Incidence Rates Of Healthcare-associated Infections Research Articles

Data quality review of the Brazilian nosocomial infections surveillance system

BackgroundSurveillance of healthcare-associated infections (HAIs) is an essential component of hospital infection prevention and control systems. We aimed to assess the quality of the data compiled by the Brazilian HAI Surveillance System from pediatric (PICUs) and neonatal intensive care units (NICUs), between 2012 and 2021. MethodsData Quality Review, including adherence, completeness, internal consistency, consistency over time, and consistency of population trend, were computed at both national and state levels based on quality metrics from World Health Organization Toolkit. Incidence rates (or incidence density) of ventilator-associated pneumonia (VAP) and central line-associated bloodstream infection (CLABSI) were obtained from the Brazilian National Nosocomial Infections Surveillance (NNIS) system. Data on sepsis-related mortality, spanning the period from 2012 to 2021, were extracted from the Brazilian National Health Service database (DATASUS). Additionally, correlations between sepsis-related mortality and incidence rates of VAP or CLABSI were calculated. ResultsThroughout the majority of the study period, adherence to VAP reporting remained below 75%, exhibiting a positive trend post-2016. Widespread outliers, as well as inconsistencies over time and in population trends, were evident across all 27 states. Only four states maintained consistent adherence levels above 75% for more than 8 years regarding HAI incidence rates. Notably, CLABSI in NICUs boasted the highest reporting adherence among all HAIs, with 148 periods out of 270 (54.8%) exhibiting reporting adherence surpassing 75%. Three states achieved commendable metrics for CLABSI in PICUs, while five states demonstrated favorable results for CLABSI in NICUs. ConclusionsWhile adherence to HAI report is improving among Brazilian states, an important room for improvement in the Brazilian NNIS exists. Additional efforts should be made by the Brazilian government to improve the reliability of HAI data, which could serve as valuable guidance for hospital infection prevention and control policies.

Healthcare‑associated infections in intensive care unit patients with and without COVID-19: a single center prospective surveillance study

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic led to a global increase in healthcare-associated infections (HAI) among intensive care unit (ICU) patients. Whether this increase is directly attributable to COVID-19 or whether the pandemic indirectly (via staff shortages or breaches in infection prevention measures) led to this increase, remains unclear. The objectives of this study were to assess HAI incidence and to identify independent risk factors for HAI in COVID-19 and non-COVID-19 ICU patients.MethodsWe established a monocentric prospective HAI surveillance in the medical ICU of our tertiary care center from September 1st 2021 until August 31st 2022, during circulation of the SARS-CoV-2 delta and omicron variants. We consecutively included patients ≥ 18 years of age with an ICU length of stay of > 2 calendar days. HAI were defined according to the European Centre for Disease Prevention and Control definitions. HAI rate was calculated per 1,000 patient-days or device-days; risk ratios (RR) and corresponding 95% confidence intervals (CI) for COVID-19 versus non-COVID-19 patients were calculated. We used multivariable Cox regression to identify independent risk factors for HAI. As a proxy for institutional COVID-19 burden, weekly COVID-19 density (i.e. percentage of COVID-19 patients among all ICU patients) was included in the model as time-dependent co-variable.ResultsWe included 254 patients, 64 (25.1%) COVID-19 and 190 (74.9%) non-COVID-19 patients; 83 HAI in 72 patients were recorded, thereof 45 ventilator-associated lower respiratory tract infections (VA-LRTI) (54.2%) and 18 blood stream infections (BSI) (21.6%). HAI incidence rate was 49.1/1,000 patient-days in COVID-19 and 22.5/1,000 patient-days in non-COVID-19 patients (RR 2.2, 95%-CI 1.4–3.4). This result was mainly due to different VA-LRTI rates (40.3 vs. 11.7/1,000 ventilator days, p < 0.001), whereas BSI rates were not statistically different (9.4 vs. 5.6/1,000 patient days, p = 0.27). Multivariable analysis identified COVID-19 as main risk factor for HAI development, whereas age, mechanical ventilation and COVID-19 density were not significant.ConclusionsThese data from the fourth and fifth wave of the pandemic show a higher HAI incidence in COVID-19 than in non-COVID-19 ICU patients, mainly due to an increase in pulmonary infections. A diagnosis of COVID-19 was independently associated with HAI development, whereas institutional COVID-19 burden was not.

Optimization of Monitoring of Nosocomial Infections in Hospitals of the Republic of North Ossetia–Alania

Introduction: Optimization of epidemiological and microbiological monitoring of nosocomial infections at the regional level will contribute to limiting circulation and spread of pathogens and improving preventive measures on the territory of the Russian Federation. Objective: To determine directions of optimization of epidemiological and microbiological monitoring of healthcare-associated infections in surgery departments and intensive care units of hospitals of the Republic of North Ossetia – Alania. Materials and methods: We carried out a retrospective epidemiological analysis of the incidence of nosocomial infections and results of microbiological monitoring conducted in surgery departments and intensive care units of ten multidisciplinary hospitals of the Republic of North Ossetia – Alania in 2015–2019. We also examined data on evaluation of preventive measures, infection control, and compliance with criteria of internal quality control and safety in health care. Results: According to the results of routine surveillance and specially organized epidemiological and microbiological monitoring, the incidence rates of healthcare-associated infections were 0.85 and 26.4 per 1,000 inpatients in surgery departments and intensive care units of hospitals of the Republic of North Ossetia – Alania, respectively. The incidence rates of certain types of nosocomial infections were statistically different (p ≤ 0.05) depending on the type of monitoring (routine/optimized): surgical site infections – 15.9/132.8 per 1,000 surgeries, catheter-associated urinary tract infections – 8.5/69.4 per 1,000 catheter days, central line-associated bloodstream infections – 7.74/89.12 per 1,000 catheter days, and ventilator-associated pneumonia – 8.12/39.74 per 1,000 ventilator days. K. pneumoniae strains isolated from surgery and intensive care patients and exhibiting extreme resistance to antimicrobial drugs belong to sequence type 1082, possess a high pandemic potential, and are widespread in many countries. According to the results of assessing compliance with the criteria of internal quality control and safety of health care, only three of ten hospitals in the Republic of North Ossetia – Alania had the compliance rate ≥ 70 %. As for the readiness for infection prevention and control in surgery departments and intensive care units, 60 % of the hospitals demonstrated a basic level and 40 % – an intermediate level of measures taken. Conclusions: Optimization of approaches to tracing healthcare-associated infections in the hospitals of the Republic of North Ossetia – Alania helped establish that actual incidence rates of nosocomial infections were on the average 26.4 times higher than those officially registered based on the results of routine surveillance.

Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India.

Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children's hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13-21.52)] and 18.36% (CI 16.05-20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98-10.08) to 9.8% (95% CI 9.78-13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

National healthcare-associated infections surveillance programs: A scoping review.

National surveillance of healthcare-associated infections (HAIs) is necessary to identify areas of concern, monitor trends, and provide benchmark rates enabling comparison between hospitals. Benchmark rates require representative and large sample sizes often based on pooling of surveillance data. We performed a scoping review to understand the organization of national HAI surveillance programs globally. The search strategy included a literature review, Google search and personal communications with HAI surveillance program managers. Thirty-five countries were targeted from four regions (North America, Europe, United Kingdom and Oceania). The following information was retrieved: name of surveillance program, survey types (prevalence or incidence), frequency of reports, mode of participation (mandatory or voluntary), and infections under surveillance. Two hundred and twenty articles of 6,688 identified were selected. The four countries with most publications were the US (48.2%), Germany (14.1%), Spain (6.8%) and Italy (5.9%). These articles identified HAI surveillance programs in 28 of 35 countries (80.0%), operating on a voluntary basis and monitoring HAI incidence rates. Most HAIs monitored surgical site infections in hip (n=20, 71.4%) and knee (n=19, 67.9%) and Clostridoides difficile infections (n=17, 60.7%). Most countries analyzed have HAI surveillance programs, with characteristics varying by country. Patient-level data reporting with numerators and denominators is available for almost every surveillance program, allowing for reporting of incidence rates and more refined benchmarks, specific to a given healthcare category thus offering data that can be used to measure, monitor, and improve the incidence of HAIs.

Results of Epidemiological and Microbiological Monitoring of Healthcare- Associated Infections in the Republic of North Ossetia–Alania

Introduction: The complex of exogenous and endogenous risk factors in multidisciplinary hospitals creates conditions for the development of nosocomial infections induced by ESKAPE pathogens. Objective: To establish epidemiological features and etiological significance of antibiotic resistant strains of the leading pathogens inducing hospital-acquired infections and to determine their prevalence in multidisciplinary clinics of the Republic of North Ossetia–Alania. Materials and methods: We analyzed the incidence of nosocomial infections and results of the microbiological monitoring of antimicrobial drug resistance in leading pathogens for the years 2012–2021. Detection of genes encoding the production of metallo-β-lactamases was performed in P. aeruginosa strains, extended-spectrum β-lactamases and PFGE profiles of E. coli and K. pneumoniae strains. Results: In the Republic of North Ossetia–Alania, the average long-term incidence rate of hospital-acquired infections in the study period was 0.74 per 1,000 inpatients. We established that 44.2 % of all such cases were diagnosed in surgical departments, 32.4 % – in maternity departments, 6.6 % – in pediatric departments, and 16.8 % – in other clinical departments. The average long-term incidence rate of nosocomial infections was the highest (0.85 per 1,000 patients) in departments of surgery, the most prevalent being surgical and injection site infections, lower respiratory tract and urinary tract infections. The leading pathogens in the etiological structure were Enterobacteriaceae spp., P. aeruginosa and Staphylococcus spp. The incidence rates estimated based on microbiological monitoring results were on average 2.5 times higher than those registered within the routine surveillance system. Conclusions: Incidence rates of healthcare-associated infections in the Republic of North Ossetia–Alania are comparable to those in the Russian Federation. Patients of surgery departments are at higher risk for nosocomial infections. Optimization of preventive measures requires a risk-based approach that takes into account in-depth microbiological monitoring data on the most common pathogens resistant to drugs of choice in local hospitals.

Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018

SummaryIntroductionSurveillance of health care-associated infections (HAIs) is an essential part of an efficient healthcare system. This study is an update on incidence and mortality rates of HAIs in Iran in 2018.MethodsAlmost all hospitals across the country (940 hospitals) entered the data of HAIs and denominators to the Iranian Nosocomial Infections Surveillance (INIS) software. Statistics were derived from INIS.ResultsFrom 9,607,213 hospitalized patients, 127,953 suffered from HAI, 15.65% of whom died. The incidence rate of HAI was calculated as 4.2 per 1000 patient-days. Considering relative frequencies among HAIs, Pneumonia (29.1%) and UTIs (25.6%) were the most common types of infection. Ventilator-associated pneumonia (VAP) was the most frequent device-associated infection (DAI) 25.66 per 1000 ventilator-days, and had the highest mortality rate (43.08%). Incidence density of other DAIs was 5.43 for catheter-associated UTI and 2.86 for catheter-associated BSI per 1000 device-days. Medical ICUs had the highest incidence and percentage of deaths (15.35% and 37.63%, respectively). The most causative organisms were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumonia. The rate of methicillin-resistance Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria was about 49%, 57%, and 58% respectively.ConclusionThis study provided an overview of HAIs in Iran and indicated that HAIs required special attention both in detection/reporting and in infection control measures. Future studies could be done on adherence rate of DAIs’ preventive bundles, interventions via multimodal strategies, evaluating the effect of training, and effect of antibiotic stewardship programs.

Incidence of hospital acquired infections in paediatric emergency unit–A one year longitudinal observational study

Background: Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality in critically ill children. This prospective surveillance study was performed to estimate the burden of HAIs in a paediatric emergency department of a tertiary care hospital. Objectives: First, to know the incidence rate of HAIs in patients admitted to pediatric emergency and second, to isolate and identify bacteria causing HAIs with special emphasis on their antibiotic sensitivity. Methods: The prospective study was conducted in a fourteen-bedded paediatric emergency of a tertiary care hospital for one year. Patients were assessed daily during their stay in emergency ward. Data pertaining to device usage, length of stay (LOS), antibiotic usage, clinical outcome was recorded for the patients admitted for more than 48 hours. On clinical suspicion of HAI appropriate samples were investigated for bacterial infection and their antibiotic susceptibility was analysed. Statistical analysis was expressed in percentages and outcome variables were calculated using Mann Whitney U test. Results: Of the 410 patients, 5 patients developed 8 episodes of HAI with crude incidence rate (CIR) of 1.95%. Ventilator associated pneumonia (VAP) was the commonest HAI. The mean LOS of patients with HAI was 49.8 + 30.73 days. Gram negative bacilli were the most common isolated pathogens in the HAI subset. Multidrug resistance trait was seen in most of the isolates. Conclusions: Low CIR in the study population can be attributed to aggressive initial empirical antibiotic management of all patients and limited stay in emergency unit. In congruence with other studies, mean LOS of HAI patients was very high. Key Message: Prevention of HAI is a team work, wherein each health care provider should follow the hospital protocol. Length of hospital stay and instrumentation were found to be the major risk factors for HAI. Microbiology laboratory support facilitates timely identification of the pathogen and an effective management of HAI.

Economic burden attributable to healthcare-associated infections in tertiary public hospitals of Central China: a multi-centre case-control study.

Healthcare-associated infection (HAI) is a major cause of morbidity, mortality and cost, which vary widely by region and hospital. In this case-control study, we calculated losses attributable to HAI in central China. A total of 2976 patients in 10 hospitals were enrolled, and the incidence rate of HAI (range, 0.88-4.15%) was significantly, but negatively associated with the cost per 1000 beds of its prevention (range, $24 929.76-$53 146.41; r = -0.76). The per capita economic loss attributable to HAIs was $2047.07 (interquartile range, $327.63-$6429.17), mainly from the pharmaceutical cost (median, $1044.39). The HAIs, which occurred in patients with commercial medical insurance, affected the haematologic system and caused by Acinetobacter baumannii, contributed most to the losses (median, $3881.55, $4734.20 and $9882.75, respectively). Furthermore, the economic losses attributable to device-associated infections and hospital-acquired multi-drug resistant bacteria were two to four times those of the controls. The burden attributable to HAI is heavy, and opportunities for easing this burden exist in several areas, including that strengthening antibiotic stewardship and practicing effective bundle of HAI prevention for patients carrying high-risk factors, for example, elders or those with catheterisations in healthcare institutions, and accelerating the medical insurance payment system reform based on diagnosis-related groups by policy-making departments.

Incidence rate of Healthcare Associated Infections in a COVID-19 Intensive Care Unit

BackgroundIntensive Care Units (ICU) faced a high pressure under the COVID-19 pandemic. It is recognized that patients admitted in these wards are more susceptible to Healthcare Associated Infections (HAIs). This study aims at comparing the incidence of HAIs in a COVID-19 ICU to a No-COVID ward.MethodsA retrospective cohort study including patients admitted to the ICU of the Teaching Hospital Policlinico Umberto I in Rome from April 2020 to March 2021 was performed. Data on age, gender, hospitalization, different types of devices (ventilation, central venous and urinary catheter), number and type of device-related HAI were collected. Statistical analyses were performed with Episheet and STATA 13.ResultsOut of 347 patients admitted in the ICUs, 329 were included in the study (217 had COVID-19 and 112 had not). In the COVID-19 group, patients were mainly male (69.58%) with a mean age of 62.5±13.5 years, whereas the other group was slightly older (63.2±16.2 years) and more balanced between the two sexes (52.68% male). A total of 133 patients developed at least one HAI, 94 of which were SARS-CoV-2 positive. Globally, 246 HAIs were diagnosed: 163 occurred in the COVID group and 83 in the No-COVID one. The cumulative days of hospitalization were 3233 for the COVID group and 2134 for the No-COVID. The incidence of HAI considered for 1000 days of hospitalization among COVID patients was 50.42 (IC 95%: 42.97-58.78), compared to 38.89 (IC 95%: 30.98-48.22) for the No-COVID one, for an incidence rate ratio of 1.30 (IC 95%: 0.99-1.71).ConclusionsEven though the confidence interval contains the value 1, the results point out that there is an increase in the incidence rate of HAI among COVID-19 patients. Further investigations are needed to better understand the reasons behind the present findings.Key messages Patients admitted to Intensive Care Units are more susceptible to Healthcare Associated Infections. Our study aims at describing the impact of COVID-19 on the risk of developing such conditions.Being infected with COVID-19 leads to an increase in the incidence rate of Healthcare Associated Infections. Further studies are needed to understand the underlying reasons.

Estimated incidence rate of healthcare-associated infections (HAIs) linked to laundered reusable healthcare textiles (HCTs) in the United States and United Kingdom over a 50-year period: Do the data support the efficacy of approved laundry practices?

Estimated incidence rate of healthcare-associated infections (HAIs) linked to laundered reusable healthcare textiles (HCTs) in the United States and United Kingdom over a 50-year period: Do the data support the efficacy of approved laundry practices?

Prospective Surveillance of Healthcare-Associated Infections in Residents in Four Long-Term Care Facilities in Graz, Austria.

Healthcare-associated infections (HCAI) are a common cause for residents’ mortality and morbidity associated with a significant socio-economic burden. Data on HCAIs in Austrian long-term care facilities are scare. Therefore, we evaluated the incidence rate of HCAIs per 1000 resident days in four LTC facilities in Graz, Austria, characterized the spectrum of HCAIs and the use of antimicrobial substances. We conducted a prospective surveillance study from 1 January to 31 December 2018 in four LTCFs of the Geriatric Health Centre of the City of Graz (total of 388 beds). Nursing staff collected data on HCAIs once a week using an electronic reporting system. During the 12-month surveillance period, 252 infections of 165 residents were recorded. The overall incidence rate of HCAIs was 2.1 per 1000 resident days. Urinary tract infections were the most commonly recorded HCAIs (49%, 124/252, 1.03 per 1000 resident days), followed by skin and soft tissue infections and respiratory tract infections. Beta-lactams (ATC class J01C) were prescribed most frequently (63/212), followed by fluoroquinolones (J01M; 54/212). In conclusion, the overall incidence rate for HCAIs was relatively low at 2.1 per 1000 resident days. Our real-life data can serve as a basis for future antimicrobial stewardship and infection prevention interventions.

Chlorhexidine Wipes to Reduce Multidrug-Resistant Gram-negative Bacterial Colonization and Healthcare-associated Infections among Medical Inpatients: A Cluster-Randomized Trial

Objective: To evaluate efficacy of chlorhexidine gluconate (CHG) to decolonize multidrug-resistant (MDR) gram-negative bacilli (GNB) bacteria, and to reduce healthcare associated infections (HAIs) in general medical inpatients. Materials and Methods: A 1-year, cluster-randomized study was conducted in a university hospital-based general medical unit. Eligible patients were randomized by study ward for routine daily and extra wiping with non-rinsed CHG-cloths (CHG group, n=145) or rinsed, non-medicated soap bath (control group, n=145), consecutively to the end of study. Study nurses received training and audits per CHG protocol. In all participants, axillae, groins, and perianal area were sampled to detect GNB colonization, on day 4 to 7 and day 11 to 14 of admission, by surveillance culture. All were followed for incidence rates of HAIs to day 14 of the study, or study exclusion. Results: MDR GNB colonization were significantly lower in CHG group than those of control group, both day 4 to 7 (15.9% versus 43.4%, respectively, p&lt;0.01), and day 11 to 14 of admission (20.6% versus 65.4%, respectively, p&lt;0.01). The incidence rates of overall HAIs did not differ between groups (5.80 versus 7.10 episodes per 1,000 patient-day, respectively, p=0.84). Three patients developed minor skin irritation in CHG group. Discussion: To the investigators’ knowledge, the present study is the first to demonstrate significant CHG reduction of MDR GNB colonization among medical patients in non-critical care unit. Use of non-rinsed CHG bath, personnel training, and audits, may maintain adequate skin concentration of CHG, and lower risk of cross-transmission. To effectively reduce HAIs, combined CHG bath and bundle of care may be required. Conclusion: Non-rinsed chlorhexidine baths are safe, well-tolerated, and effective to reduce MDR gram-negative bacterial colonization among general medical inpatients, and possible to lower risk of subsequent HAIs and cross-transmission, by day 14 of admission. Keywords: Multidrug-resistant gram-negative bacilli, Chlorhexidine bath, Decolonization, Healthcare associated infections, General medical inpatients

Pilot Survey for National Point Prevalence Study of Healthcare-Associated Infections in Acute-Care Hospitals in South Korea

Background: The Korean National Healthcare-Associated Infections Surveillance System (KONIS) was established to conduct nationwide surveillance of device-associated healthcare-associated infections (HAIs) and surgical site infections annually in 2006. However, no surveillance on overall HAIs has been conducted. Objective: We conducted a point-prevalence survey of total HAIs to estimate the incidence rate of HAIs in acute-care hospitals in South Korea. Methods: We defined HAIs according to KONIS and NHSN criteria. In total, 29 acute-care hospitals including 9 tertiary-care hospitals (TCHs) and 20 secondary-care hospitals (SCHs) were recruited as representing the population of every metropolitan city and province in South Korea. Patients who stayed at the hospitals on August 1, 2018, were randomly selected: 100 for SCHs and 200 for TCHs. Their medical records were retrospectively reviewed for HAIs according to the NHSN criteria by the infection control nurses (ICNs) from each hospital. A web-based data collection and analysis program was developed, and participating ICNs were educated in a 1-day training course with pre- and postevaluations. They received continuous feedback of input data and questions through the web-based system during the study. To generate estimates of the incidence rate of HAIs, we converted prevalence to incidence using the formula of Rhame and Sudderth. Results: Of 4,296 patients, 133 had ≥1 HAI (3.1%). In total, 141 HAIs were identified: gastrointestinal infections (n = 30, 21.3%), bloodstream infections (n = 30, 21.3%), pneumonia (n = 29, 20.6%), urinary tract infection (n =26, 18.4%). Among the gastrointestinal infections, C. difficile infections were the most common (17.7%). Device-associated infections accounted for 34.8% of all HAIs. The overall incidence of HAIs in TCHs was 4.39%, which was a higher incidence than SCHs (3.76%). Intensive care units had 12.6% of HAIs, whereas general wards had 3.4%. HAI incidences were 5.7%, 2.8%, and 2.3%, respectively, for each of the medical wards, surgical wards, and pediatric wards. The 3 most common pathogens were Escherichia coli, Acinetobacter baumannii, and Enterococcus faecium. Conclusions: The prevalence of HAI in Korea is lower than in most Western countries. The HAI burden of Clostridium difficile infection is surprisingly high, which calls for prompt control at the national level. To obtain national-level data on HAI burdens, ongoing surveillance is needed.Funding: NoneDisclosures: None

Reduced Incidence of Healthcare-associated Infections in a Long-term Care Facility by Converting to Automated Touchless Dispensing and Closed-refill Systems

Background Automated touchless dispensing and closed-refill systems minimize touch points that help prevent cross contamination events and reduce dispenser contamination with clinically significant pathogens in healthcare settings. Additionally, most consumers prefer touchless dispensing when using public restrooms. However, many healthcare settings still utilize manual dispensers for soap and sanitizer. Some even have open, bulk, refillable dispensing systems and manual pumps and dispensers. A finding of a clinical in-use study revealed a significant reduction in the incidence of healthcare associated infections (HAIs) following the conversion to automated touchless soap and sanitizer dispensing systems with premeasured dosage amounts in a long-term care (LTC) care facility. Methods A LTC facility was qualified as a testing site for clinical in-use study of hand hygiene (HH) products’ impact on healthcare workers’ (HCWs) hands. The facility replaced all HH manual dispensing systems and locally purchased hygiene products with automated touchless dispensers, closed-refill systems, and quality formulations. In addition to the biophysical measurements of HCWs hands using bioengineering instrumentation, the baseline incidence of HAIs was recorded prior to the intervention and surveillance continued from 2014 to 2018. HAI rates provided by the testing site were compared to the baseline data collected in 2014 with specific emphasis on the infection outbreak season from October to December in each year. Results Descriptive data analysis of HAI incidence rates revealed significant and sustained reduction in HAI rates from 6.7% in October through December of 2014 to 1.6 % the same period in 2015, 2.8 % in 2016 and 2.4 % in 2017. Conclusions Converting the HH framework from manual dispensing to automated touchless dispensing with closed refill systems during a clinical-in-use study resulted in a sustained reduction of HAI rates over a 3-year period. Increased awareness of HH, touchless hygienic dispensing systems, and HCW improved skin integrity are variables to consider for HAI reduction. Automated touchless dispensing and closed-refill systems minimize touch points that help prevent cross contamination events and reduce dispenser contamination with clinically significant pathogens in healthcare settings. Additionally, most consumers prefer touchless dispensing when using public restrooms. However, many healthcare settings still utilize manual dispensers for soap and sanitizer. Some even have open, bulk, refillable dispensing systems and manual pumps and dispensers. A finding of a clinical in-use study revealed a significant reduction in the incidence of healthcare associated infections (HAIs) following the conversion to automated touchless soap and sanitizer dispensing systems with premeasured dosage amounts in a long-term care (LTC) care facility. A LTC facility was qualified as a testing site for clinical in-use study of hand hygiene (HH) products’ impact on healthcare workers’ (HCWs) hands. The facility replaced all HH manual dispensing systems and locally purchased hygiene products with automated touchless dispensers, closed-refill systems, and quality formulations. In addition to the biophysical measurements of HCWs hands using bioengineering instrumentation, the baseline incidence of HAIs was recorded prior to the intervention and surveillance continued from 2014 to 2018. HAI rates provided by the testing site were compared to the baseline data collected in 2014 with specific emphasis on the infection outbreak season from October to December in each year. Descriptive data analysis of HAI incidence rates revealed significant and sustained reduction in HAI rates from 6.7% in October through December of 2014 to 1.6 % the same period in 2015, 2.8 % in 2016 and 2.4 % in 2017. Converting the HH framework from manual dispensing to automated touchless dispensing with closed refill systems during a clinical-in-use study resulted in a sustained reduction of HAI rates over a 3-year period. Increased awareness of HH, touchless hygienic dispensing systems, and HCW improved skin integrity are variables to consider for HAI reduction.

Healthcare-associated infection prevention and control management in a tertiary hospital and an overall evaluation.

Healthcare-associated infection (HAI) is a crucial factor influencing medical quality. Studies about HAI management situations are rare, especially for the Inner Mongolia region of China. Therefore, this study aimed to investigate management procedures and the overall evaluation of HAI in order to inform HAI management improvement more scientifically. A questionnaire was used to investigate HAI-related prevention and control indicators in tertiary hospitals in the Inner Mongolia region from July 2018 to June 2019. The survey showed that the mean incidence rate of HAI was 3.79%. The mean rate of hand hygiene compliance of healthcare workers (HCWs), inpatient's antibiotics-use rate, and the detection of the antibiotic ratio before therapy was 54.34%, 34.33%, and 25.40%, respectively. The mean of the surgical site infection (SSI) rate of the level I incision and the preventive antibiotics-use ratio of the level I incision was 1.31% and 28.89%, respectively. The mean of the multi-drug resistant organism (MDRO) infection rate was 0.40% and the mean of the MDRO detection rate was 18.55%. The mean of the central line-associated bloodstream infection rate was 2.24%, the ventilator-associated pneumonia (VAP) rate was 11.17%, and the catheter-associated urinary tract infection (CAUTI) rate was 1.95‰. As for the overall evaluation, 19 (35.85%) hospitals had a bad grade, 18 (33.96%) hospitals had a medium grade, and 16 (30.19%) hospitals had a good grade. The incidence rate of HAI in tertiary hospitals in the Inner Mongolia region is higher than the national level. Also, the overall evaluation of bad-grade hospitals and their deficiencies should be used as an example to improve the HAI management level.

Increased financial burdens and lengths of stay in patients with healthcare-associated infections due to multidrug-resistant bacteria in intensive care units: A propensity-matched case-control study.

Background and objectivesIncidence rates of healthcare-associated infections (HAIs) depend upon infection control policy and practices, and the effectiveness of the implementation of antibiotic stewardship. Amongst intensive care unit (ICU) patients with HAIs, a substantial number of pathogens were reported to be multidrug-resistant bacteria (MDRB). However, impacts of ICU HAIs due to MDRB (MDRB-HAIs) remain understudied. Our study aimed to evaluate the negative impacts of MRDB-HAIs versus HAIs due to non-MDRB (non-MRDB-HAIs).MethodsAmong 60,317 adult patients admitted at ICUs of a 2680-bed medical centre in Taiwan between January 2010 and December 2017, 279 pairs of propensity-score matched MRDB-HAI and non-MRDB-HAI were analyzed.Principal findingsBetween the MDRB-HAI group and the non-MDRB-HAI group, significant differences were found in overall hospital costs, costs of medical and nursing services, medication, and rooms/beds, and in ICU length-of-stay (LOS). As compared with the non-MDRB-HAI group, the mean of the overall hospital costs of patients in the MDRB-HAI group was increased by 26%; for categorized expenditures, the mean of costs of medical and nursing services of patients in the MDRB-HAI group was increased by 8%, of medication by 26.9%, of rooms/beds by 10.3%. The mean ICU LOS in the MDRB-HAI group was increased by 13%. Mortality rates in both groups did not significantly differ.ConclusionsThese data clearly demonstrate more negative impacts of MDRB-HAIs in ICUs. The quantified financial burdens will be helpful for hospital/government policymakers in allocating resources to mitigate MDRB-HAIs in ICUs; in case of need for clarification/verification of the medico-economic burdens of MDRB-HAIs in different healthcare systems, this study provides a model to facilitate the evaluations.

Surveillance of healthcare-associated infections in a Tunisian university hospital

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

Analysis of the incidence of newborn's healthcare associated infections and intrauterine infections in several maternity hospitals in Moscow

Purpose of the study. To estimate the incidence of newborn's healthcare associated infections (HAI) and intrauterine infections in the Russian Federation, Moscow and three maternity hospitals in Moscow. Materials and methods. The retrospective epidemiological analysis of neonates HAIs and intrauterine infections during 2008–2017 was performed in the Russian Federation and Moscow and during 2009–2017 in three maternity hospitals (MH) in Moscow. In this study the maternity hospitals would be known as MH № X01, № X02 and № X03. Also, in this study, the calculation and analysis of the proportion of cases of newborn's HAIs and intrauterine infections with laboratory confirmation were performed in Moscow's maternity hospitals. The data was selected from Form № 2 for the Russian Federation and Moscow. Also, the data of the maternity hospitals was drawn from the base of the Hygiene and Epidemiology Center in Moscow. The morbidity rate of HAIs and intrauterine infections of newborns was counted on 1,000 newborns. Microsoft Office Excel 2010 software packages were used for this purpose. The calculation of the increase / decrease rate was made by the method of least squares. Results. The incidence of intrauterine infections and HAIs of newborns in the Russian Federation, Moscow, and maternity hospitals is characterized by the next mutual trends – a significant dominance cases of intrauterine infections' over the cases of HAI, extremely irregular registration and distribution of the nosologies' proportion. Concerning to the dynamics of morbidity during 2009–2017 in maternity hospitals in Moscow, the HAIs newborn's incidence has tendency of decline, and intrauterine infections has considerable increase of the incidence. This consistent pattern is observed in all described maternity hospitals. The structure of the incidence in maternity hospitals is similar to each other. The leading diagnoses among intrauterine infections are intrauterine infection without a lesion and intrauterine pneumonia. The interest of other infections is about 1%. The proportion of cases with laboratory confirmation of the newborn's HAIs and intrauterine infections is extremely small. Besides that, there were identified some indirect signs of poor-quality registration of nosocomial infections. Conclusion. Significant difference in the number of cases of newborn's HAIs and intrauterine infections and their multidirectional incidence trends, once again point to the concealment of a part of nosocomial infections, under such diagnoses, as intrauterine infection without a lesion and intrauterine pneumonia. Laboratory confirmation of cases of HAIs and intrauterine infections in the maternity hospitals is carried out only by a small proportion of patients. Thereby, the incidence rates of HAIs of newborns and intrauterine infections in maternity hospitals in Moscow raise doubts about their reliability.

Incidence of healthcare-associated infections in a tertiary hospital in Beijing, China: results from a real-time surveillance system

BackgroundTo quantify the five year incidence trend of all healthcare-associated infections (HAI) using a real-time HAI electronic surveillance system in a tertiary hospital in Beijing, China.MethodsThe real-time surveillance system scans the hospital’s electronic databases related to HAI (e.g. microbiological reports and antibiotics administration) to identify HAI cases. We conducted retrospective secondary analyses of the data exported from the surveillance system for inpatients with all types of HAIs from January 1st 2013 to December 31st 2017. Incidence of HAI is defined as the number of HAIs per 1000 patient-days. We modeled the incidence data using negative binomial regression.ResultsIn total, 23361 HAI cases were identified from 633990 patients, spanning 6242375 patient-days during the 5-year period. Overall, the adjusted five-year HAI incidence rate had a marginal reduction from 2013 (4.10 per 1000 patient days) to 2017 (3.62 per 1000 patient days). The incidence of respiratory tract infection decreased significantly. However, the incidence rate of bloodstream infections and surgical site infection increased significantly. Respiratory tract infection (43.80%) accounted for the most substantial proportion of HAIs, followed by bloodstream infections (15.74%), and urinary tract infection (12.69%). A summer peak in HAIs was detected among adult and elderly patients.ConclusionsThis study shows how continuous electronic incidence surveillance based on existing hospital electronic databases can provide a practical means of measuring hospital-wide HAI incidence. The estimated incidence trends demonstrate the necessity for improved infection control measures related to bloodstream infections, ventilator-associated pneumonia, non-intensive care patients, and non-device-associated HAIs, especially during summer months.