German National Nosocomial Infection Surveillance Research Articles

Surveillance of external ventricular drainage-associated meningitis and ventriculitis in German intensive care units

In light of the infection risk associated with external ventricular drainage (EVD), we decided to establish the surveillance of EVD-associated meningitis/ventriculitis in German intensive care units (ICUs) in the framework of the German national nosocomial infection surveillance system (KISS). Here, we present the current reference data and subsequent risk-factor analysis for EVD-associated meningitis/ventriculitis rates. The surveillance method corresponds with the surveillance methods for device-associated infections recommended by the National Healthcare Safety Network (NHSN). All ICUs participating for at least 1 month from 2008 to 2016 in the module ICU-KISS were included in the reference dataset and the multivariate analysis. Current reference data (2008-2016) are based on input from 157 ICUs. The mean EVD-associated meningitis/ventriculitis rate per 1,000 EVD days was 3.96, with little variation between neurosurgical, surgical, interdisciplinary (hospitals with >400 beds), and neurological ICUs. In total, 893 EVD-associated meningitis/ventriculitis cases and 225,351 EVD days were included in the risk-factor analysis. After multivariate analysis, 2 factors remained significant: (1) stay in an ICU labeled other than neurosurgical, surgical, interdisciplinary (>400 beds), and neurological as a protective factor and (2) EVD utilization rate above the 75th quantile as a risk factor for acquisition of EVD-associated meningitis/ventriculitis. EVD-associated meningitis and ventriculitis are frequent complications of care in intensive care patients at risk. A long hospital stay and/or the presence of the EVD puts the patient at high risk for pathogen acquisition with subsequent infection.

Gender-related risk factors for surgical site infections. Results from 10\u2009years of surveillance in Germany

BackgroundSurgical site infections (SSI) are among the most frequently occurring healthcare-associated infections worldwide. Various analyses to determine risk factors have been conducted in the past, generally attributing a higher SSI-risk to male patients. However, when focusing on specific procedures, this is not always true. Our objective was to identify for which procedures male or female sex represents an independent risk factor for SSI and which parameters may explain these differences.MethodsWe used the database of surgical procedures from the German national nosocomial infection surveillance system. We included procedures conducted between 2008 and 2017. We excluded procedures solely executed for one sex (e.g. mastectomy) and procedures with 20,000 or fewer operations. The observed outcome was the occurrence of SSI. All models were adjusted for confounders, which were eliminated with backward selection. The following factors were included in the analysis: age, ASA score, wound contamination class, duration of surgery, and season. All models contained the investigated factor sex.ResultsSixteen procedure types with 1,266,782 individual procedures and 18,824 SSI were included. Overall, the incidence rate ratio and the adjusted odds ratio for SSI were significantly higher for male patients. The included individual procedures were grouped into five surgical categories. For orthopedics and traumatology as well as abdominal surgery, SSI-rates were significantly higher for male patients. For heart and vascular surgery, SSI-rates were significantly higher for female patients. Other included surgical categories and individual procedures yielded diverse results. Similar results were found when solely analyzing deep and organ-space SSI. Multivariable analysis for attributable gender-related risk factors revealed differences with regard to underlying risk factors.ConclusionsSSI-rates differ by sex for certain procedures. When examining underlying risk factors, differences between male and female patients can be demonstrated. Our analysis considered a limited number of parameters, which were not sufficient to fully explain the observed differences. Further studies are required to obtain a more comprehensive understanding of the topic and to include gender-specific aspects into future SSI-prevention strategies.

Decrease of methicillin resistance in Staphylococcus aureus in nosocomial infections in Germany–a prospective analysis over 10 years

Methicillin resistant Staphylococcus aureus (MRSA) remains an important cause of healthcare-associated infections. Here, we describe the development of methicillin-resistant isolates among nosocomial Staphylococcus aureus (SA) infections in Germany between 2007 and 2016. We analyzed data from the voluntary German national nosocomial Infection Surveillance System. Data on bloodstream infections (BSI) and lower respiratory tract infections (LRTI) were derived from intensive care units (ICU), whereas data on surgical site infections (SSI) were collected from surgical departments (SD). Univariate analysis was performed on trend of proportion, while multivariable logistic regression was performed to identify risk factors for MRSA-infections. Data of 1218 ICU and 1,556 SD were included. Overall, a decrease in the proportion of MRSA among all nosocomial SA-infections from 32.8% to 20.0% was noted. MRSA decreased from 37.1% to 21.8% (p = 0.01) for BSI, from 38.7% to 19.2% for LTRI (p<0.01) and. from 21.1% to 7.4% (p<0.01) in SSI. Logistic regression revealed that SA-infections in Mecklenburg Western-Pomerania were more likely caused by MRSA (Odds ratio (OR): 2.5; 95% CI: 1.7, 3.6). We observed a significant reduction of the proportion of nosocomial Staphylococcus aureus infections due to MRSA in Germany over the course of the last 10 years.

Continuous increase of vancomycin resistance in enterococci causing nosocomial infections in Germany − 10 years of surveillance

BackgroundEnterococci are frequent pathogens causing nosocomial infections in Germany. Infections due to strains with vancomycin resistance are high when compared with other European states. Therefore, the study aimed to describe the recent progression of nosocomial infections due to vancomycin-resistant enterococci (VRE) in Germany.MethodsWe analyzed data from two components of the German national nosocomial infection surveillance system for the period 2007–2016. For primary bloodstream infections (BSIs) and urinary tract infections (UTIs) we used data from intensive care units and for surgical site infections (SSIs) data from surgical departments. In a sensitivity analysis, we considered only data from participants that participated continuously from 2007 to 2016 (“core group”). We calculated proportions of VRE among all nosocomial enterococcal infections with 95% confidence intervals (95% CIs) and trends over time. A multivariable logistic regression was used to compare occurrence of VRE proportions among German federal states.ResultsEnterococcal infections from 857 ICUs and 1119 surgical departments were analyzed. On ICUs, the proportion of vancomycin resistance in enterococci causing nosocomial infections significantly increased for BSIs from 5.9 to 16.7% and for UTIs from 2.9 to 9.9%; for surgical site infections, the proportion of VRE increased from 0.9 to 5.2% (P < 0.001 for all). In the core group, the increase of VRE was more pronounced in ICUs (BSIs: 5.5 to 21.6%; UTIs: 2 to 11.2%) but was not seen in surgical departments (SSIs: 1.5 to 2.8%). Compared with the most populous German federal state North Rhine Westphalia, enterococcal infections in Hesse (Odds Ratio (OR) 2.3, 95% CI 1.7–3.1), Saxony (OR 2.5, 95% CI 1.8–3.5) and Thuringia (OR 1.9, 95% CI 1.4–2.6) were more likely to be caused by vancomycin-resistant strains.ConclusionIn Germany, the proportion of VRE in nosocomial infection due to enterococci is still increasing. It remains unclear, why a large variation in the proportion of VRE exists between German federal states.

Hospital ownership: a risk factor for nosocomial infection rates?

In some countries, a relationship between hospital ownership and the occurrence of healthcare-associated infection (HCAI) rates has been described. To investigate the association between hospital ownership and occurrence of HCAI in Germany. Five different components of the German national nosocomial infection surveillance system were analysed with regard to the influence of hospital ownership in the period 2014-2016. Endpoints included ventilator-associated pneumonia, central-venous-catheter-associated bloodstream infections, urinary-catheter-associated urinary tract infections, surgical site infections (SSI) following hip prosthesis and colon surgery, meticillin-resistant Staphylococcus aureus (MRSA), Clostridium difficile infections (CDI) and hand rub consumption per 1000 patient-days. Three hospital ownership types (public, non-profit and private) were analysed using univariate and multi-variate methods. The distribution of hospitals according to the three ownership types was similar in all components. In total, 661 intensive care units (ICUs), 149 departments performing colon procedures, and 349 departments performing hip prosthesis were included. In addition, 568 hospitals provided their MRSA rates and 236 provided their CDI rates, and 1833 ICUs and 12,934 non-ICUs provided their hand rub consumption data. In general, the differences between the hospital types were rather small and not significant for the ICUs. In the multi-variate analysis, public hospitals had a lower SSI rate following hip prosthesis (odds ratio 0.80, 95% confidence interval 0.65-0.99). Hospital ownership was not found to have a major influence on the incidence of HCAI in Germany.

ICU mortality following ICU-acquired primary bloodstream infections according to the type of pathogen: A prospective cohort study in 937 Germany ICUs (2006-2015).

ObjectiveMortality due to intensive care unit (ICU) acquired primary blood stream infections (PBSI) is related primarily to patient co-morbidities, types of pathogens and quality of care. The objective of this study is to determine the impact of various types of pathogen on ICU mortality.MethodsData from the German National Nosocomial Infection Surveillance System of patients with PBSI from 2006 to 2015 was used for this analysis. A BSI is primary when the pathogen recognized is not related to an infection on another site. Only mono-microbial infections stratified into the 13 pathogens most frequently causing PBSI were considered. Univariate and multivariate risk factor analyses were performed using the following risk factors: Sex, age, length of stay, device use, time until onset of PBSI, type and size of hospital, type of ICU and type of pathogen. ICU mortality following S.aureus PBSI was used as the reference value.ResultsA total of 4,556,360 patients with 16,978,882 patient days from 937 ICUs were considered in the analysis. Of 14,626 PBSI in total, 12,745 mono-microbial PBSI were included. The ICU mortality was 18.6%. Compared with S.aureus and adjusted by age, sex and type of ICU, S.maltophilia was associated with significantly higher ICU mortality (OR 1.71; 95%CI 1.19–2.47) as followed by Enterococci (OR 1.20; 95%CI 1.06–1.36), E.coli (OR 1.24; 95%CI 1.02–1.49), C.albicans (OR 1.37; 95%CI 1.16–1.61), non albicans Candida spp. (OR 1.49; 95%CI 1.18–1.88) and P.aeruginosa (OR 1.49; 95%CI 1.21–1.84). Coagulase negative Staphylococci were associated with significant lower ICU mortality (OR 0.86; 95%CI 0.75–0.99).ConclusionBecause of the limitation of the study in adjusting for severity of illness and appropriateness of therapy, the differences between the pathogens may not only be explained by differences in virulence, but may reflect the prognosis after receiving the microbiological results and may therefore be useful for intensive care physicians.

Use of ventilator utilization ratio for stratifying alcohol-based hand-rub consumption data to improve surveillance on intensive care units

Germany has established a nationwide surveillance system of alcohol-based hand-rub consumption (AHC) per patient-day in hospital settings as a surrogate parameter for hand hygiene (HH) compliance. Analysis of AHC data in intensive care units (ICUs) shows not only a wide range of consumption between units of different specialties, but also within units of one specialty. This seems to reflect variation in the number of HH opportunities per patient-day between ICUs due to variation in complexity of care. To investigate whether ventilator utilization ratio (VUR) might be a good surrogate for describing complexity and intensity of care on ICUs and whether stratification by VUR works as a new method of setting benchmarks for AHC data. Data from 365 ICUs participating in the German national nosocomial infection surveillance system (KISS) were used. VUR was calculated by dividing the number of ventilator-days per unit by the number of patient-days per unit. AHC was stratified according to VUR in quartiles. The median AHC was 107mL/patient-day [interquartile range (IQR): 86-134] and the median VUR was 33% (IQR: 22-45%). The Spearman rank correlation coefficient was 0.28 (P<0.0001). After stratifying AHC according to VUR, the AHC in quartile I was significantly lower compared to quartile IV. There was also significant difference between quartile I and quartiles II and III. Stratification of AHC data according to VUR is suggested to improve the quality of benchmark parameters based on AHC data as surrogate parameter for HH compliance in ICUs.

Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance

ObjectiveTo describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS). MethodThe epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS. ResultsData from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50–0.72) and 0.61 (CI95 0.52–0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64–0.76) and 0.43 (CI95 0.35–0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64–1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects. ConclusionsParticipating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should – if possible – be considered for infection control management and for risk adjustment in the benchmarking process.

Alcohol-based hand rub consumption surveillance in German hospitals – latest results

HAND-KISS is a unit-based surveillance system of alcohol-based hand rub consumption (AHC). It is part of the German national nosocomial infection surveillance system (KISS).

Regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in Germany: data from the German National Reference Center for the Surveillance of Nosocomial Infections (KISS)

Surveillance systems for hospital infections are reporting increasing rates of extended-spectrum β-lactamase (ESBL)-positive Enterobacteriaceae in Europe. We aimed to perform a national survey on this trend and on the regional distribution of nosocomial infections due to ESBL-positive Enterobacteriaceae in German hospitals. Data from 2007 to 2012 from two components of the German national nosocomial infection surveillance system were used for this analysis. The data derive from intensive care units and surgical departments. Independent factors determining the proportion of ESBL-positive Enterobacteriaceae among nosocomial infections due to Enterobacteriaceae and changes in its regional distribution (broken down into German federal states) were calculated by regression analysis. From 2007 to 2012, the data showed a significantly increasing proportion of ESBL-positive Enterobacteriaceae in surgical site infections (from 11.46 to 15.38, 134%, p 0.003), urinary tract infections (9.36 to 16.56, 177%, p <0.001) and lower respiratory tract infections (11.91 to 14.70, 123%, p <0.001) due to Enterobacteriaceae. Factors independently associated with a growing proportion were: Thuringia (p 0.009; odds ratio (OR) 1.53), North Rhine-Westphalia (p <0.001; OR 1.41) and general surgery ward (p 0.002; OR 1.47). The proportion of ESBL-positive Enterobacteriaceae in nosocomial infections has significantly increased in Germany over the last 6 years. Hospitals in Central Germany and surgical departments in all of Germany are especially affected by this development.

Gender-Specific Differences in Surgical Site Infections: An Analysis of 438,050 Surgical Procedures from the German National Nosocomial Infections Surveillance System

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.

How many outbreaks of nosocomial infections occur in German neonatal intensive care units annually?

Outbreaks on neonatal intensive care units (NICUs) achieve huge media interest, but the real number of neonatal outbreaks within a country is unknown. This calculation is based on the data of the component for nosocomial infections in very low birth weight (VLBW) infants of the German national nosocomial infection surveillance system (NEO-KISS) from 2006 to 2011. Almost all German NICUs caring for VLBW infants participated in this surveillance system. A cluster was defined and an outbreak was assumed when at least two cases of severe neonatal infection (bloodstream infection, pneumonia) occurred within a defined time interval in one center with the same pathogen species in different patients. Four different intervals were used for calculation: 14, 30, 60, and 90days. Infections with coagulase-negative staphylococci (CoNS) were excluded. A total of 228 NICUs provided data in the six-year study period. A total of 37,038 VLBW infants and 1,361,950 patient days were used for the calculation. 7,405 severe neonatal infections occurred, and a microbiological detection of the pathogen was successful in 2,084 cases. Altogether, between 121 and 280 outbreaks were calculated according to the different time intervals used. Most outbreaks were due to Staphylococcus aureus, followed by Enterococcus spp. and Enterobacter spp. It can be assumed that at least between 26 and 61 neonatal outbreaks with at least two severe infections take place in German NICUs per year. The actual number seems to be higher because only laboratory-confirmed infections in a subgroup of patients were used for the analysis.

P124: Increase in alcohol-based hand rub consumption over a period of five years in German hospitals

In 2008, the German national nosocomial infection surveillance system (KISS) introduced a new surveillance module: HAND-KISS. HAND-KISS is a unit-based system for the surveillance of alcohol-based hand rub consumption (AHC). On the basis of HAND-KISS data, we studied the change in AHC between 2008 and 2012.

Nationwide Benchmarking of Hand Hygiene Performance

Affiliations: 1. First Global Patient Safety Challenge, Patient Safety Program, World Health Organization, Geneva, Switzerland; 2. Infection Control Program and World Health Organization Collaborating Center on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Received March 5, 2012; accepted March 11, 2012; electronically published April 19, 2012. World Health Organization 2012. All rights reserved. The World Health Organization has granted the publisher permission for the reproduction of this article. 0899-823X/2012/3306-0013$15.00. DOI: 10.1086/665720 Hand hygiene promotion is key to patient safety and a cornerstone of effective healthcare-associated infection prevention efforts. Many healthcare settings worldwide have committed to the implementation of hand hygiene campaigns with set targets for improvement. Evaluation of these strategies, especially by performance monitoring and infrastructure indicators, is a critical element to their success. This provides managers with information on the impact of campaign implementation and healthcare workers with feedback to motivate and sustain behavior change. Several countries have recently taken up this challenge at national level and included hand hygiene in quality improvement goals and indicators. In this issue, Behnke et al present alcohol-based hand rub (ABHR) consumption data collected prospectively on a voluntary basis through the German national nosocomial infection surveillance system since January 2008. Hospitals report data to a centralized system stratified by type of ward (intensive care unit [ICU] and non-ICU) and specialty. The overall objective is to facilitate improvement through both intrahospital (ie, between wards) and interhospital benchmarking. Established in 2008, the national German hand hygiene campaign includes more than 900 healthcare settings and is one of the largest worldwide. In line with the World Health Organization (WHO) hand hygiene improvement strategy, participating facilities are requested to (1) secure the active support of administrators; (2) participate in a 1-day introductory course, national workshops, and a national hand hygiene day; (3) organize training of healthcare workers at least once a year; (4) increase ABHR availability, monitor its consumption, and provide feedback; and (5) implement the WHO’s My 5 Moments for Hand Hygiene model. Considering the broad national scope, these features and organization are exceptional, particularly the nationwide ABHR consumption data collection system. Behnke et al report the 4-year results for a sample of 152 hospitals and show a 40.9% and 27.2% increase in median ABHR consumption per patient-day in ICUs and non-ICUs, respectively. Although such increases may be easily achieved in institutions where ABHR is newly introduced and replaces hand washing, these are astonishing in a context where ABHR was widely available for many years before the start of the national campaign. This dramatic increase strongly supports the effectiveness of the multimodal promotion strategy, particularly the performance feedback provided. However, establishing whether this increase reflects actual hand hygiene compliance improvement remains challenging. ABHR consumption measurement was chosen as a surrogate parameter for hand hygiene performance in Germany because direct observation of compliance was considered resource demanding and unfeasible over long periods. This choice was possible as the vast majority of hand hygiene actions in German hospitals involve ABHR, a crucial prerequisite for the use of its consumption as a surrogate of compliance. On the basis of 2010 ABHR consumption results, the reported estimates of the median number of hand hygiene actions per patient-day are low compared with that reported in the literature and would suggest defective hand hygiene behavior. Although the authors emphasize the existence of a good correlation between ABHR consumption and hand hygiene compliance rates reported elsewhere, their results are controversial and raise concerns about the ultimate outcome of hand hygiene promotion. ABHR consumption as a surrogate marker for hand hygiene compliance has several limitations. First, there is a need for accurate validation of consumption data entered in the system. Second, as recognized by Behnke and colleagues, consumption does not allow estimates of hand hygiene performance according to actual opportunities and is vulnerable to the influence of unnecessary hand hygiene actions by healthcare workers, use for other purposes (eg, surface disinfection), and use by patients and visitors. Hand hygiene compliance

The step from a voluntary to a mandatory national nosocomial infection surveillance system: the influence on infection rates and surveillance effect

BackgroundThe German national nosocomial infection surveillance system, KISS, has a component for very low birth weight (VLBW) infants (called NEO-KISS) which changed from a system with voluntary participation and confidential data feedback to a system with mandatory participation and confidential feedback.MethodsIn order to compare voluntary and mandatory surveillance data, two groups were defined by the surveillance start date. Neonatal intensive care unit (NICU) parameters and infection rates of the NICUs in both groups were compared. In order to analyze the surveillance effect on primary bloodstream infection rates (BSI), all VLBW infants within the first three years of participation in both groups were considered. The adjusted effect measures for the year of participation were calculated.ResultsAn increase from 49 NICUs participating in 2005 to 152 in 2006 was observed after the introduction of mandatory participation. A total of 4280 VLBW infants was included in this analysis. Healthcare-associated incidence densities rates were similar in both groups. Using multivariate analysis with the endpoint primary BSI rate and comparing the first and third year of participation lead to an adjusted incidence rate ratio (IRR) of 0.78 (CI95 0.66-0.93) for old (voluntary) and 0.81 (CI95 0.68-0.97) for new (mandatory) participants.ConclusionsThe step from a voluntary to a mandatory HCAI surveillance system alone may lead to substantial improvements on a countrywide scale.

Individual units rather than entire hospital as the basis for improvement: the example of two Methicillin resistant Staphylococcus aureus cohort studies.

BackgroundTwo MRSA surveillance components exist within the German national nosocomial infection surveillance system KISS: one for the whole hospital (i.e. only hospital based data and no rates for individual units) and one for ICU-based data (rates for each individual ICU). The objective of this study was to analyze which surveillance system (a hospital based or a unit based) leads to a greater decrease in incidence density of nosocomial MRSAMethodsTwo cohort studies of surveillance data were used: Data from a total of 224 hospitals and 359 ICUs in the period from 2004 to 2009. Development over time was described first for both surveillance systems. In a second step only data were analyzed from those hospitals/ICUs with continuous participation for at least four years. Incidence rate ratios (IRR) with 95% confidence intervals were calculated to compare incidence densities between different time intervals.ResultsIn the baseline year the mean MRSA incidence density of hospital acquired MRSA cases was 0.25 and the mean incidence density of ICU-acquired MRSA was 1.25 per 1000 patient days. No decrease in hospital-acquired MRSA rates was found in a total of 111 hospitals with continuous participation in the hospital- based system. However, in 159 ICUs with continuous participation in the unit-based system, a significant decrease of 29% in ICU-acquired MRSA was identified.ConclusionsA unit-based approach of surveillance and feedback seems to be more successful in decreasing nosocomial MRSA rates, compared to a hospital-based approach. Therefore each surveillance system should provide unit-based data to stimulate activities on the unit level.

Decreasing healthcare-associated infections (HAI) is an efficient method to decrease healthcare-associated Methicillin-resistant S.aureus (MRSA) infections Antimicrobial resistance data from the German national nosocomial surveillance system KISS

BackgroundBy analysing the data of the intensive care unit (ICU) component of the German national nosocomial infection surveillance system (KISS) during the last ten years, we have observed a steady increase in the MRSA rates (proportions) from 2001 to 2005 and only a slight decrease from 2006 to 2010. The objective of this study was to investigate the development of the incidence density of nosocomial MRSA infections because this is the crucial outcome for patients.FindingsData from 103 ICUs with ongoing participation during the observation period were included. The pooled incidence density of nosocomial MRSA infections decreased significantly from 0.37 per 1000 patient days in 2001 to 0.15 per 1000 patient days in 2010 (RR = 0.40; CI95 0.29-0.55). This decrease was proportional to the significant decrease of all HCAI during the same time period (RR = 0.61; CI95 0.58-0.65).ConclusionsThe results underline the need to concentrate infection control activities on measures to control HCAI in general rather than focusing too much on specific MRSA prevention measures. MRSA rates (proportions) are not a very useful indicator of the situation.

Laminar Airflow Ceiling Size: No Impact on Infection Rates Following Hip and Knee Prosthesis

Laminar airflow (LAF) systems are widely used, at least in orthopedic surgery. However, there is still controversial discussion about the influence of LAF on surgical site infection (SSI) rates. The size of the LAF ceiling is also often a question of debate. Our objective is to determine the effect of this technique under conditions of actual rather than ideal use. Cohort study using multivariate analysis with generalized estimating equations method. Data for hip and knee prosthesis procedures from hospitals participating in the German national nosocomial infection surveillance system (KISS) from July 2004 to June 2009 were used for analysis. A total of 33,463 elective hip prosthesis procedures due to arthrosis (HIP-A) from 48 hospitals, 7,749 urgent hip prosthesis procedures due to fracture (HIP-F) from 41 hospitals, and 20,554 knee prosthesis (KPRO) procedures from 38 hospitals were included. The data were analyzed for hospitals with and without LAF in the operating rooms and by the size of the LAF ceiling. The endpoints were severe SSI rates. The overall severe SSI rate was 0.74 per 100 procedures for HIP-A, 2.39 for HIP-F, and 0.63 for KPRO. For all 3 prosthesis types, neither LAF nor the size of the LAF ceiling was associated with lower infection risk. The data demonstrate consistency and reproducibility with the results from earlier registry studies. Neither LAF nor ceiling size had an impact on severe SSI rates.

Impact of department volume on surgical site infections following arthroscopy, knee replacement or hip replacement

ObjectiveTo examine the association between surgical department volume and the risk of surgical site infections (SSI) after orthopaedic procedures.BackgroundA minimum volume regulation of at least 50 knee replacements per year...

Increase of alcohol based hand rub consumption in hospitals participating in the German surveillance system

A new national surveillance system (HAND-KISS) of alcohol based hand rub consumption (AHC) in hospitals was implemented to the German national nosocomial infection surveillance system (KISS) in the year 2008. We analyzed the differences of AHC increase of hospitals over three years.