Surveillance Of Hospital-acquired Infections Research Articles

Ensuring Accuracy: Making the Case for Inter-rater Reliability in Hospital Acquired Infection Surveillance

Background: Infection preventionists (Ips) have self-reported surveillance as the most time-consuming job task (1,2). APIC’s MegaSurvey 2020 reported that 60% of Ips consider themselves proficient or expert within this competency domain (2). Accurate coding of health care acquired infections is critical to identifying epidemiologically significant events, using data to improve practice, and compliance with state and federal mandated CMS reporting (3,4). Validated case study scenarios were distributed to infection preventionists to better understand how experience level and time spent performing surveillance affects interrater reliability (IRR) in applying the National Healthcare Safety Network (NHSN) surveillance definitions (5,6). Methods: Case study scenarios determined to have high item discrimination were added to an online test bank and distributed annually to Ips of varying experience levels and care settings as part of a mandatory training program (5). The test bank currently consists of forty-two validated questions. Each year, the participants receive approximately thirty questions, including twenty randomly selected from the test bank and ten beta scenarios under development. Only validated test bank scenarios are used to calculate the passing score of 85%. Participants are blinded to which questions are test bank scenarios versus beta scenarios. Additional information was gathered at the beginning of the test to determine CIC status, years of experience, and weekly hours spent doing surveillance. Data was analyzed for passing score on the first attempt for testing years 2019, 2021, 2022, and 2023. Results: Thirty-six Ips passed the IRR test on the first attempt (33%). Of those who passed on the first attempt, twenty-nine (81%) were certified and twenty-two (61%) reported at least nine hours a week performing surveillance. Of the seventy-three Ips (67%) who did not pass on the first attempt, thirty were certified (41%) and sixty (82%) reported performing surveillance for 8 hours or less per week. Conclusion: The first-time pass rate for certified and non-certified Ips was 33%, markedly lower than the self-reported proficiency rate of 60%. The majority of Ips who passed on the first attempt were certified and spent at least nine hours per week performing surveillance. certified and non-certified Ips who did not regularly perform surveillance as part of their weekly job tasks were less likely to pass the test on the first attempt. Given the first-time pass rate among all participants is below optimal, establishing inter-rater reliability systems and ongoing surveillance education for Ips is crucial to ensure accuracy of publicly reported data.

Hospital-acquired infections surveillance: The machine-learning algorithm mirrors National Healthcare Safety Network definitions.

Surveillance of hospital-acquired infections (HAIs) is the foundation of infection control. Machine learning (ML) has been demonstrated to be a valuable tool for HAI surveillance. We compared manual surveillance with a supervised, semiautomated, ML method, and we explored the types of infection and features of importance depicted by the model. From July 2021 to December 2021, a semiautomated surveillance method based on the ML random forest algorithm, was implemented in a Brazilian hospital. Inpatient records were independently manually searched by the local team, and a panel of independent experts reviewed the ML semiautomated results for confirmation of HAI. Among 6,296 patients, manual surveillance classified 183 HAI cases (2.9%), and a semiautomated method found 299 HAI cases (4.7%). The semiautomated method added 77 respiratory infections, which comprised 93.9% of the additional HAIs. The ML model considered 447 features for HAI classification. Among them, 148 features (33.1%) were related to infection signs and symptoms; 101 (22.6%) were related to patient severity status, 51 features (11.4%) were related to bacterial laboratory results; 40 features (8.9%) were related to invasive procedures; 34 (7.6%) were related to antibiotic use; and 31 features (6.9%) were related to patient comorbidities. Among these 447 features, 229 (51.2%) were similar to those proposed by NHSN as criteria for HAI classification. The ML algorithm, which included most NHSN criteria and >200 features, augmented the human capacity for HAI classification. Well-documented algorithm performances may facilitate the incorporation of AI tools in clinical or epidemiological practice and overcome the drawbacks of traditional HAI surveillance.

Active Surveillance of Hospital-acquired Infections in Pediatric Intensive Care Unit: a single center study

Active Surveillance of Hospital-acquired Infections in Pediatric Intensive Care Unit: a single center study

Active Surveillance of Hospital-acquired Infections in Pediatric Intensive Care Unit: a single center study

Active Surveillance of Hospital-acquired Infections in Pediatric Intensive Care Unit: a single center study

ICU infection surveillance can be based on electronic routine data: results of a case study

BackgroundThe surveillance of hospital-acquired infections in Germany is usually conducted via manual chart review; this, however, proves resource intensive and is prone to a certain degree of subjectivity. Documentation based on electronic routine data may present an alternative to manual methods. We compared the data derived via manual chart review to that which was derived from electronic routine data.MethodsData used for the analyses was obtained from five of the University of Leipzig Medical Center’s (ULMC) ICUs. Clinical data was collected according to the Protection against Infection Act (IfSG); documentation thereof was carried out in hospital information systems (HIS) as well as in the ICU-KISS module provided by the National Reference Center for the Surveillance of Nosocomial Infections (NRZ). Algorithmically derived data was generated via an algorithm developed in the EFFECT study; ward-movement data was linked with microbiological test results, generating a data set that allows for evaluation as to whether or not an infection was ICU-acquired.ResultsApproximately 75% of MDRO cases and 85% of cases of sepsis/primary bacteremia were classified as ICU-acquired by both manual chart review and EFFECT. Most discrepancies between the manual and algorithmic approaches were due to differentiating definitions regarding the patients’ time at risk for acquiring MDRO/bacteremia.ConclusionsThe concordance between manual chart review and algorithmically generated data was considerable. This study shows that hospital infection surveillance based on electronically generated routine data may be a worthwhile and sustainable alternative to manual chart review.

Hospital-acquired infections surveillance and prevention: using Natural Language Processing to analyze unstructured text of hospital discharge letters for surgical site infections identification and risk-stratification.

Hospital-acquired infections surveillance and prevention: using Natural Language Processing to analyze unstructured text of hospital discharge letters for surgical site infections identification and risk-stratification.

1221. Stenotrophomonas maltophilia Outbreak Associated with Sink Drains in an Intensive Care Unit

Abstract Background Stenotrophomonas maltophilia (SMA) is an opportunistic pathogen that causes significant morbidity and mortality and has been associated with outbreaks in various hospital environments. We describe an outbreak of SMA in our intensive care unit (ICU) and highlight the sink drain as the probable source of SMA. Methods Clinical surveillance for hospital-acquired infections due to SMA was instituted in December of 2017, when a cluster of cases was identified in our ICU. We first performed an environmental survey in random sites in our ICU rooms: high-touch surfaces, drains in handwashing sinks, clean water, enteral feeding, and ice machines. SMA was only found in the sink drain. We then performed an environmental survey focused on sink drains and the surrounding areas. We identified rooms where patients positive for SMA were previously hospitalized. Sampling sites were standardized for all rooms: bed rail, sink drain, splash zone, and air near sinks. Bed rails were swabbed with sponge-swabs and sink drains with flocked swabs with liquid Amies transport media. Swab samples were cultured in broth and solid media. Splash zone samples were collected using MacConkey agar plates left for four hours immediately adjacent and at one foot from the sink. Air samples were also collected for 10 minutes onto MacConkey agar plates using EMD Millipore MAS-100 NT impactor air sampler. All media was incubated aerobically at 35-37°C. Identification of all isolated gram-negative organisms was performed using MALDI-TOF MS. Results Five rooms were surveyed (Table 1). All rooms were found to have medical supplies within the splash zone. 100% (5/5) of sink drain samples had SMA recovered in culture, compared to 10% (1/10) of splash zone samples, 20% (1/5) of air samples, and 20% (1/5) of bed rails. In addition, we isolated other gram-negative organisms. We repeated the environmental survey after placing a sink drain cover in rooms found to have SMA in areas other than the drain. In the follow-up survey, we found no growth in cultures except for air samples (Table 2). Conclusion Sink drains pose a risk for SMA, possibly via contamination of medical supplies near sinks. Further investigation, including sequencing of environmental and clinical isolates, is needed to understand the mode of transmission. Disclosures All Authors: No reported disclosures.

Surveillance of hospital acquired infections in veterinary practices

The importance of surveillance of hospital-acquired infections (HAI) is often overlooked within the veterinary community, with limited research available, resulting in this vital step being overlooked. When carried out correctly, it allows a practice to accumulate data on the rates of HAIs and ascertain when further action is required. Without these data, practices are often unaware of the severity of their problem. All practices should have an infection control ambassador or committee appointed to ensure these statistics are used correctly and shared with all team members. This article will examine current literature available and determine the pros and cons of each surveillance method and how they may be implemented.

Surveillance of hospital-acquired infections and monitoring of empiric antibiotic therapy in an internal medicine department

Introduction: Hospital-acquired infections (HAIs) are the most serious and frequent complication of healthcare systems. In 2019 the Marche Region has introduced a project to check HAIs and also the use of antibiotics in empirical therapy. The aim of this analysis was to conduct a periodic descriptive prevalence study according to the regional plan. Materials and Methods: In the quarter January-March 2020, the Internal Medicine Department of the Mazzoni Hospital of Ascoli Piceno has been considered, enrolling patients with HAIs to whom has been prescribed at least one antibiotic in empirical therapy. To assess the prevalence of multi-drug resistant organisms (MDRO), microbiological isolates were examined and laboratory response times were measured as a quality indicator. Besides, the incidence of HAIs from medical device, the clinical outcomes and the average length of stay have been analyzed. Results: The results show: high incidence of HAIs and high percentage of MDRO. The response time of the laboratory analysis is on average over 48-72 hours after sampling. The data show a widespread use of broad-spectrum antibiotics and low adherence to the new regional empiric therapy guidelines. Conclusions: The high incidence of HAIs implies the urgent need of an active surveillance of an Antimicrobial Stewardship team. This would represent a strategic solution to prevent and limit antimicrobial resistance and reduce morbidity, mortality and costs.

Device-Associated Hospital-Acquired Infections: Does Active Surveillance With Bundle Care Offer a Pathway to Minimize Them?

Background and objectiveThe prevalence of hospital-acquired infections (HAIs) is underreported in developing nations due to a lack of systematic active surveillance. This study reports the burden of device-associated HAIs (DA-HAIs) based on two years of active surveillance with in situ bundle care in closed intensive care units (ICUs) of a tertiary care hospital.Materials and methodsA prospective surveillance study was carried out in 140-bedded ICUs (2,100-bed hospital) of a tertiary care private medical college hospital. Daily active surveillance for catheter-associated urinary tract infection (CAUTI), ventilator-associated event (VAE), and central line-associated bloodstream infection (CLABSI) was done by trained infection control nurses (ICNs) along with quality champion nurses with HAI surveillance forms with bundle care auditing, which was attached to the case sheets of all patients on devices. The surveillance definitions of DA-HAIs were adapted from the Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (CDC-NHSN) 2017 surveillance criteria. Data were analyzed at the end of every month to generate the cumulative device-associated infection (DAI) rates and device utilization ratio (DUR). These data were compared with NHSN and International Nosocomial Infection Control Consortium (INICC) - India HAI rates and communicated to corresponding ICUs and also presented at the hospital infection control committee (HICC) meeting.ResultsThe surveillance data were reported over 71,877 patient days during the study period. The DUR of urinary catheters, ventilator, and central line were 0.53, 0.16, and 0.22, respectively. CAUTI, VAE, and CLABSI rates were 0.97, 10.5, and 0.43 per 1,000 device days, respectively. Among 166 DA-HAIs reported, 182 pathogens were identified. Klebsiella pneumoniae was the most common organism isolated, accounting for 37.4% of all DA-HAI cases, followed by Acinetobacter baumanii (30.8%). Most of the Gram-negative organisms were carbapenem-resistant (153/175; 87.4%). Vancomycin resistance rate in Enterococcus was 28.5% (2/7).ConclusionDUR and CAUTI, VAE, CLABSI rates were less/on par with the benchmarks of INICC and CDC-NHSN in almost all ICUs of our tertiary care unit. Gram-negative pathogen with 87.4% carbapenem resistance worsened the scenario. Proper active surveillance with bundle care and training by ICNs made a significant difference in all DA-HAI rates, especially VAE, which decreased to 10.5 from 23.6 per 1,000 ventilator days. Sustained active surveillance of HAI and bundle care auditing by a trained infection prevention team with a stringent antibiotic policy are the need of the hour to combat DAIs.

How accurately is hospital acquired pneumonia documented for the correct assignment of a hospital acquired complication (HAC)?

In 2016, the Australian Commission on Safety and Quality in Healthcare (ACSQHC) released a list of 16 categories of potentially preventable, high impact hospital-acquired complications (HAC) identified by using administrative coded data (ACD). An important category are hospital-acquired infections (HAI). Within this category, hospital-acquired pneumonia (HAP) is among the most frequent complications documented. There are no published studies concerning the current ACSQHC approach to HAI surveillance using ACD and no pneumonia-specific ACD studies reported from Australia. Published work indicates that ACD detection of HAP has low a sensitivity and positive predictive value (PPV). The current study was designed to examine whether coders correctly reflected the documentation of HAP that was present in the medical record and also evaluated the medical documentation that was present. One hundred patients with ACD encoded HAP were selected for review, drawn from admissions to 2 Hunter New England Health hospitals during 2017. Patient records and the eMR were reviewed by two medical officers to assess medical and radiological documentation of pneumonia. The district coding manager reviewed the accuracy of coding of a subset of 23 cases where medical review had not located documented evidence of HAP. Of the 100 reviewed cases, the median patient age was 75 years (range 0-95 years) with 3% under 16 years of age. Twenty one were intensive care-associated of which 13 were associated with ventilation. In 23 cases the documentation was disputed and a secondary review took place - the coding manager confirmed coding changes in 14 of these 23 cases. This study found that administrative coded data of HAP, utilizing the ACSQHC method reliably reflected the available documentation with a PPV of 86% (95% binomial exact confidence interval 77-92%), much higher than documented by previous ACD studies. The actual documentation of pneumonia by medical staff frequently used the non-specific term 'lower respiratory infection (LRTI)' which we recommend to be avoided. Radiological confirmation was absent in one third of cases. We recommend the adoption of a medical note template checklist for HAP to prompt clinicians with the accepted diagnostic criteria. We also recommend documenting a reason as to why any antibiotic has been commenced in a hospitalized patient in accord with the ACSQHC Antimicrobial Stewardship Clinical Care Standard.

Selected aspects of the knowledge and practice concerning hand hygiene guidelines in the context of infection control structures in hospitals and long-term care facilities - findings of a questionnaire survey.

Hand hygiene (HH) is the simplest and the most fundamental means of hospital-acquired infection (HAI) prevention in both hospitals and long-term care facilities (LTCFs) which differ as to their structure, organization and epidemiology. The objective of this study was to evaluate the knowledge of, and attitudes towards, compliance with the HH guidelines by medical staff of LTCFs and hospitals, in the context of infection control organization. The study was carried out among medical staff of LTCFs and hospitals using an anonymous questionnaire designed by the authors. The questionnaire was composed of 22 questions. Among 237 healthcare workers from LTCFs and hospitals (51.5% vs. 48.5%), the vast majority were women (97.5% vs. 94.8%), who were nurses (86.9% vs. 91.3%) with 21-30 years of experience (28.5% vs. 44.3%). The respondents, both working in hospitals and in LTCFs, declared that there was some surveillance of HAIs in their workplace - 78.8% vs. 87.8%, respectively, p = 0.082. However, the respondents from LTCFs significantly more often than those working in hospitals declared the lack of HAI registration (12.3% vs. 0.9%, p = 0.002), as well as the lack of surveillance of multidrug-resistant microorganisms (16.4% vs. 4.3%, p = 0.010). Although the knowledge of WHO HH guidelines was declared by over 90% of the respondents, only about 70% of them (with no significant difference between both types of facilities) properly indicated the 5 moments of HH. The results of the study indicate that the organizational conditions and practice of HH in LTCFs and hospitals present some differences. Therefore, there is a need for observational studies concerning HH in the context of the structure and organization of infection control, as they are necessary for the development and implementation of effective programs to improve the situation in this field. Med Pr. 2020;71(5):531-7.

Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties.

Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted in 2012–2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). Results: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. Conclusions: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.

Hospital acquired infections in pediatrics unit at Butare University Teaching Hospital (CHUB)

Background: Hospital acquired infection (HAI) also called nosocomial infection is an infection acquired in hospital or other healthcare facilities. HAIs are a major public health problem all over the world, but particularly in developing nations and they are among the major causes of death and increased morbidity among hospitalized patients. It was found that HAI in sub-Saharan Africa is the major cause of illness and death in children.Aim: The aim of this study was to provide knowledge on the prevalence of hospital acquired infection in pediatric unit of the University Teaching Hospital of Butare (Rwanda).Methods: Hospital acquired infections surveillance method and definition of infections described by CDC/NHSN were used.Results and conclusion: This study showed that the prevalence of HAI was very high (12.1 %) and the main bacteria causing NIs in pediatric unit were Kleblesiela pneumonia, followed by E. coli and Staphylococcus aureus. Low Respiratory HAIs were the most prevalent.Keywords: Prevalence, Hospital Acquired infection, Pediatrics

Gold Standard Evaluation of an Automatic HAIs Surveillance System.

Hospital-acquired Infections (HAIs) surveillance, defined as the systematic collection of data related to a certain health event, is considered an essential dimension for a prevention HAI program to be effective. In recent years, new automated HAI surveillance methods have emerged with the wide adoption of electronic health records (EHR). Here we present the validation results against the gold standard of HAIs diagnosis of the InNoCBR system deployed in the Ourense University Hospital Complex (Spain). Acting as a totally autonomous system, InNoCBR achieves a HAI sensitivity of 70.83% and a specificity of 97.76%, with a positive predictive value of 77.24%. The kappa index for infection type classification is 0.67. Sensitivity varies depending on infection type, where bloodstream infection attains the best value (93.33%), whereas the respiratory infection could be improved the most (53.33%). Working as a semi-automatic system, InNoCBR reaches a high level of sensitivity (81.73%), specificity (99.47%), and a meritorious positive predictive value (94.33%).

Control of Acinetobacter baumannii outbreak in the neonatal intensive care unit in Latvia: whole-genome sequencing powered investigation and closure of the ward

BackgroundAcinetobacter baumannii is an emerging pathogen capable of causing hospital-acquired infections (HAIs). It has the ability to survive on environmental surfaces for months, making transmission difficult to control. Our report describes the investigation and restriction of an outbreak of A.baumannii in the Neonatal Intensive Care Unit (NICU) using whole-genome sequencing (WGS) and multi-modal infection control measures.MethodsA prospective surveillance of HAIs was initiated in the NICU at the Pauls Stradins Clinical University Hospital (PSCUH) in Latvia on 1/9/2012 and identified an outbreak of A.baumannii. Case definitions for A.baumannii bloodstream infection (BSI) and colonization were implemented; surveillance cultures were obtained from all admitted patients to monitor the rate of colonization; an infection prevention and control team was formed and infection control interventions implemented. Environmental sampling of the NICU and Labour ward was performed. We employed WGS to differentiate phenotypically identical multidrug-resistant A.baumannii (MDRAB) strains from simultaneous intrahospital outbreaks in the adult Intensive Care Unit and NICU.ResultsBetween 1/9/2012 and 31/12/2017 the surveillance included 2157 neonates. A total of 17 neonates had A.baumannii BSI, with the highest rate of 30.0 cases per 1000 bed-days in November 2012. Rectal screening samples were positive for A.baumannii-complex in 182 neonates reaching 119.6 per 1000 bed-days in July 2015. All 298 environmental cultures were negative. Two phenotypically identical MDRAB isolates from the simultaneous intrahospital outbreaks were differentiated using WGS, ruling out an inter-ward transmission. Adherence to stringent infection control measures decreased BSI cases but colonization remained persistent. With several relapses, the outbreak was ongoing for four years. No new A.baumannii BSI cases were registered after total environmental decontamination in the NICU in July 2015. Colonization reappeared and persisted until in November 2016 when the ward was temporarily closed, relocated and renovated. No A.baumannii cases were registered after the renovation.ConclusionThe HAI surveillance system successfully detected and facilitated the control of the A.baumannii outbreak. Whole-genome sequencing was found to be a useful method for differentiation of phenotypically identical A.baumannii strains from the intrahospital outbreak. Only multi-modal infection control program, including closure, temporary relocation, and renovation of the ward, restricted the outbreak.

The Infection Control Risk Assessment and Strategies to Reduce HAIs at Hospital in Yogyakarta Indonesia

&#x0D; &#x0D; &#x0D; Identifying the problem of infection is needed to analyze risk management. One of the tools to manage the risk of Hospital-Acquired Infections (HAIs) is by using the ICRA (Infection Control Risk Assessment). Arranging a risk assessment of infection control is essential to prevent the potential incidence of infection that is not expected. This research analyzes the Infection Control Risk Assessment and reduction strategies of Health-Care-Associated Infections at Hospital in Yogyakarta . The type of analysis was descriptive qualitative with case study approach. The researcher used informants who were involved in the implementation of the prevention and infection with the data control. The researcher also collected data using depth interviews and documents reviews. Risk management process, the findings of risk identification (1) the transmission of infectious diseases, microorganisms through direct and indirect contact, (2) infection, (3) the duration of treatment, delayed homecoming, disability, (4) healthcare workers, patients, visitors, and hospital environments. The highest risk assessment was surgical site infection. The HAIs reduction strategies were taken by breaking the chain of infection, bacterial identifying using HAIs, using the rational antibiotic, optimizing surveillance of HAIs, implementing periodic regular meetings, reporting, cooperating, evaluating, socializing, monitoring and preventing, the reinvigorating the SOP for the type of HAIs. The advice for the management of Hospital is that they need to notice more on the implementation process of the prevention and infection control.&#x0D; &#x0D; &#x0D;

Identifying hospital-acquired infections using retrospective record review from the Irish National Adverse Events Study (INAES) and European point prevalence survey case definitions

Point prevalence surveys (PPSs) collect data on hospital-acquired infections (HAIs) at one point in time but do not provide information on incidence over the entire admission or impact on patients or healthcare resources. Retrospective record review examines the entire admission to determine adverse event prevalence, incidence, preventability, physical impairment and additional length of stay. To establish whether European HAI surveillance definitions can be applied to the Irish National Adverse Events Study (INAES) retrospective record review data to determine HAI burden. In the INAES, 1574 admissions were reviewed using a two-stage methodology and 247 adverse events were found. These were examined against European HAI case definitions to determine whether the event was an HAI. Results were compared with the 2011/12 European PPS data for Ireland. The prevalence of HAI adverse events in INAES was 4.4% (95% confidence interval (CI) 3.1-6.1%) with an incidence of 3.8 (95% CI 2.5-5.2) HAI adverse events per 100 admissions. The PPS HAI prevalence for Ireland was 5.2%. HAI types and micro-organisms were similar in INAES and the PPS. Approximately three-quarters of INAES HAI adverse events were preventable, 7% caused permanent impairment and 7% contributed to death. A mean of 10 additional bed days were attributed to HAI adverse events, equivalent to €9400 per event. Retrospective record review is an accurate source of information on HAI incidence, preventability and impact that complements PPS prevalence rates. HAI adverse events result in higher costs to the healthcare system than other adverse events.

A Study on Hospital Acquired Infections among Patients in a Tertiary Care Hospital of Darjeeling District, West Bengal

Introduction&#x0D; Hospital Acquired Infections (HAI), also called ‘Nosocomial Infections’ are identified at least 48-72 hours following admission to health institution. In many hospitals, HAI appears to be a hidden, cross-cutting problem. Thus a continuous surveillance is imperative for determining the extent of the problem and its effective prevention and control. Present study determines the incidence and different types of hospital acquired infections and the bacterial pathogens responsible for those.&#x0D; Materials and Methods&#x0D; An observational longitudinal study was undertaken during January to June 2014, among 107 patients admitted in ENT wards of North Bengal Medical College and Hospital (NBMCH), selected by consecutive inclusion technique. Information was taken using a predesigned, pretested semi-structured schedule. The collected data were analyzed as frequencies, percentages and means ± standard deviations.&#x0D; Results&#x0D; The present study found incidence rate of hospital acquired infections as 19.6% and incidence density as 26.35 per 1000 patient days. Surgical site infection was commonest type (57.2%) followed by urinary tract infection (23.8%) and blood stream infection (19.0%) respectively. 15.4% of blood cultures, 100.0% of surgical wound swab cultures and 21.7% of urine cultures were positive and gram negative bacteria were most frequently occurring organisms. Most commonly found bacteria were Pseudomonas and Klebsiella.&#x0D; Discussion &#x0D; Background characteristics of the study population; incidence rate, the different types of hospital acquired infections among those admitted patients and the bacterial pathogens responsible for those infections have been discussed along with review of literature.&#x0D; Conclusion&#x0D; Even if in a tertiary health care facility, hospital acquired infection rate could not be brought down into &lt;10%. So implementation of stringent guidelines on prevention of HAI and continuous surveillance and monitoring system can help to diminish this problem in future.

Incidence of hospital-acquired infections following kidney, pancreas or kidney-pancreas transplantations: A surveillance-based study

Background Bacterial hospital-acquired infections (HAI) are frequent complications of the early post-transplantation period. The most frequent infections are urinary tract infection, bacteremia and surgical site infection. The objective was to report the incidence of early HAI among kidney, pancreas or kidney-pancreas transplant recipients in a French university hospital. Methods An active standardized surveillance of HAI among kidney, pancreas or kidney-pancreas recipients was done in a university hospital of 800 beds (Lyon, France). All patients transplanted between October 1, 2013 and December 31, 2016 were followed during their hospital stay or up to 30 days post-transplantation. Data on patient characteristics, invasive devices, transplantation type, outcome in the unit and HAI were recorded. HAI included urinary tract infections, bacteremia, surgical site infections and pneumonia. Only the first infection per site and per patient was analyzed. Incidence rates were expressed per 1000 patient-days with their 95% confidence interval (95% CI). Multivariate Poisson regressions adjusted on gender, age, ASA score, transplantation type and time period were fitted to assess the risk of HAI. Results Overall, 568 transplanted patients accounting for 8800 patients-days were analyzed (489 kidney, 12 pancreas and 67 kidney-pancreas transplantation). Mean age was 51 years (range 19–80 y), 61% were men, mean BMI was 25 (range 15–38). Seven patients deceased (1%, none because of infection) and 50 undergone a revised surgery (4 for infectious complications); 17 grafts were removed (1 for infection). Mean length of stay, length of urinary catheterization and central venous catheterization were respectively 18 days (+14), 8 days (+6), and 10 days (+8). Donor type was living-related donor, unrelated living donor, brain death donor and cardiac arrest donor for respectively 10%, 3%, 77% and 59% of transplanted patients. Concerning deceased donor, preservation solution was contaminated for 39% of cases, with negative coagulase Staphylococcus identified in 59% of them. HAI incidence was 10.2 (95% CI: 7.2–11.3; N = 80) per 1000 patient-days, without difference according to the transplantation type (adjusted incidence rate ratio [aIRR] = 1.37; 95% CI: 0.71–2.65) in kidney vs. kidney-pancreas or pancreas recipients or time period (aIRR = 0.90; 95% CI: 0.80–1.02, per 1 semester). The 3 most frequent causative microorganisms were Escherichia coli (29%), Enterococcus faecalis (16%) and Enterobacter cloacae (13%). Enterobacteriaceae were found in 53% of HAI and 57% of them were resistant to third generation cephalosporin. Incidences of urinary tract infections, bacteremia and pneumonia were respectively 6.0 (95% CI: 4.6–7.8; N = 58), 2.4 (95% CI: 1.5–3.5; N = 23) and 0.7 (95% CI: 0.3–1.4; N = 7), without differences according to transplantation type after multivariate analysis. Surgical site infections concerned 3% of patients (incidence: 1.7; 95% CI: 1.0–2.7; N = 16) with higher incidence in kidney-pancreas or pancreas compared with kidney recipients (aIRR = 14.20; 95% CI: 3.31–60.85). Conclusion Fourteen percent of kidney and/or pancreas transplanted patients had developed at least one HAI during post-transplantation hospitalization. The most frequent type of HAI was urinary tract infection and the most frequent microorganism involved was Escherichia coli. Incidence rates varied according to infection site and according to transplantation type for SSI. Detailed description of HAI among those patients will help for preventive measures including antibiotic prophylaxis.