Prevalence Of Hospital-acquired Infections Research Articles

Metabolic Immunomodulation of Macrophage Polarization by Pseudomonas aeruginosa Biofilms

Despite extensive investment in better healthcare practices, hospital acquired infections (HAIs) remain a major public health concern. In 2011, the CDC's HAI Prevalence Survey identified 722,000 patients with infections contracted during treatment at acute care hospitals, resulting in 75,000 deaths. It has been well demonstrated that the establishment of bacterial biofilm in the wound is a major contributor to the failure of acute wound treatment and development of chronic, non‐healing wounds; however how the metabolic phenotype of a colonizing biofilm influences the wound healing process remains unknown. This gap in knowledge inhibits the development of effective treatment protocols and results in chronic wounds being the leading cause of non‐traumatic limb amputations. Herein, we define how metabolic exchange and metabolite competition between P. aeruginosa biofilms and macrophages promotes a pro‐inflammatory polarization of macrophages and inhibits reprogramming of macrophages into a pro‐resolution phenotype.Using 1D 1H Nuclear Magnetic Resonance (NMR) small molecule metabolomics in conjunction with immunologic profiling, we demonstrate substantial overlap between the metabolic profile of P. aeruginosa biofilm phenotype and the metabolic profile driving macrophage polarization either into the classical inflammatory phenotype (M1) or the non‐classical anti‐inflammatory phenotype (M2). This metabolic overlap included key metabolic pathways that regulate immunomodulation in macrophages such as shifts between the citrate cycle (TCA) and pentose phosphate metabolism (PPP) and selective amino acid metabolism. Furthermore, exposure of non‐polarized macrophages to medium conditioned with soluble, small molecule metabolites (<3 kDa) derived either from P. aeruginosa planktonic cultures (referred to as PCM) or P. aeruginosa biofilm cultures (referred to as BCM) resulted in distinct metabolic profiles directly related to recently characterized metabolic pathways contributing to macrophage immunomodulation such as enhanced glycolysis, uncoupling of the TCA cycle, and selective amino acid uptake and metabolism. Finally, we use novel, naturally‐derived, biofilm‐targeted therapeutics to manipulate the biofilm immunomodulation of macrophage polarization to promote a shift from a pro‐inflammatory phenotype (M1) to a pro‐resolution phenotype (M2) in primary macrophages. Based on these findings, we demonstrate that P. aeruginosa biofilms mediate specific pathological effects against host macrophages through coordinated metabolic interactions, which result in chronic immune polarization and may contribute to deviation from the normal wound healing process and development of a chronic wound. Given the non‐invasive nature of NMR metabolomics profiling, these findings have the potential to lead to novel approaches for prevention and treatment of non‐healing wounds, including development of evidence‐based, personalizable treatment protocols executed at the bedside.Support or Funding InformationNIH NIGMS 1K01GM103821 to M.C.B.A. Kopriva Research Scholarship ‐ Montana State University to A.L.F.

Prevalence of healthcare-associated infections in Polish adult intensive care units: summary data from the ECDC European Point Prevalence Survey of Hospital-associated Infections and Antimicrobial Use in Poland 2012–2014

Infection is a major cause of morbidity and mortality in intensive care units (ICUs) worldwide. Local epidemiological studies need to be conducted to set the priorities for surveillance and prevention programmes. To investigate the epidemiology of hospital-acquired infections (HAIs) among patients admitted to Polish adult ICUs over a three-year period. Data were collected according to the European Centre for Disease Prevention and Control (ECDC) European Union Point Prevalence Survey of Healthcare-associated Infections and Antimicrobial Use in European Acute Care Hospitals (EU-PPS HAI & AU) protocol for 39,318 patients within 160 acute care hospitals. From this initial database, data for adult ICU patients (N=945) were filtered for further analyses. HAIs were present in 370 patients (39%) and 430 HAI episodes were recorded. The most common HAIs were respiratory tract infections (45%), usually caused by Enterobacteriaceae and Gram-negative non-fermenters. The majority (87%) of these infections were likely to be device associated. Out of 61 cases of bloodstream infection, 51% were catheter associated. These bloodstream infections were mainly caused by coagulase-negative staphylococci. Among 57 cases of surgical site infection, 42% were classified as organ/space, 33% were classified as deep incisional, and 25% were classified as superficial. The predominant micro-organisms were Enterobacteriaceae and Staphylococcus aureus. Out of 50 cases of urinary tract infection, 96% were device associated. The prevalence of HAI among Polish adult ICU patients is higher than described in similar studies, but may be partially affected by methodological differences. The proportion of device-associated infections was very high, so there is an urgent need to introduce countrywide, targeted surveillance and prevention programmes.

Point prevalence & risk factor assessment for hospital-acquired infections in a tertiary care hospital in Pune, India.

Background & objectives:Hospital-acquired infections (HAIs) are a major challenge to patient safety and have serious public health implications by changing the quality of life of patients and sometimes causing disability or even death. The true burden of HAI remains unknown, particularly in developing countries. The objective of this study was to estimate point prevalence of HAI and study the associated risk factors in a tertiary care hospital in Pune, India.Methods:A series of four cross-sectional point prevalence surveys were carried out between March and August 2014. Data of each patient admitted were collected using a structured data entry form. Centers for Disease Control and Prevention guidelines were used to identify and diagnose patients with HAI.Results:Overall prevalence of HAI was 3.76 per cent. Surgical Intensive Care Unit (ICU) (25%), medical ICU (20%), burns ward (20%) and paediatric ward (12.17%) were identified to have significant association with HAI. Prolonged hospital stay [odds ratio (OR=2.81), mechanical ventilation (OR=18.57), use of urinary catheter (OR=7.89) and exposure to central air-conditioning (OR=8.59) had higher odds of acquiring HAI (P<0.05).Interpretation & conclusions:HAI prevalence showed a progressive reduction over successive rounds of survey. Conscious effort needs to be taken by all concerned to reduce the duration of hospital stay. Use of medical devices should be minimized and used judiciously. Healthcare infection control should be a priority of every healthcare provider. Such surveys should be done in different healthcare settings to plan a response to reducing HAI.

Implementation of enteral feeding protocol in an intensive care unit: Before-and-after study.

AIMTo determine the effects of implementing an enteral feeding protocol on the nutritional delivery and outcomes of intensive care patients.METHODSAn uncontrolled, observational before-and-after study was performed in a tertiary mixed medical-surgical intensive care unit (ICU). In 2013, a nurse-driven enteral feeding protocol was developed and implemented in the ICU. Nutrition and outcome-related data from patients who were treated in the study unit from 2011-2012 (the Before group) and 2014-2015 (the After group) were obtained from a local electronic database, the national Population Registry and the hospital’s Infection Control Service. Data from adult patients, readmissions excluded, who were treated for at least 7 d in the study unit were analysed.RESULTSIn total, 231 patients were enrolled in the Before and 249 in the After group. The groups were comparable regarding demographics, patient profile, and severity of illness. Fewer patients were mechanically ventilated on admission in the After group (86.7% vs 93.1% in the Before group, P = 0.021). The prevalence of hospital-acquired infections, length of ICU stay and ICU, 30- and 60-d mortality did not differ between the groups. Patients in the After group had a lower 90-d (P = 0.026) and 120-d (P = 0.033) mortality. In the After group, enteral nutrition was prescribed less frequently (P = 0.039) on day 1 but significantly more frequently on all days from day 3. Implementation of the feeding protocol resulted in a higher cumulative amount of enterally (P = 0.049) and a lower cumulative amount of parenterally (P < 0.001) provided calories by day 7, with an overall reduction in caloric provision (P < 0.001). The prevalence of gastrointestinal symptoms was comparable in both groups, as was the frequency of prokinetic use. Underfeeding (total calories < 80% of caloric needs, independent of route) was observed in 59.4% of the study days Before vs 76.9% After (P < 0.001). Inclusion in the Before group, previous abdominal surgery, intra-abdominal hypertension and the sum of gastrointestinal symptoms were found to be independent predictors of insufficient enteral nutrition.CONCLUSIONThe use of a nurse-driven feeding protocol improves the delivery of enteral nutrition in ICU patients without concomitant increases in gastrointestinal symptoms or intra-abdominal hypertension.

Prevalence of hospital-acquired infections in intensive care units in public hospitals in Tehran, Iran, in 2012-2014

Infection control and hospital-acquired infection (HAI) prevalence have recently attracted much attention especially in developing countries. The aim of this study was to estimate the prevalence of HAI in public hospitals in Tehran, Iran, more specifically, to determine the epidemiological status of nosocomial infections in intensive care units (ICUs) of 3 public hospitals. The study was conducted in 3 governmental hospitals and all patients who had been in the hospital for at least 48 hours and had a primary diagnosis of HAI were included in the study. The study was performed on 1470 patients who were admitted to the ICU from 2012-2014; among them, 200 cases were affected by infectious diseases. The data collected using the questionnaire included demographic characteristics, length of admission, and cause of hospital infection which were all verified by the Infection Control Center (ICC). The clinical signs and symptoms of patients were also controlled. The effects of seasonal variation on HAI were also investigated by analyzing the data obtained in various seasons. Statistical analysis was performed using SPSS software. The chi-square ( X 2 ) test was used to compare categorical variables and a 2-sided P-value of less than 0.05 was considered as significant. The effect of season on HAI prevalence was analyzed using Kruskal-Wallis Test. The prevalence of nosocomial infections was 13.65% in the study. Urinary tract (40.9%) and surgical wounds (26.1%) were the most common types of infections. Bacteriological analysis suggested that Escherichia coli (35.6%) and Staphylococcus aureus (26%) were the most prevalent microorganisms related to the incidence of HAI. The results obtained showed that HAIs were more prevalent during spring. The prevalence of nosocomial infection observed in the present study seems quite high. The results showed that the length of hospitalization was positively associated with HAI. Statistical analysis showed that long length of hospitalization, age, and season are risk factors for the development of HAI during hospitalization. Furthermore, like similar studies, gram-negative bacteria were found to be the most common cause of nosocomial infections.

High prevalence of hospital-acquired infections caused by gram-negative carbapenem resistant strains in Vietnamese pediatric ICUs: A multi-centre point prevalence survey.

There is scarce information regarding hospital-acquired infections (HAIs) among children in resource-constrained settings. This study aims to measure prevalence of HAIs in Vietnamese pediatric hospitals.Monthly point prevalence surveys (PPSs) in 6 pediatric intensive care units (ICUs) in 3 referral hospitals during 1 year.A total of 1363 cases (1143 children) were surveyed, 59.9% male, average age 11 months. Admission sources were: other hospital 49.3%, current hospital 36.5%, and community 15.3%. Reasons for admission were: infectious disease (66%), noninfectious (20.8%), and surgery/trauma (11.3%). Intubation rate was 47.8%, central venous catheter 29.4%, peripheral venous catheter 86.2%, urinary catheter 14.6%, and hemodialysis/filtration 1.7%. HAI was diagnosed in 33.1% of the cases: pneumonia (52.2%), septicemia (26.4%), surgical site infection (2%), and necrotizing enterocolitis (2%). Significant risk factors for HAI included age under 7 months, intubation and infection at admission. Microbiological findings were reported in 212 cases (43%) with 276 isolates: 50 Klebsiella pneumoniae, 46 Pseudomonas aeruginosa, and 39 Acinetobacter baumannii, with carbapenem resistance detected in 55%, 71%, and 65%, respectively. Staphylococcus aureus was cultured in 18 cases, with 81% methicillin-resistant Staphylococcus aureus. Most children (87.6%) received antibiotics, with an average of 1.6 antibiotics per case. Colistin was administered to 96 patients, 93% with HAI and 49% with culture confirmed carbapenem resistance.The high prevalence of HAI with carbapenem resistant gram-negative strains and common treatment with broad-spectrum antibiotics and colistin suggests that interventions are needed to prevent HAI and to optimize antibiotic use.

Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units.

BackgroundVietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam.MethodsMonthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08:00 a.m. on the survey day were included.ResultsAmong 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively).ConclusionA high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

Health professionals' knowledge about relative prevalence of hospital-acquired infections in Delta State of Nigeria.

IntroductionHospital-acquired infections (HAIs) constitute a serious global public health challenge, causing great suffering to many people across the globe at any given time. This study ascertains the knowledge of health professionals on the challenge and their compliance with infection control measures.MethodsValidated questionnaires were administered to 660 health professionals and supported with face-to-face interview. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (SPSS Inc, USA). Chi-square was used to test association between the independent and the outcome variables. Cut-off point for statistical significance was 5% (p value<0.05).ResultsUTIs (61.4%) followed by Hospital-acquired Pneumonia (55.6%) were known to be the most prevalent HAIs in government hospitals while Staphylococcus aureus (54.4%) was reported the most microbial agent. In private health facilities, Hospital-acquired Pneumonia was known to be the most common (66.1%) while Pseudomonas aeruginosa was the most reported culprit. HAIs were reported to have occurred more in government hospitals and catheterization was the commonest modes of transmission in both health facilities.ConclusionThe prevalence of HAIs in this state was reported to be high. Although health-care professionals have good knowledge of HAIs, active effort is not always made to identify and resolve them. Standardized surveillance of HAIs is urgently needed.

Highly Bactericidal Polyurethane Effective Against Both Normal and Drug-Resistant Bacteria: Potential Use as an Air Filter Coating.

The battle against the prevalence of hospital-acquired infections has underscored the importance of identifying and maintaining the cleanliness of possible infection transmission sources in the patient's environment. One of the most crucial lines of defense for mitigating the spread of pathogens in a healthcare facility is the removal of microorganisms from the environment by air filtration systems. After removing the pathogenic microorganisms, the filters used in these systems can serve as reservoirs for the pathogens and pose a risk for secondary infection. This threat, combined with the ever-growing prevalence of drug-resistant bacterial strains, substantiates the need for an effective bactericidal air filter. To this end, a broad-spectrum bactericidal polyurethane incorporating immobilized quaternary ammonium groups was developed for use as an air filter coating. In this study, the bactericidal activity of the polymer coating on high-efficiency particulate air (HEPA) filter samples was quantified against eight bacterial strains commonly responsible for nosocomial infection-including drug-resistant strains, and confirmed when applied as a filter coating in conditions mimicking those of its intended application. The coated HEPA filter samples exhibited high bactericidal activity against all eight strains, and the polyurethane was concluded to be an effective coating in rendering HEPA filters bactericidal.

Introduction to the 7th Annual Conference on the Science of Dissemination and Implementation: transforming health systems to optimize individual and population health

Introduction to the 7th Annual Conference on the Science of Dissemination and Implementation: transforming health systems to optimize individual and population health

Hospital acquired infection prevalence survey: is there any Franc-Comtois paradox?

Hospital acquired infection (HAI) prevalence surveys have been conducted in French healthcare facilities (HCF) since 1996. Overall HAI prevalence rate remained steady around 5.0% in France from 2006 to 2012. A decreased by 10.8% was found when a multilevel analysis was applied and contrasting trends were shown: no significant change for short stay hospitalization (from 5.3% to 5.6%) whereas a significant decrease by 21% was observed in the others. In Franche-Comte (FC), from 2006 to 2012, an unexpected increasing HAI prevalence trend by 17.3% (from 5.2% to 6.1%) was observed.

Decolonization and decontamination: what's their role in infection control?

Hospital-acquired infections cause up to 19% of infections in paediatric patients contributing to the spread of antimicrobial resistance. This review evaluates the effect of decolonization and decontamination in hospitalized children and neonates as an adjunct to standard infection control measures. Few studies on decolonization and decontamination are available in children. The evidence about the effectiveness of daily chlorhexidine washcloths on bacteraemia in paediatric patients relies on a single randomized controlled trial, in neonates with central venous access in a single retrospective observational study. It is uncertain whether nasal mupirocin reduces methicillin-resistant Staphylococcus aureus carriage and infections in neonates, whereas oral chlorhexidine mouthwashes have not proven effective in children in intensive care settings. Scanty evidence demonstrates a reduction in the rate of ventilation-acquired pneumonia with digestive tract decontamination in paediatric patients and no studies are available in neonates. These strategies have not been extensively tested in resource-poor countries. Strong evidence about the efficacy of decolonization and decontamination interventions exists in adult medicine but not in paediatric patients. There is an urgent need to understand how these interventions could be adapted to neonates and resource-poor settings in which the prevalence of hospital-acquired infections is higher.

Impact of Hospital‐Acquired Infection on Vitamin D Status in Critically Ill Patients

Background Vitamin D appears to have important effects on human immune functions, including ex vivo upregulation of the antimicrobial peptide LL-37 in monocytes. Vitamin D depletion is common in critical illness (CI), but little is known about the inter-relationships between hospital-acquired infection and vitamin D status. Objective: Examine changes in blood levels of 25-hydroxyvitamin D [25(OH)D], vitamin D binding protein (VDBP), and LL-37 over time in critically ill patients with or without new bloodstream infections (BSI) or pneumonia (PNA). Methods Fifty-four subjects were dichotomized based on the presence or absence of new BSI (n=13) or PNA (n=12) diagnosed within 28 days of entry. Plasma 25(OH)D (chemiluminescence), VDBP and LL-37 (ELISA) were measured at baseline, 14 and 28 days. Mixed linear models were used for analyses. Results Subjects (age: 60 ± 13.6 yr) had severe CI (APACHE II: 21.3 ± 8.0) and 76% were vitamin D deficient (25(OH)D < 20 ng/mL). Baseline plasma 25(OH)D, LL-37 and VDBP were similar in those ± infection. However, 25(OH)D levels decreased significantly over time in subjects with PNA (P=0.002). LL-37 levels were unaltered over time ± infection and were unrelated to 25(OH)D levels. VDBP levels were unchanged in subjects with BSI, but increased over time in those without BSI (P<0.0001). VDBP levels remained unchanged in subjects with PNA, but rose over time in those without PNA (P=0.0003). Conclusions Changes in plasma 25(OH)D and VDBP were associated with prevalence of hospital-acquired infection in CI and may be an acute-phase response. Further study should investigate if such changes influence vitamin D bioavailability or susceptibility to infection.

The impact of nutritional status on morbidities in mechanically ventilated critically ill children in PICUs (1024.8)

Mechanically ventilated children in pediatric intensive care units (PICUs) are at risk for hospital‐acquired infections (HAI) and prolonged hospitalizations. We performed a multicenter, international cohort study to determine the unique contribution of nutritional status to clinical outcomes in mechanically ventilated children in PICUs (N=1622). Nutritional status was 17.9% underweight (BMI Z score &lt; ‐2), 54.2% normal weight (BMI Z score &gt; ‐2 and &lt;1), 14.5% overweight (BMI Z score &gt; 1 and &lt; 2), and 13.4% obese (BMI Z score &gt; 2). Prevalence of HAI, length of stay, and ventilator‐free days (VFD) were evaluated using multivariate analyses, controlling for diagnosis, admission type, PICU location and size. Compared to normal weight, risk for HAI was significantly higher in underweight (OR 1.79; 95% CI 1.16, 2.75; p=.008), overweight (OR 1.34; 95% CI 1.04, 1.73; p=.02), and obese children (OR 1.50; 95% CI 1.09, 2.05; p=.01). Hazard ratios for hospital discharge were significantly lower among underweight (HR 0.71; 95% CI 0.61, 0.84; p&lt;.001) and obese (HR 0.81; 95% CI 0.68, 0.96; p=.02) compared to normal weight children. Underweight was associated with significantly fewer VFD than normal weight (p&lt;.001), overweight (p&lt;.001), and obesity (p=.03). Nutritional status is an important contributor to morbidities in the PICU. Future studies exploring outcomes related to nutritional status during PICU admissions are needed.Grant Funding Source: Supported by the Jean Hankin Nutritional Epidemiology award from the Academy of Nutrition and Dietet

The use of point prevalence surveys of healthcare-associated infection to identify risk factors and facilitate infection prevention and control planning

Abstract Background Healthcare-associated infections contribute greatly to the global burden of morbidity and mortality in relation to infectious disease. Consequences impact on individuals, populations and health services. Surveillance of infection provides the information to lead infection prevention activities. However, surveillance can require a significant resource investment by healthcare organisations. Point prevalence surveys of healthcareassociated infections are a useful surveillance methodology where resources are limited. Findings provide information in relation to infection and also in relation to patient risk factors. Methods Repeated point prevalence surveys were implemented over 4 years in 2006–09 in a 345-bed acute private hospital in the Republic of Ireland. Each annual survey followed an unchanged methodology and the data were collected and analysed by the infection prevention and control team. Results The prevalence of hospital-acquired infection ranged from 1.1% to 4.4% with a mean value of 3.2% (CI: 2.09–4.62). Mean prevalence of invasive devices was as follows: peripheral venous catheters: 61.3%; urinary catheters: 19.4%; and central venous catheters: 3.9%. The findings of the studies indicated the high prevalence of risk factors associated with invasive devices, particularly peripheral venous catheters. The results supported the introduction of a bundled approach to patient care in relation to invasive devices. This integrated the use of ‘care bundles' or checklists into daily patient care and management. Conclusion A multidisciplinary approach incorporating ward staff in relation to documentation and auditing of compliance with the bundle has increased awareness regarding the risks of invasive devices and the importance of infection prevention strategies.

Analysis of hospital acquired infection in neonatal intensive care unit

Objective To analyze the prevalence of hospital acquired infection and the associated risk factors.Methods Nine hundred and three hospitalized preterm infants in our neonatal intensive care unit from August 2006 to October 2010 were retrospectively studied.Risk factors of hospital acquired infection were analyzed by single factor analysis and logistic regression analysis method.Site and pathogen of infection were also analyzed.Results One hundred and ten preterm infants developed 123 times of hospital acquired infection.The incidence of hospital acquired infection was 12.2％,and hospital acquired infection patient-day rates was 7.3‰.The mortality was 2.7％.Gestational age less than 32 weeks,birth weight less than 1500 gram,non-invasive ventilation,tracheal intubation,umbilical vein catheter(UVC),peripherally inserted central catheter(PICC),parenteral nutrition were the risk factors of hospital acquired infection.Logistic regression analysis showed mechanical ventilation,UVC and PICC were the main risk factors.The main sites of infection were sepsis(45.5％),low respiratory infection and conjunctivitis.Seventy positive culture samples were obtained.Bacteria were the main pathogen.Fifty percent was gram-staining positive,while 46％ was gram-staining negative.Conclusion It is very important to identify the high risk factors for hospital acquired infection.Standardized management of preterm infants,standardized usage of umbilical vein catheter and peripherally inserted central catheter,minimized usage of intubation would be conductive to reduce the incidence of hospital acquired infection. Key words: Preterm infant; Hospital acquired infection; Risk factors

Prevalence of hospital-associated infections can be decreased effectively in developing countries

Hospital-acquired infections (HAI) are an important public health problem worldwide. Little information is available from African countries, but published data show that the burden of HAI is greater in Africa than in developed countries. In 2002, the World Health Organization (WHO) published guidelines for preventing HAI. To evaluate the impact of a hospital infection control programme on the prevalence of HAI among patients in a large Ugandan hospital. A one-day cross-sectional prevalence survey and a ward procedure survey were performed in Lacor Hospital in March 2010 using standardized questionnaires. All patients admitted to hospital not less than two days before the survey were eligible to participate in the prevalence survey. Modified WHO criteria for HAI were used. The ward procedure survey examined the procedures to prevent HAI. Several hospital infection control measures were subsequently implemented, in accordance with WHO infection control guidelines, starting in October 2010. The prevalence survey and ward procedure survey were repeated in October 2011. The prevalence of HAI was 34% in 2010 and 17% in 2011. The prevalence of infected patients reduced from 28% to 14%. The prevalence of HAI was lower in all age groups and for all types of HAI except urinary tract infections following the implementation of infection control activities. This study showed that HAI is an important problem in this large African hospital, and that the prevalence of HAI can be reduced effectively following the adoption of basic infection control procedures.

Prevalence of Staphylococcus aureus in Intensive care Units and Post Operative Ward as a possible source of Nosocomial infection: An experience of tertiary care hospital

Background and Objectives: Hospital Acquired Infection (HAI) also called nosocomial infection is a global problem. It also acts as a leading cause of death and increased morbidity among hospitalized patients. Staphylococcus aureus is one of the commonest pathogens causing HAI and is also closely associated with human body. WHO study has shown highest prevalence of HAI in Intensive care unit (ICU), Neonatal care unit (NICU), Post operative ward (POW). Hence it becomes very imperative to check the prevalence of HAI. Therefore this study was carried out to determine the prevalence of S. aureus in hospital environment as a possible source for HAI. Material and Methods: Environmental samples and blood samples of the patients were collected from ICU, NICU, POW using sterile cotton swabs during study period. Standard protocol was followed to isolate and identify S. aurues which was followed by antibiotic sensitivity tests. Results: A total of 216 environmental samples were collected out of which 18.98% (41) samples showed the presence of S. aureus. It was also isolated from the blood samples of patients admitted to ICU (7.5%) and NICU (6.8%). None of the isolates from environmental samples were MRSA(methycillin resistant Staphylococcus aures). Conclusion: S. aureus was found as a prominent environmental flora of hospital setting. Presence of these organisms in sensitive units like ICU, NICU, POW and the isolation of S. aureus from clinical samples indicates a possibility of HAI. It indicates the necessity of continuous surveillance of hospital environmental for quality control. DOI: http://dx.doi.org/10.3126/jmcjms.v1i1.7882 Janaki Medical College Journal of Medical Sciences (2013) Vol. 1 (1):21-25

PSU8 Budget Impact Analysis of Anti-Bacterial Suture Use in Appendectomy Procedures in Spain

Surgical Site Infection (SSIs) is the most frequent type of hospital-acquired infection, accounting for more than (37%). The prevalence of hospital-acquired infection in Spain is 7.8%, where SSI account for 19%. For appendectomy procedures, the SSI rate of 4.9% is reported. SSI increases the patient's risk of morbidity and mortality, prolongs hospital stay by more than a week, and worsens the overall patient quality of life. Moreover, the risk of SSI has increased recently due to multiple comorbidities. In addition, SSI is becoming more treatment-resistant than ever. The aim of this study was to analyze the economic consequences of using antibacterial sutures in appendectomy procedures in Spain. A dynamic excel-based decision-analytic model was developed. Published literature reviews were used to estimate the three key variables: SSI reduction using antibacterial sutures (55%7) compared to standard sutured, prolonged length of hospital stay due to SSI (7.7 days), and the cost of hospital stay per day (2,057€). The rate of readmission due to persistent infection was used (18%), which was estimated as costs 2,166€, and it was added to the prior amount to calculate total costs of infection. Country input data for the model were reported as the number of appendectomy procedures performed per year (34,500). The list price at which regular and antibacterial sutures were purchased was also collected. A two-way sensitivity analysis was conducted, with two variables being the infection rate and suture price. Antibacterial sutures were found to be 14% more expensive; however, allowing a 56% of hospital cost avoidance. This may have an impact of 4,970,273€ in annual savings in Spain. This analysis presents new evidence of support of the use of antibacterial sutures by demonstrating that it could reduce the SSI rate, and could allow cost-savings compared to standard sutures, among other benefits.

Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

Hospital-acquired infections (HAIs) are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60-700 beds. The study was conducted during all four season of 2008-2009. All of the patients admitted for ≥48h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance (NNIS) guidelines. Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections (2.5%), surgical site infections (2.4%), urinary tract infections (1.4%), and pneumonia (1.3%). A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 (95% confidence interval [CI] 1.21-2.02). Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 (95% CI 2.38-6.26), and using an urinary catheter, adjusted OR of 3.06 (95% CI 2.19-4.28). Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 (95% CI 2.34-4.47) in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection. This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections.