Point Prevalence Survey Of Healthcare-associated Infections Research Articles

Planning and executing a national point prevalence study: a blueprint for the future.

Healthcare-associated infections (HAIs) are a significant risk for patients and a burden on the health system. In 2021, the Te Tāhū Hauora Health Quality & Safety Commission New Zealand Infection Prevention and Control Team undertook a national HAI point prevalence survey (PPS) across all 20 district health boards (DHBs). We describe the process that was undertaken to plan for and execute the PPS. The key stages of this project were planning, communication and engagement, piloting and then refining the process, training surveyors, delivering the full PPS, and finally, data analysis and reporting. Support for the PPS was received at a national level from clinical and non-clinical management. The sharing of this information may support other health provider groups to use similar methodology to better understand the epidemiology of both infectious and non-infectious diseases locally. It provides a useful planning strategy for those considering similar surveys.

National point-prevalence survey of healthcare-associated infections and antimicrobial use: UK-PAS/UKHSA joint call to action for all paediatric services.

The negative impact of high antimicrobial use (AMU), antimicrobial resistance and healthcare-associated infections (HCAIs) on children is concerning. However, a lack of available paediatric data makes it challenging to design and implement interventions that would improve health outcomes in this population, and impedes efforts to secure additional resources. The upcoming 2023 national point-prevalence survey of HCAIs and AMU in hospitals, led by the UK Health Security Agency, is an opportunity to collect valuable information, which will enable healthcare providers and policy makers to optimize antimicrobial stewardship and infection prevention practices in all populations, including children. These data will facilitate benchmarking and sharing of best practice, internally, nationally and internationally. This is a joint call to action asking all healthcare professionals-particularly in paediatrics-to nominate a lead for their institution and participate in this survey, to ensure appropriate paediatric representation, and help protect children from these growing threats.

Healthcare-associated infections and antimicrobial use in surgical wards of a large urban central hospital in Blantyre, Malawi: a point prevalence survey

SummaryBackgroundThere are limited data on healthcare-associated infections (HAI) from African countries like Malawi.AimWe undertook a point prevalence survey of HAI and antimicrobial use in the surgery department of Queen Elizabeth Central Hospital (QECH) in Malawi and ascertained the associated risk factors for HAI.MethodsA cross-sectional point prevalence survey (PPS) was carried out in the surgery department of QECH. The European Centre for Disease Prevention and Control PPS protocol version 5.3 was adapted to our setting and used as a data collection tool.Findings105 patients were included in the analysis; median age was 34 (IQR: 24–47) years and 55.2% patients were male. Point prevalence of HAI was 11.4% (n=12/105) (95% CI: 6.0%–19.1%), including four surgical site infections, four urinary tract infections, three bloodstream infections and one bone/joint infection. We identified the following risk factors for HAI; length-of-stay between 8 and 14 days (OR=14.4, 95% CI: 1.65–124.7, p=0.0143), presence of indwelling urinary catheter (OR=8.3, 95% CI: 2.24–30.70, p=0.003) and history of surgery in the past 30 days (OR=5.11, 95% CI: 1.46–17.83, p=0.011). 29/105 patients (27.6%) were prescribed antimicrobials, most commonly the 3rd-generation cephalosporin, ceftriaxone (n=15).ConclusionThe prevalence rates of HAI and antimicrobial use in surgery wards at QECH are relatively high. Hospital infection prevention and control measures need to be strengthened to reduce the burden of HAI at QECH.

Patterns of antibiotic use in hospital-acquired infections

Monitoring the use of antimicrobials in hospitalized patients is critical owing to the risk of resistance selection. This study aimed to describe the patterns of antimicrobial prescription for the most frequent healthcare-associated infections (HAIs) in France, relating drugs and microbiological data. We used data from the 2017 point-prevalence survey of HAI and antimicrobial use in France, a large nationally representative sample survey of inpatients. We sought unambiguous correspondence between individual indications of antibiotic regimen and HAI sites to determine which molecules were directed towards which pathogen, considering its resistance profile. Among 75,698 adult patients from 401 hospitals, 5.1% had an active HAI and 4.3% were being treated for an HAI. The two most frequent antibiotic indications were lower respiratory tract (LRTI, 27.7%) and urinary tract infections (UTI, 18.4%). For LRTI, the most prescribed antibiotic was amoxicillin-clavulanic acid (27.6%) and most frequently isolated pathogens (each accounting for around 17% of isolates) were Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. Meticillin-resistant S.aureus LRTI was more likely to be treated with linezolid. For UTI, ofloxacin, ceftriaxone, amoxicillin/co-amoxiclav were most-prescribed (∼13% each) and E.coli predominantly isolated (52.0%). Extended-spectrum beta-lactamase-producing E.coli UTI were more likely treated by fosfomycin, pivmecillinam or ertapenem. This study provides a baseline of antimicrobial use in relation to microbiological information in patients with the most common HAIs. These results can serve to direct future efforts in antimicrobial stewardship. Our work could be extended to a broader population, notably in Europe where similar surveys have been conducted.

Burden of healthcare-associated infections in Italy: incidence, attributable mortality and disability-adjusted life years (DALYs) from a nationwide study, 2016

Healthcare-associated infections (HAIs) are an increasing public health threat. Measuring disease burden in disability-adjusted life-years (DALYs) allows the combination of morbidity and mortality into one figure, as it represents the summation of years lived with disability and years of life lost. To evaluate the incidence, attributable deaths and burden of the most significant HAIs in Italy. Prevalence data from the study sample of the 2016 national Point Prevalence Survey of HAIs in acute-care settings were used to estimate the incidence of five HAIs. The methodology from the Burden of Communicable Diseases in Europe (BCoDE)-project was employed for DALY calculations, adapting the disease models to the Italian population. We estimated a total of 641,065 (95% uncertainty interval, UI 585,543.00-699,207.90) new yearly cases of HAIs and 29,375 (95% UI 23,705.97-35,905.80) deaths in Italy in 2016. The total annual DALYs were estimated to be 424,657.45 (95% UI 346,240.35-513,357.28), corresponding to 702.53 DALYs (95% UI 575.22-844.66) per 100,000 general population. Bloodstream infections accounted for the majority of total DALYs (59%), healthcare-associated pneumonia for 29%, surgical site infections for 9%, CDI for 2% and urinary tract infections accounted for less than 1% of total DALYs. Results of this study suggest HAIs have a substantial burden in Italy. Reducing the burden of HAIs through infection prevention and control efforts is an achievable goal. This study provides data that could be used to guide policy-makers in the implementation of these measures.

A Six-Year Point Prevalence Survey of Healthcare-Associated Infections in an Italian Teaching Acute Care Hospital.

Healthcare-associated infections (HAI) represent one of the most common cause of infection and an important burden of disease. The aim of this study was to analyze the results of a six-year HAI point prevalence survey carried out yearly in a teaching acute care hospital from 2013 to 2018, following the European Center for Disease Prevention and Control (ECDC) guidelines. Surgical site infections, urinary tract infections, bloodstream infections, pneumonia, meningitis, and Clostridium difficile infections were considered as risk factors. A total of 328 patients with HAI were detected during the 6-year survey, with an average point prevalence of 5.24% (95% CI: 4.70–5.83%). Respiratory tract infections were the most common, followed by surgical site infections, urinary tract infections, primary bloodstream infections, Clostridium difficile infections, and central nervous system infections. A regression model showed length of stay at the moment of HAI detection, urinary catheter, central venous catheter, and antibiotic therapy to be the most important predictors of HAI prevalence, yielding a significant adjusted coefficient of determination (adjusted R2) of 0.2780. This will provide future infection control programs with specific HAI to focus on in order to introduce a proper prophylaxis and to limit exposure whenever possible.

The impact of healthcare associated infections on mortality and length of stay in Singapore-A time-varying analysis.

Methods that include the time-varying nature of healthcare-associated infections (HAIs) avoid biases when estimating increased risk of death and excess length of stay. We determined the excess mortality risk and length of stay associated with HAIs among inpatients in Singapore using a multistate model that accommodates the timing of key events. Analysis of existing prospective cohort study data. Seven public acute-care hospitals in Singapore. Inpatients reviewed in a HAI point-prevalence survey (PPS) conducted between June 2015 and February 2016. We modeled each patient's admission over time using 4 states: susceptible with no HAI, infected, died, and discharged alive. We estimated the excess mortality risk and length of stay associated with HAIs, with adjustment for the baseline characteristics between the groups for mortality risk. We included 4,428 patients, of whom 469 had ≥1 HAI. Using a multistate model, the expected excess length of stay due to any HAI was 1.68 days (95% confidence interval [CI], 1.15-2.21 days). Surgical site infections were associated with the longest excess length of stay of 4.68 days (95% CI, 2.60-6.76 days). After adjusting for baseline differences, HAIs were associated with increased hazards of in-hospital mortality (adjusted hazard ratio [aHR], 1.32; 95% CI, 1.09-1.65) and decreased hazards in being discharged (aHR, 0.75; 95% CI, 0.67-0.84). HAIs are associated with increased length of hospital stay and mortality in hospitalized patients. Avoiding nosocomial infections can improve patient outcomes and free valuable bed days.

Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey.

The use of invasive devices increases the risk of healthcare associated infections (HAI). The recent national HAI point prevalence survey secondary outcomes aimed to estimate the prevalence of patients with an indwelling urinary catheter device and vascular access devices; and also identify prevalence of those managed under transmission based precautions (TBP); and those colonised or infected with a multi drug resistant organism (MDRO). A point prevalence study was conducted in large acute care Australian public hospitals. All data were collected by two trained Research Assistants. Surveillance methodology was based on the European Centre for Disease Prevention and Control PPS Protocol. Data was also collected on prevalence of TBPs and MDROs. A total of 2767 acute adult inpatients were sampled across 19 hospitals. The prevalence of peripheral vascular, central vascular and urinary catheters devices was 55.2% (95%CI: 53.3%-57.1%), 14.8% (95%CI: 13.5%-16.1%) and 20.7% (95%CI: 19.2%-22.3%) respectively. Of the 2767 patients sampled 285 (10.3%, 95%CI: 9.2%-11.5%) were documented as either being infected or colonised with a MDRO, and 781 (11.8%) patients were being managed under the hospital TBP policy. This is the first national study to describe the prevalence of devices, TBPs and MDROs in Australian healthcare settings. In an era where device use should be constantly reviewed to minimise risk of HAI, and the increasing challenges of managing patients with MDROs, this data can serve as a benchmark for future studies.

Antibiotic use among hospitalized patients in northern Nigeria: a multicenter point-prevalence survey

BackgroundThe evaluation of antibiotic use among hospitalized patients is a primary step required to design antibiotic stewardship intervention. There is paucity of data describing antibiotic use in hospitals across Northern Nigeria. This study evaluates the prevalence and indications for antibiotic use among inpatients in three acute care hospitals.MethodsA point-prevalence survey was conducted among patients in the wards before or at 8.00 a.m. on the day of the survey, using the point-prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals protocol. The survey was conducted between April and May 2019. The medical records of the patients were reviewed by a clinical pharmacist with the support of physicians and nurses.ResultsOverall, 80.1% (257/321) of the patients used at least one antibiotic on the day of the survey. The prevalence of antibiotic use ranged from 72.9% in obstetrics and gynecology to 94.6% in pediatric medical specialty. Community acquired infections (38.7%) and surgical antibiotic prophylaxis (22.5%) were the most common indications. Surgical antibiotic prophylaxis was used or scheduled to be used for more than a day in all the cases. Metronidazole (30.5%), ciprofloxacin (17.1%), ceftriaxone (16.8%), amoxicillin-clavulanate (12.5%) and gentamicin (11.8%) were the most commonly prescribed antibiotics. Overall, broad spectrum antibiotics represented one-third of all the prescriptions. The change of initial antibiotic prescription was reported in one-third of the patients and the reasons include a switch to oral antibiotic (28.5%), escalation (4.5%) and de-escalation (3.6%). Of the 257 patients with an antibiotic prescription, 6.2% had redundant antibiotic combinations.ConclusionThe prevalence of antibiotic use was high with one in three prescriptions having a broad spectrum antibiotic. Prolonged use of surgical antibiotic prophylaxis and redundant antibiotic combination were observed. Antimicrobial stewardship interventions are recommended in order to reduce the use of antibiotics and promote appropriate antibiotics prescribing.

Application of a new methodology and R package reveals a high burden of healthcare-associated infections (HAI) in Germany compared to the average in the European Union/European Economic Area, 2011 to 2012.

BackgroundHealthcare-associated infections (HAIs) pose a major challenge to health systems. Burden of disease estimations in disability-adjusted life years (DALYs) are useful for comparing and ranking HAIs.AimTo estimate the number of five common HAIs, their attributable number of deaths and burden for Germany.MethodsWe developed a new method and R package that builds on the approach used by the Burden of Communicable Diseases in Europe (BCoDE) project to estimate the burden of HAIs for individual countries. We used data on healthcare-associated Clostridioides difficile infection, healthcare-associated pneumonia, healthcare-associated primary bloodstream infection, healthcare-associated urinary tract infection and surgical-site infection, which were collected during the point prevalence survey of HAIs in European acute-care hospitals between 2011 and 2012.ResultsWe estimated 478,222 (95% uncertainty interval (UI): 421,350–537,787) cases for Germany, resulting in 16,245 (95% UI: 10,863–22,756) attributable deaths and 248,920 (95% UI: 178,693–336,239) DALYs. Despite the fact that Germany has a relatively low hospital prevalence of HAIs compared with the European Union/European Economic Area (EU/EEA) average, the burden of HAIs in Germany (308.2 DALYs/100,000 population; 95% UI: 221.2–416.3) was higher than the EU/EEA average (290.0 DALYs/100,000 population; 95% UI: 214.9–376.9). Our methodology is applicable to other countries in or outside of the EU/EEA. An R package is available from https://CRAN.R-project.org/package=BHAI.ConclusionThis is the first study to estimate the burden of HAIs in DALYs for Germany. The large number of hospital beds may be a contributing factor for a relatively high burden of HAIs in Germany. Further focus on infection prevention control, paired with reduction of avoidable hospital stays, is needed to reduce the burden of HAIs in Germany.

Prevalence of And Factors Associated with Healthcare-associated Infections in Slovenian Acute Care Hospitals: Results of the Third National Survey.

IntroductionIn the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them.MethodsPatients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors.ResultsAmong 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.1; 95% confidence intervals [CI]: 3.1–5.4), peripheral vascular catheter (aOR 3.0; 95% CI: 2.3–3.9), urinary catheter (aOR 1.8; 95% CI: 1.4–2.3).ConclusionsThe prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

Healthcare-associated infections point prevalence survey and antimicrobials use in acute care hospitals (PPS 2016–2017) and long-term care facilities (HALT-3): a comprehensive report of the first experience in Molise Region, Central Italy, and targeted intervention strategies

BackgroundHealthcare associated infections (HAIs) are a major public health concern both in acute hospitals and long-term care facilities (LTCFs), considering the clinical presentations and related costs. The study describes the first regional experience on HAIs and antimicrobials consumption obtained through point prevalence survey (PPS) 2016–2017 in the “Antonio Cardarelli” acute hospital, and in the LTCF of Larino municipality (Healthcare-associated infections and Antimicrobial use in European Long-Term care facilities, HALT-3) of Molise Region, Central Italy, both coordinated by the European Center for Disease Control (ECDC). MethodsPPS was carried out during 24–26 November 2016, while HALT-3 on 29 June 2017. Standardized protocols and software provided by ECDC were used to collect facilities information, patients/residents, HAIs and antibiotic consumption data. ResultsAn active HAI was found in 16 (7.1%) of 224 admitted patients in the acute hospital, and 50% occurred in a clinical specialty ward. Bundles, checklist for HAIs prevention and antimicrobial stewardship were lacking. Among 29 LTCF residents the HAIs prevalence was 3.4%. Surveillance programs for HAIs and antimicrobial stewardship strategy were not available. ConclusionThe overall results identified the need and types of interventions to be implemented in both settings, either at organizational or individual level, to improve antibiotic prescription practice and limit risk factors involved in potentially preventable infections.

Healthcare-associated infections in paediatric and neonatal wards: A point prevalence survey at four South African hospitals.

Healthcare-associated infections (HAIs) cause substantial morbidity, mortality and healthcare costs. The prevalence of neonatal/paediatric HAI at South African (SA) district and regional hospitals is unknown. To document HAI rates, antimicrobial use for HAI, infection prevention staffing, hand hygiene (HH) provisions and HH compliance rates in neonatal and paediatric wards in two district and two regional hospitals in the Western Cape Province, SA. An HAI point prevalence survey (PPS) was conducted in neonatal and paediatric wards at two district and two regional hospitals in the Western Cape during December 2016, applying National Healthcare Safety Network HAI definitions. HAI events and antimicrobial therapy active at 08h00 on the PPS day and during the preceding 7 days (period prevalence) were documented. Provisions for HH and HH compliance rates were observed on each ward using the World Health Organization's HH surveillance tool. Pooled point and period HAI prevalence were 9.9% (15/151; 95% confidence interval (CI) 6 - 15.8) and 12.6% (19/151; 95% CI8 - 18.9), respectively. Hospital-acquired pneumonia (5/15, 33.3%), bloodstream infection (3/15, 20.0%) and urinary tract infection (3/15, 20.0%) were predominant HAI types. Risk factors for HAI were a history of recent hospitalisation (8/19, 42.1% v. 17/132, 12.9%; p<0.001) and underlying comorbidity (17/19, 89.5% v. 72/132, 54.5%; p<0.004). HH provisions (handwash basins/alcohol hand rub) were available and functional. HH compliance was higher in neonatal than in paediatric wards (125/243, 51.4% v. 25/250, 10.0%; p<0.001). Overall HH compliance rates were higher among mothers (46/107, 43.0%) than nurses (73/265, 27.8%) and doctors (29/106, 27.4%). Neonatal and paediatric HAIs are common adverse events at district and regional hospitals. This at-risk population should be prioritised for HAI surveillance and prevention through improved infection prevention practices and HH compliance.

Estimating the morbidity and mortality associated with infections due to multidrug-resistant bacteria (MDRB), France, 2012.

BackgroundA study based on 2007 data estimated that 386,000 infections due to multidrug-resistant bacteria (MDRB) occurred in Europe that year and 25,000 patients died from these infections. Our objective was to estimate the morbidity and mortality associated with these infections in France.MethodsThe MDRB considered were methicillin-resistant Staphylococcus aureus (MRSA), glycopeptide-resistant enterococci, third-generation cephalosporin-resistant (3GC-R) Escherichia coli and Klebsiella pneumoniae, carbapenem-resistant Klebsiella pneumoniae, Acinetobacter spp. and Pseudomonas aeruginosa (CR P. aeruginosa). The number of invasive infections (infections with bacteria isolated from blood or cerebrospinal fluid) due to MDRB, as reported by France to EARS-Net in 2012, was corrected for the coverage of our surveillance network and extrapolated to other body sites using ratios from the French healthcare-associated infections point prevalence survey and the literature. Mortality associated with MDRB infection was estimated using proportions from the literature. Methods and parameters were reviewed by a panel of experts.ResultsWe estimate that 158,000 (127,000 to 245,000) infections due to MDRB occurred in 2012 in France (incidence: 1.48 to 2.85 per 1000 hospital days), including 16,000 invasive infections. MRSA, 3GC-R E. coli and K. pneumoniae were responsible for 120,000 (90,000 to 172,000) infections, i.e., 75% of the total. An estimated 12,500 (11,500 to 17,500) deaths were associated with these infections, including 2,700 associated with invasive infections. MRSA, 3GC-R E. coli and CR P. aeruginosa accounted for 88% of these deaths.ConclusionThese first estimates confirm that MRSA, 3GC-R Escherichia coli and Klebsiella pneumoniae account for the largest portion of the morbidity and mortality of infections due to MDRB in France. These results are not directly comparable with the European study because the methodology used differs in many respects. The differences identified between our study and previous studies underline the need to define a standardised protocol for international assessments of the morbidity and mortality of antibiotic resistance. Estimating morbidity and mortality will facilitate communication and awareness in order to reinforce adherence and support of healthcare professionals and policy-makers to MDRB prevention programs.Electronic supplementary materialThe online version of this article (doi:10.1186/s13756-016-0154-z) contains supplementary material, which is available to authorized users.

The prevalence of and risk factors for healthcare-associated infections in Slovenia: results of the second national survey.

IntroductionIn the second Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute-care hospitals, we estimated the prevalence of all types of HAIs and identified risk factors.MethodsPatients from acute-care hospitals were enrolled into a one-day cross-sectional study in October 2011. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors.ResultsAmong 5628 patients, 3.8% had at least one HAI and additional 2.6% were still being treated for HAIs on the day of the survey; the prevalence of HAIs was 6.4%. The prevalence of urinary tract infections was the highest (1.4%), followed by pneumoniae (1.3%) and surgical site infections (1.2%). In intensive care units (ICUs), the prevalence of patients with at least one HAI was 35.7%. Risk factors for HAIs included central vascular catheter (adjusted odds ratio (aOR) 4.0; 95% confidence intervals (CI): 2.9-5.7), peripheral vascular catheter (aOR 2.0; 95% CI: 1.5-2.6), intubation (aOR 2.3; 95% CI: 1.4-3.5) and rapidly fatal underlying condition (aOR 2.1; 95% CI: 1.4-3.3).ConclusionsThe prevalence of HAIs in Slovenian acute-care hospitals in 2011 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.

Point-prevalence survey of healthcare-associated infections in Beijing, China: a survey and analysis in 2014

Point-prevalence studies can identify priorities for infection control. In May 2014, the Beijing Nosocomial Infection Control and Quality Improvement Centre organized a point-prevalence survey in 124 acute care hospitals in Beijing province. By analysing the survey results and factors affecting the point prevalence of healthcare-associated infections (HCAIs) in secondary and tertiary acute care hospitals in a certain area of China, this study provides evidence and reference to monitor HCAIs in a wide variety of hospitals. An epidemiological cross-sectional survey conducted by infection control practitioners was used to assess the point-prevalence rate of HCAIs by reviewing cases and performing bedside surveys. In total, 124 hospitals and 61,990 patients were surveyed, and 1389 (2.2%) HCAIs were diagnosed in 1294 (2.1%) patients. Respiratory tract infections were the most common HCAIs (54.4%, 51.7-56.9%), followed by urinary tract infections (15.0%, 13.2-16.9%), gastrointestinal tract infections (7.7%, 6.3-9.1%), surgical site infections (6.3%, 5.1-7.6%) and bloodstream infections (5.5%, 4.3-6.8%). In this survey, the top three pathogens were Pseudomonas aeruginosa, Acinetobacter baumannii and Escherichia coli. Rates of central vein catheter insertion, urethral catheterization and mechanical ventilation were 9.9%, 12.4% and 3.8%, respectively. Overall, 23.7% of the patients underwent surgery on or before the date of the survey. HCAIs were present in 14.5% of intensive care unit patients, 2.3% of medical patients and 2% of surgical patients. Diarrhoea was found in 0.8% of the assessed cases; however, tests for Clostridium difficile are not routinely available in China. In areas with limited personnel and resources, regular investigation of the point prevalence of HCAIs can be performed in lieu of comprehensive monitoring to elucidate risk factors and disease burdens of HCAIs.

Prevalence of Healthcare-Associated Infections in Surgical Clinics of the University Clinical Centre of the Republic Of Srpska

Introduction. Healthcare-associated infections (HAI) are a global public health problem that exists in all health care systems and lead to very significant consequences. All health care systems are obliged to continuously improve preventive measures, which can reduce occurrence of HAI by 10 to 70 percent. First step in improving prevention is constitution of functional epidemiological surveillance over HAI. Aim of the study. The objective of this study was to show, through the point prevalence survey, the rates of HAI in surgical clinics of the University Clinical Centre of the Republic of Srpska (UCC RS), their most important epidemiological characteristics, the most frequently isolated microorganisms and their resistance to antibiotics. Material and methods. In this study, we used standardized methodology for the point prevalence survey of HAI and antimicrobial use, including case definitions established by the European Centre for Disease Control (ECDC). The study was conducted in October 2014 at the surgical clinics of the UCC RS, and it included a total of 196 patients. Results. The prevalence of HAI at the surgical clinics of the UCC RS was 11.7%. The most common localization of HAI were surgical site infections (60.8%). The most common isolated microorganisms were Acinetobacter spp., Enterococcus spp., Pseudomonas aeruginosa i Staphylococcus aureus. All isolated Acinetobacter and 50% ofisolated Pseudomonas were resistant to carbapenems, 50% of Staphylococcus aureus to methicillin, 50% Enterococcus spp. to vancomycin, and 40% Enterobacteriaceaeto cephalosporins, 3rd generation. Conclusion. The prevalence of HAI at the surgical clinics of the UCC RS is within the frame of the prevalence in developing countries. More attention must be given to this problem. The prevalence study may be the method of choice for HAI surveillanceat national level.

Healthcare-Associated Infections (HAI): The Perfect Storm has Arrived!

1. Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM[⇑][1] 1. Clinical Laboratory Science Program, College of Health Professions, Texas State University, San Marcos, TX 2. Marilyn Felkner, DrPH, MT(ASCP) 1. Emerging and Acute Infectious Disease Branch (EAIDB), Infectious Disease Control Unit, Texas Department of State Health Services (DSHS), Austin, TX 3. Julie Reagan, PhD, JD, MPH 1. Georgia Southern University, Jiann-Ping Hsu College of Public Health, Statesboro, GA 4. Amber Hogan Mitchell, DrPH, MPH, CPH 1. The International Safety Center, Apopka, FL 5. Pat Tille, PhD, MT(ASCP) 1. Medical Laboratory Science, College of Pharmacy, South Dakota State University, SD 1. Address for Correspondence: Rodney E. Rohde, PhD, MS, SV, SM (ASCP)CM, MBCM, Professor & Chair, CLS Program; Associate Dean for Research, Clinical Laboratory Science Program, College of Health Professions, Texas State University, 601 University Drive, San Marcos, TX 78666, 512-245-2562, 512-245-7860, rrohde{at}txstate.edu INTRODUCTION On any given day approximately 1 of every 25 inpatients in U.S. acute care hospitals has at least one healthcare–associated infection (HAI), adding up to about 722,000 infections in 2011. Pneumonia and surgical-site infection are the most common infection types, and Clostridium difficile is the most common pathogen.1 The CDC Multistate Point-Prevalence Survey of Healthcare-Associated Infections, published in the New England Journal of Medicine, used 2011 data from 183 U.S. hospitals to estimate the burden of a wide range of infections in hospital patients. That year, about 721,800 infections occurred in 648,000 hospital patients. About 75,000 patients with HAI died during their hospitalizations. The most common healthcare-associated infections were pneumonia (22%), surgical site infections (22%), gastrointestinal infections (17%), urinary tract infections (13%), and bloodstream infections (10%). The most common germs causing HAI by rank were C. difficile (12%), Staphylococcus aureus , including Methicillin Resistant S. aureus (MRSA, 11%), Klebsiella (10%), E. coli (9%), Enterococcus (9%), and Pseudomonas (7%). Klebsiella and E. coli are members of the Enterobacteriaceae bacteria family, which has become increasingly resistant to last-resort antibiotics known as carbapenems, typically referred to as carbapenem resistant Enterobacteriaceae (CRE).1 Practically, what this means is that over 200 patients will die the day you read this article and every day until the global community is able to address this healthcare crisis. If you do the simple math you will realize this results in about 4% of hospitalized patients who developed one or more HAI due to the care received in the hospital… ABBREVIATIONS: CAUTI – Catheter-associated urinary tract infection, CDC – Centers for Disease Control and Prevention, CLABSI – Central line-associated blood stream infection, EVS – Environmental services, HAI – Healthcare-associated infections, HCW – Healthcare Worker, MRSA – Methicillin resistant Staphylococcus aureus , SSIs – Surgical site infections [1]: #corresp-1

Determining the effect of social deprivation on the prevalence of healthcare-associated infections in acute hospitals: a multivariate analysis of a linked data set

Healthcare-associated infections (HCAIs) endanger safety by increasing morbidity, mortality, and hospital stay. Studies identifying risk factors for HCAI rarely address the wider determinants of health. However, a well-characterized association exists between increasing social deprivation and poor health outcomes. Therefore it is important to determine whether HCAIs are associated with social deprivation. To determine the association between social deprivation and the prevalence of HCAI, in all inpatients in an acute hospital in Scotland on a single day across September and October 2011. This study linked Scottish data from the 2011 European Point Prevalence Survey of HCAI and Antimicrobial Prescribing to the Scottish Morbidity Record 01, a national dataset with Scottish Index of Multiple Deprivation (SIMD) included. Multivariate logistic regression was used to model HCAI prevalence against SIMD quintile. No overall association was found between SIMD quintile and prevalence of HCAI in all inpatients. A significant difference was found between HCAI prevalence across SIMD quintile in patients undergoing surgical procedures, with higher prevalence observed with increasing deprivation (P=0.0071). Variables associated with HCAI prevalence were: intensive care specialty, psychiatric and medical specialties, minimum invasive surgery, and all categories of length of stay. This study found a significant difference in HCAI prevalence across SIMD quintile in patients undergoing surgery. To our knowledge this was the first study to examine the overall association between HCAI and SIMD. The findings highlight the broad and comprehensive nature of social deprivation in determining health outcomes.

Point prevalence surveys of healthcare-associated infections and use of indwelling devices and antimicrobials over three years in a tertiary care hospital in India

Few hospitals in India perform regular surveillance for healthcare-associated infections (HAIs) and use of indwelling devices and antimicrobials. The aim of this study was to conduct two one-day point prevalence surveys of HAIs and use of indwelling devices and antimicrobials in a large 1800-bed tertiary care hospital in India. The overall prevalence of HAIs was 7%, and surgical site infections were the most common (33%). Indwelling devices were present in 497 (27%) patients, and 915 (50%) patients were receiving antimicrobials. This study helped to generate robust baseline data on the prevalence of HAIs and use of indwelling devices and antimicrobials in the study hospital.