU of Firat University Hospital after it was relocated on 14 March 2012. This study was designed to investigate the effect of restructuring on infection rates through a comparison of periods encompassing one year before relocation and one year after relocation. Nosocomial infections were diagnosed according to modified Centers for Disease Control and Prevention (CDC) criteria. In total, 406 patients who were over 18 years old and admitted to the ICU were included; they were hospitalised for 48 h or longer and had non-infectious diseases according to physical examination, laboratory and culture results on admission. The data of 214 patients (Group A) and 192 patients (Group B) were examined. RESULTS Parameters such as age, gender, primary diagnosis and mean GCS score at admission and mean duration of hospitalisation showed no effect on the rates of infection, but rates of total infection (41.1% vs. 25%), urinary (18.7% vs. 10.4%) and VIP (32.7% vs. 14.6%) were detected in Groups A and B. Statistically significant differences were found for the causative pathogens Pseudomonas (15.4% vs. 6.8%), Acinetobacter (18.2% vs. 12%) and Escherichia (8.9% vs. 2.1%); the mean duration of mechanical ventilation (15.01±16.681 vs. 12.22±17.595) and discharge with improvement (31.8% vs. 44.3%). CONCLUSION We detected that restructuring (such as acclimatization, educated staff, hepa filter) caused a significant decline in infection rates. Because ICU staff may be a major cause of infection, we believe that providing education and conducting effective surveillance programs will be the most important factors for reducing infection rates.
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Affiliation(s)
- Ahmet Deniz
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Ömer Lütfi Erhan
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - Mustafa Kemal Bayar
- Department of Anaesthesiology and Reanimation, Ankara University School of Medicine, Ankara, Turkey
| | - Ümit Karatepe
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
| | - İsmail Demirel
- Department of Anaesthesiology and Reanimation, Fırat University School of Medicine, Elazığ, Turkey
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Hansen S, Schwab F, Behnke M, Carsauw H, Heczko P, Klavs I, Lyytikäinen O, Palomar M, Riesenfeld Orn I, Savey A, Szilagyi E, Valinteliene R, Fabry J, Gastmeier P. National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project. J Hosp Infect 2009; 71:66-73. [DOI: 10.1016/j.jhin.2008.07.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2008] [Accepted: 07/18/2008] [Indexed: 10/21/2022]
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Manniën J, van den Hof S, Brandt C, Behnke M, Wille JC, Gastmeier P. Comparison of the National Surgical Site Infection surveillance data between The Netherlands and Germany: PREZIES versus KISS. J Hosp Infect 2007; 66:224-31. [PMID: 17512635 DOI: 10.1016/j.jhin.2007.03.024] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2007] [Accepted: 03/23/2007] [Indexed: 11/25/2022]
Abstract
As there has been increasing interest in comparing surgical site infection (SSI) rates between countries, we compared the SSI surveillance data for The Netherlands ('PREZIES') and Germany ('KISS'). Both surveillance systems have comparable protocols with many similar risk factors, including SSI definitions developed by the Centers for Disease Control and Prevention and optional postdischarge surveillance. Nine surgical procedure categories from several specialities were included, the reporting of which were similar, with respect to content and with enough data for proper comparison. Differences for the SSI data were found between PREZIES and KISS for duration of surgery, wound contamination class, American Society of Anesthesiologists physical status classification and the postoperative duration of hospitalization. A significantly higher superficial SSI rate was found for seven surgical procedures according to PREZIES and a higher deep SSI rate for five procedures. When considering only deep SSI during hospitalization, the differences in SSI rates were much smaller. Differences in intensity of postdischarge surveillance led to 34% of SSI being detected after discharge for PREZIES and 21% for KISS. In conclusion, even though similar infection surveillance protocols are used in The Netherlands and Germany, differences occurred in the implementation. Comparisons between countries are most reliable if only deep SSIs during hospitalization are taken into account, since these SSI are not affected by postdischarge surveillance and the diagnostic sensitivity for deep SSI is probably more alike between countries than for superficial SSI.
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Affiliation(s)
- J Manniën
- Netherlands Centre for Infectious Disease Control, National Institute for Public Health and the Environment, The Netherlands.
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Abstract
International comparisons yield interesting insights regarding quality of care, beyond the field of healthcare-associated infection (HAI) prevention. Therefore, the exchange of experiences of national surveillance systems should be encouraged. However, the interpretation of differences of HAI rates should be made very carefully. Differences in healthcare systems, legal and cultural aspects, as well as differences in the methods of the surveillance systems, may have an enormous influence. One of the most crucial aspects of surveillance data is their validity, therefore it would be very helpful to combine the experience of all European validation studies performed in order to develop a protocol for a meaningful and cost-effective method for performing validation studies. Meanwhile some national surveillance systems have shown their effectiveness with reductions of 24 57% for surgical site infections (SSIs) and 20 29% for HAI in ICUs. Today, mandatory public reporting is probably the most demanding problem for the national HAI surveillance systems in Europe. The exchange of experience between the European surveillance networks in this respect in particular--remains a cornerstone and will motivate further activities in the individual countries.
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Affiliation(s)
- Petra Gastmeier
- Institute of Medical Microbiology and Hospital Epidemiology, Hannover Medical School, Hannover, Germany.
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Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit: a case-control study. BMC Pulm Med 2004; 4:3. [PMID: 15109397 PMCID: PMC419357 DOI: 10.1186/1471-2466-4-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 04/26/2004] [Indexed: 11/10/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5) and 2.5 (IQR: 2.0) days respectively (P < 0.0001). Respiratory failure (OR, 11.8; 95%, CI, 2.2–62.5; P < 0.004), coma in admission (Glasgow coma scale < 9) (OR, 17.2; 95% CI, 2.7–107.7; P < 0.002), depressed consciousness (OR, 8.8; 95% CI, 2.9–62.5; P < 0.02), enteral feeding (OR, 5.3; 95% CI, 1.0–27.3; P = 0.044) and length of stay (OR, 1.3; 95% CI, 1.0–1.7; P < 0.04) were found as important risk factors. Most commonly isolated microorganism was methicillin resistant Staphylococcus aureus (30.4%). Mortality rates were higher in patients with VAP (70.3%) than the control patients (35.5%) (P < 0.003). Mean cost of patients with and without VAP were 2832.2+/-1329.0 and 868.5+/-428.0 US Dollars respectively (P < 0.0001). Conclusion Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.
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Affiliation(s)
- Riza Hakan Erbay
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Ata Nevzat Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Medicine Faculty, Akdeniz University, Antalya, Turkey
| | - Mehmet Zencir
- Department of Public Health, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Simay Serin
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Habip Atalay
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
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Memish ZA, Arabi Y, Cunningham G, Kritchevsky S, Braun B, Richards C, Weber S, Pereira CR. Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study. Am J Infect Control 2003; 31:237-42. [PMID: 12806362 DOI: 10.1067/mic.2003.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. DESIGN The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. SETTINGS The study took place in intensive care units (ICUs) from 14 countries, which were from the Asian Pacific (3), Europe (7), Middle East (2), and South America (2), in addition to 41 US hospitals. METHODS We compared the National Nosocomial Infections Surveillance catheter-associated BSI rate between the non-US and US units. We also compared the following organization factors between the 2 groups: hospital factors (ownership, average daily census of patients); ICU type (medical vs surgical); number of beds; and infection control-related factors (number of staff, number of hours spent on study ICU surveillance, years of experience, number of inservice sessions on line infection, number of blood cultures drawn/1000 patients). RESULTS We found no significant difference in catheter-associated BSI rates between non-US and US hospitals (5.02 +/- 0.75 vs 3.82 +/- 0.42/1000 days, respectively; P =.27). Non-US hospitals were more likely to be government-owned (10/14 vs 7/41;P <.001) and to have larger daily patient census (795 +/- 84 vs 276 +/- 47 patients; P <.001). There was no difference in ICU type or number of beds. Infection control committees were present in all US and non-US hospitals. No significant differences were found in the number of staff involved in surveillance in the study ICU, years of experience, hours spent on surveillance, or the provision of inservices on line care. The use of barriers during line insertion also did not differ. CONCLUSIONS Catheter-associated BSIs in patients in the ICU were not significantly different between non-US and US hospitals. All hospitals had infection control committees, and there were no significant differences in time spent and numbers of persons involved in ICU surveillance activities. These findings suggest that many aspects of the standards of care do not differ between the 2 groups.
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Affiliation(s)
- Ziad A Memish
- King Abdulaziz Medical City, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia
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Vilar-Compte D, Mohar A, Sandoval S, de la Rosa M, Gordillo P, Volkow P. Surgical site infections at the National Cancer Institute in Mexico: a case-control study. Am J Infect Control 2000; 28:14-20. [PMID: 10679132 DOI: 10.1016/s0196-6553(00)90006-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To quantify the surgical infection rate and to identify risk factors associated with surgical site infection. METHODS We conducted a case-control study of all surgical patients between January 1, 1993, and June 30, 1994. The frequency of surgical site infection per 100 surgeries was calculated. The odds ratio (OR) was estimated by using logistic regression analysis. SETTING A 130-bed tertiary-care teaching hospital for adult patients with cancer. RESULTS The study followed 3372 surgeries. Three hundred thirteen patients had a surgical site infection (rate per 100 surgeries: 9. 30). The risk factors associated with surgical site infection were diabetes mellitus (OR = 2.5, 95% confidence interval [CI] = 1.27-4. 91), obesity (OR = 1.76, 95% CI = 1.14-2.7), presence of surgical drains for >5 and <16 days (OR = 1.84, 95% CI = 1.02-3.31), and presence of surgical drains for >/=16 days (OR = 2.14, 95% CI = 1. 0-4.6). The bacteria most frequently isolated were Escherichia coli 38 (21.8% of the total of microorganisms found), Pseudomonas sp 22 (12.6%), Staphylococcus aureus 16 (9.2%), and coagulase-negative Staphylococcus 25 (13.6%). The coexistence of other nosocomial infections was greater among the cases (OR = 1.8, 95% CI = 1.1-3.1) than in the control group. CONCLUSIONS The surgical site infection rate in our hospital is slightly higher than the rates reported for general hospitals. The risk factors associated with surgical site infection are similar to those previously reported. Diabetes mellitus, obesity, and prolonged presence of a surgical drain increased the risk of infection.
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Affiliation(s)
- D Vilar-Compte
- Department of Infectious Diseases and the Clinical Research Investigation Division, Instituto Nacional de Cancerología, Mexico, D.F 14000, Mexico
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Cookson B. Infection and antimicrobial prescribing control in the new millennium: nightmare or nirvana? J Clin Pathol 2000; 53:66-70. [PMID: 10767860 PMCID: PMC1731048 DOI: 10.1136/jcp.53.1.66] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- B Cookson
- Hospital and Respiratory Infection Division, Central Public Health Laboratory, London, UK
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Gikas A, Pediaditis I, Roumbelaki M, Troulakis G, Romanos J, Tselentis Y. Repeated multi-centre prevalence surveys of hospital-acquired infection in Greek hospitals. CICNet. Cretan Infection Control Network. J Hosp Infect 1999; 41:11-8. [PMID: 9949959 DOI: 10.1016/s0195-6701(99)90031-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Three prevalence studies for the estimation of hospital-acquired infections (HAIs) were carried out in eight Greek hospitals on an annual basis during the years 1994-1996. The overall prevalence of HAI was 6.8, 5.5 and 5.9% for the three years, respectively. Among these, urinary tract infections ranged from 22.4 to 38.2%, lower respiratory tract infections ranged from 21.1 to 32.6%, surgical site infections ranged from 14.6 to 22.7% and bloodstream infections ranged from 9.0 to 13.2%. The prevalence of antibiotic usage among the hospitalized patients was found to be 49.3% in 1994, 47.3% in 1995 and 52.7% in 1996. Unjustified prescription of prophylactic usage was found to be the major component of these high percentages. Appropriate use of antibiotics for prophylaxis is one of the priorities of the current infection control programmes. The development of a nationwide network for the surveillance of HAIs in Greece is planned using the experience gained.
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Affiliation(s)
- A Gikas
- Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine--WHO Collaborating Centre for Research and Training in Mediterranean Zoonoses, Faculty of Medicine, University of Crete, Greece.
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Emmerson AM, Enstone JE, Griffin M, Kelsey MC, Smyth ET. The Second National Prevalence Survey of infection in hospitals--overview of the results. J Hosp Infect 1996; 32:175-90. [PMID: 8690881 DOI: 10.1016/s0195-6701(96)90144-9] [Citation(s) in RCA: 251] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study was designed to assess the overall prevalence of infection among the patients in hospitals in the UK and the Republic of Ireland. Patient data were collected and entered directly into a portable Olivetti (A12 notebook) computer with a custom-designed program (Epi-Info version 5.01). The statistical analysis was performed using the Statistical Package for Social Sciences software (SPSS). In all, 37,111 patients from 157 centers were studied, and a mean hospital acquired infection (HAI) prevalence rate of 9.0% (range 2-29%) was calculated. HAI rates were higher in teaching hospitals (11.2%) than in non-teaching hospitals (8.4%) P < 0.001. Four major sites of infections--infections of the urinary tract (23.2%), surgical-wound infections (10.7%), lower-respiratory tract (22.9%) and skin infections (9.6%)--accounted for 66.5% (2559 of 3848) of the total infections identified.
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Affiliation(s)
- A M Emmerson
- Department of Microbiology, University Hospital, Nottingham, UK
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