Healthcare Associated Infection Prevalence Survey Research Articles

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p < 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Inappropriate hospital admission as a risk factor for the subsequent development of adverse events: a cross-sectional study

BackgroundAll health overuse implies an unnecessary risk of patients suffering adverse events (AEs). However, this hypothesis has not been corroborated by direct estimates for inappropriate hospital admission (IHA). The objectives of the study were the following: (1) to analyze the association between IHA and the development of subsequent AEs; (2) to explore the distinct clinical and economic implications of AEs subsequent IHA compared to appropriate admissions.MethodsAn observational cross-sectional study was conducted on hospitalized patients in May 2019 in a high-complexity hospital in Madrid, Spain. The Appropriateness Evaluation Protocol was used to measure IHA, and the methodologies of the Harvard Medical Practice Study and the European Point Prevalence Survey of Healthcare-associated Infections were used to detect and characterize AEs. The association between IHA and the subsequent.ResultsA total of 558 patients in the hospital ward were studied. IHA increased the risk of subsequent occurrence of AEs (OR [95% CI]: 3.54 [1.87 to 6.69], versus appropriate) and doubled the mean AEs per patient (coefficient [95% CI]: 0.19 [0.08 to 0.30] increase, versus appropriate) after adjusting for confounders. IHA was a predictive variable of subsequent AEs and the number of AEs per patient. AEs developed after IHA were associated with scheduled admissions (78.9% of AEs, versus 27.9% after appropriate admissions; p < 0.001). Compared with AEs developed after appropriate admissions, AEs after IHA added 2.4 additional days of stay in the intensive care unit and incurred an extra cost of €166,324.9 for the studied sample.ConclusionsPatients with IHA have a higher risk of subsequent occurrence of AE. Due to the multifactorial nature of AEs, IHA is a possible contributing factor. AEs developed after IHA are associated with scheduled admissions, prolonged ICU stays, and resulted in significant cost overruns.

23. Aotearoa New Zealand point prevalence survey of healthcare-associated infections

23. Aotearoa New Zealand point prevalence survey of healthcare-associated infections

A Point Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Public Acute Care Hospitals in Crete, Greece.

Background: Both healthcare-associated infections (HAIs) and antimicrobial resistance are associated with an increased length of stay and hospital costs, while they have also been linked to high morbidity and mortality rates. In 2016 and 2017, the latest point prevalence survey (PPS) of HAIs and antimicrobial use in European acute care hospitals highlighted an HAI prevalence of 6.5%, while Greece had a higher HAI prevalence of 10%. The aim of this PPS was to record the prevalence of HAIs and antimicrobial use in all eight public acute care hospitals in Crete, Greece during the COVID-19 pandemic in order to highlight the types of infections and antimicrobial practices that need to be prioritized for infection control initiatives. Methods: The PPS was conducted between 30 March and 15 April 2022, according to the ECDC standardized relevant protocol (version 5.3). Statistics were extracted using the ECDC Helics.Win.Net application (software version 4.1.0). Results: A total of 1188 patients were included. The overall point prevalence of patients with at least one HAI was 10.6%. The most frequent types of infections were pneumonia (34.3%), bloodstream infections (10.5%), systemic infections and urinary tract infections (10.5% and 9.1%, respectively). In 14 (12.4%) cases, the pathogen responsible for HAI was SARS-CoV-2 following onsite spread, accounting for almost 10% of all HAIs. Microorganisms were identified in 60.1% of HAIs. Antimicrobials were administered in 711 (59.8%) patients, with 1.59 antimicrobials used per patient. Conclusion: The prevalence of HAI and antimicrobial use among hospitalized patients in Crete, Greece was similar to the national HAI prevalence in 2016 despite the enormous pressure on public hospitals due to the COVID-19 pandemic. Nevertheless, both HAI prevalence and antimicrobial use remain high, underlining the need to implement adequate infection control and antimicrobial stewardship interventions.

First national point prevalence survey of healthcare-associated in-fections and antimicrobial use in acute care hospitals in the Republic of Moldova

Introduction. HAIs present a major public health problem with an impact on morbidity, mortality and quality of life. The objective of the study was to highlight the problem of HAIs and AM use, identification of risk factors and raising awareness of the phenomenon.&#x0D; Material and methods. The methodology of the PPS was patient-based, developed based on ECDC Protocol 5.3/2016. The study was accomplished in 2018. The sample of the PPS included 67 hospitals, 546 wards and 10594 patients.&#x0D; Results. The prevalence of HAIs was 1,6%, with predominance of pneumonia (25%), SSI (16.1%), LRI (14.9%), UTI (11.3%) and varies depending on the wards profile, clinical diagnosis, length of hospital stay and risk factors (medical device, surgery). HAIs were caused by Klebsiella spp. in 26%, Enterococcus spp. – 18% and coagulase-negative Staphylococci – 14%, P. aeruginosa – 12%. Klebsiella spp. presented resistance to 3rd generation cephalosporins in 84,6% and to carbapenems – 46.2%. The prevalence of AM use was 42.7%, for the group of 3rd generation cephalosporins – 34.5%. More frequently antibiotics were administered for treatment (73.8%), and for surgical prophylaxis &gt;1 day in 93.5%.&#x0D; Conclusions. Data on HAIs and AM consumption in hospitals, first obtained by implementing active surveillance based on the ECDC tool, are standardized and comparable at national and international level and allow assessing the situation in hospitals, obtaining evidence for infection prevention and control and AM stewardship programmes at local level, as well as reasoning the national policies.

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.

Analysis of Continuous Prevalence Survey of Healthcare-Associated Infections Based on the Real-Time Monitoring System in 2018 in Shandong in China

Background Healthcare-associated infection (HAI) is a serious threat to the safety of patients worldwide. The prevalence survey is widely used to explore and study the characteristics of HAI. However, the annual continuous prevalence survey of hospital-acquired infections has not been reported so far. Aim This study is aimed at examining the occurrence and development trend of HAIs dynamically and accurately. Methods An annual continuous HAI prevalence survey based on the real-time monitoring system was conducted in representative hospitals from different regions in Shandong in China. Findings. A total of 64 hospitals participated in the survey, and 2,741,433 patients were monitored in 2018. The highest prevalence of HAIs in Shandong was 3.83% (February 15), the lowest was 1.85% (February 28), and the average was 2.45%. The percentile distribution of prevalence of HAIs in this study was as follows: P10, 2.23%; P25, 2.31%; P50, 2.41%; P75, 2.55%; and P90, 2.73%. Conclusion This study dynamically and accurately showed the occurrence and development trend of HAIs in Shandong in 2018. The results of this study can be used as a reference for the HAI prevalence survey in various medical institutions in Shandong and provide the basis for the regional HAI prevention and control strategy.

Five-year point prevalence survey of healthcare-associated infections and antimicrobial use in a Japanese university hospital

SummaryBackgroundPeriodic point prevalence surveys (PPSs) provide a method for assessing changes in healthcare-associated infections (HAIs) and antimicrobial use over time. Following the introduction of an antimicrobial stewardship programme at Nagoya University Hospital (Aichi, Japan) a five-year PPS study was performed to highlight any epidemiological changes.MethodsOne-day PPSs were performed annually in July at Nagoya University Hospital. Data on patient characteristics, medical devices, active HAIs and antimicrobial use were collected using a standard data-collection form.ResultsA total of 4339 patients were included. Over the five-year study period the median patient age was 62 years, median duration of hospital admission was nine days, 9% of patients had an HAI and 35.2% received at least one antimicrobial. Overall there were 406 HAIs (95% confidence interval, 369–447) with surgical site infection, pneumonia and febrile neutropenia occurring most frequently. Enterobacterales were the most common pathogens (N = 78, 28.6%) and 32.1% were third-generation cephalosporin-resistant. Meropenem was the most frequently prescribed antimicrobial for HAIs. Surgical antimicrobial prophylaxis changed drastically, with shorter durations and a marked reduction in oral cephalosporin use. However, antimicrobials for medical prophylaxis gradually increased.ConclusionsThis five-year PPS study shows consistent data for patient background, HAIs and causative pathogens and highlights changes in antimicrobial use during the era of the National Action Plan on Antimicrobial Resistance. To describe the epidemiology of Japanese hospitals by PPS, multicentre PPSs including in community hospitals should be performed annually.

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 nationwide assessment of the burden of healthcare-associated infections and antimicrobial use among surgical patients: results from Serbian point prevalence survey, 2017

BackgroundAs the only non-European Union (EU) country, Serbia participated in a second point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use (AMU) organized by the European Centre for Disease Prevention and Control (ECDC) in the EU countries. Here, we aimed to estimate the prevalence of HAI and AMU in patients who had recently undergone a surgery and to compare risk profile, HAI rates, and AMU among surgical patients and non-surgical patients.MethodsA national PPS was performed in 65 Serbian acute-care hospitals, in November 2017. In this paper, the data of 61 hospitals for adult acute-care were analyzed. To ensure the comparability of study design we used the Serbian translation of ECDC case definitions and ECDC PPS protocol. The trained infection control staff, led by a hospital coordinator, reviewed medical records to identify HAI active at the time of the survey and AMU. Only inpatients admitted to the ward before 8 a.m. on the day if the survey were included.ResultsA total of 12,478 patients from 61 hospitals for adult acute-care were eligible for inclusion in this study. Significantly higher proportions of surgical patients were female, belonged to the 60-to-79 age group, and were less severely ill. Also, extrinsic factors (invasive devices, hospitalization at the ICU, and prior antibiotics therapy) were more frequent in surgical patients. Prevalence of HAIs was higher among surgical patients (261/3626; 7.2%) than among non-surgical patients (258/8852; 2.9%) (p < 0.0001). The highest prevalence of all HAIs was noted in patients who had kidney transplantation (4/11; 36.4%), while SSIs were the most prevalent among patients who had peripheral vascular bypass surgery (3/15; 20.0%). Non-surgical patients received treatment for community-acquired infections in significantly higher proportion (2664/8852; 64.3) (p < 0.001). Surgical prophylaxis for more than 1 day was applied in 71.4% of surgical patients.ConclusionWe have provided an insight into the burden of HAIs and AMU among Serbia acute-care hospitals, and highlighted several priority areas and targets for quality improvement.

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.

Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents

Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich &amp; Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.Funding: NoneDisclosures: None

Trend of healthcare-associated infections in a teaching hospital in Tunisia, 2014-2019

Abstract Background National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. During this period, actions to improve HAI prevention were implemented, including strengthened isolation measures; hand hygiene promotion using the World Health Organization multimodal strategy; and promotion of appropriate antimicrobial use. We aimed to examine trends in HAI in Sahloul Hospital over six years. Methods Annual prevalence surveys of healthcare-associated infections (HAIs) between 2014 and 2019 were conducted in the university hospital in Tunisia. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Results Over six years, prevalence of HAI ranged from 11.4% in 2014 to 9.5% in 2019. The prevalence of HAIs did not show a significant change across the six surveys. However, there were significant (P = 0.008) reductions in the prevalence of total HAIs in intensive care units, which had the highest frequencies of HAIs over those six years. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2019, 27 germs were identified, the most frequent were Gram Negative Bacilli (74%), mostly Escherichia coli. Conclusions This HAI prevention strategy was influential in decreasing infections among hospitalized patients in intensive care units. Challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms. Key messages Using prevalence surveys, we were able to have an insight into the most common isolates identified throughout the last six years. Repeated prevalence surveys are an effective tool for monitoring HAI frequency and contributing to the establishment of effective infection control.

Antimicrobial Use in US Hospitals: Comparison of Results From Emerging Infections Program Prevalence Surveys, 2015 and 2011.

In the 2011 US hospital prevalence survey of healthcare-associated infections and antimicrobial use 50% of patients received antimicrobial medications on the survey date or day before. More hospitals have since established antimicrobial stewardship programs. We repeated the survey in 2015 to determine antimicrobial use prevalence and describe changes since 2011. The Centers for Disease Control and Prevention's Emerging Infections Program sites in 10 states each recruited ≤25 general and women's and children's hospitals. Hospitals selected a survey date from May-September 2015. Medical records for a random patient sample on the survey date were reviewed to collect data on antimicrobial medications administered on the survey date or day before. Percentages of patients on antimicrobial medications were compared; multivariable log-binomial regression modeling was used to evaluate factors associated with antimicrobial use. Of 12 299 patients in 199 hospitals, 6084 (49.5%; 95% CI, 48.6-50.4%) received antimicrobials. Among 148 hospitals in both surveys, overall antimicrobial use prevalence was similar in 2011 and 2015, although the percentage of neonatal critical care patients on antimicrobials was lower in 2015 (22.8% vs 32.0% [2011]; P = .006). Fluoroquinolone use was lower in 2015 (10.1% of patients vs 11.9% [2011]; P < .001). Third- or fourth-generation cephalosporin use was higher (12.2% vs 10.7% [2011]; P = .002), as was carbapenem use (3.7% vs 2.7% [2011]; P < .001). Overall hospital antimicrobial use prevalence was not different in 2011 and 2015; however, differences observed in selected patient or antimicrobial groups may provide evidence of stewardship impact.

Point prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute care hospitals: results of the Global-PPS and ECDC-PPS 2017

BackgroundThe point prevalence survey of healthcare-associated infections (HAIs) and antimicrobial use organized by the European Centre for Disease Prevention and Control (ECDC-PPS) and the Global Point Prevalence Survey of antimicrobial consumption (Global-PPS) were simultaneously performed in Belgian acute care hospitals in 2017.MethodsBelgian acute care hospitals were invited to participate in either the ECDC or Global-PPS. Hospital/ward/patient-level data were collected between September–December 2017. All patients present in the wards at 8 a.m. on the day of the PPS were included. The data of the ECDC and Global-PPS on antimicrobial consumption were pooled. Detailed data on HAIs were analysed for ECDC-PPS.ResultsOverall, 110 Belgian acute care hospital sites participated in the ECDC and Global-PPS (countrywide participation rate: 81.4%, 28,007 patients). Overall, a crude prevalence of patients with at least one antimicrobial of 27.1% (95% confidence interval (CI) 26.5–27.6%) was found. The most frequently reported indications were pneumonia (23.2%), urinary tract infections (15.2%) and skin and soft tissue infections (11.9%). The reason for antimicrobial use was recorded for 81.9% of the prescriptions, a stop/review date for 40.8% and compliance with local antibiotic guidelines for 76.6%. In the ECDC-PPS, the crude prevalence of patients with at least one HAI was 7.3% (95%CI 6.8–7.7%). Most frequently reported HAIs were pneumonia (21.6%) and urinary tract infections (21.3%).ConclusionsHAI and antimicrobial use prevalence remained stable in comparison with the previous PPS (7.1% and 27.4% in 2011 and 2015, respectively). Belgian hospitals should be further stimulated to set local targets to improve antibiotic prescribing and reduce HAI.

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.

A six-years point prevalence survey of healthcare-associated infections in an Italian hospital

Abstract Healthcare-Associated Infections (HAIs) are among the most serious public health problems in Europe representing the most frequent adverse event during care delivery. Despite their limitations, point prevalence surveys of HAIs are often preferred to prospective surveillance, since they provide a feasible estimate when resources are limited. The aim of this study was to analyze the results of a six-years point prevalence survey of HAIs in a teaching acute care hospital in Italy and to investigate the main risk factors of HAIs in the acute-care hospital. A point prevalence survey to detect HAIs was carried out in Gemelli Hospital during the last 6 years, from 2013 to 2018. Inpatients of any age in Gemelli Hospital were eligible for inclusion. Patients in outpatient areas were excluded. HAIs were identified according to diagnosis guideline from ECDC in 2011. Statistically significant differences were tested through t-test and Chi-square test. Multi-variate analysis was performed to evaluate the impact of regressor factors for predict HAI’s prevalence. The statistical significance level was set at p &amp;lt; 0.05. The point prevalence ranged from 3,16% in 2017 to 6,64% in 2013. Pneumonia and surgical site infections (SSI) were the most frequent HAIs during the 6 years, with a rate of 27,31% and 26,20% respectively of all HAIs. The multiple logistic regression showed that length of stay at the moment of detection, urinary catheter, CVC and antibiotic therapy are useful to meaningfully predict HAI prevalence, with a regression coefficient (adjusted R2) of 0.2780. Thanks to proper hospital policies, the point prevalence of HAIs does not seem to increase through the years, even though it is still too early to draw any conclusions. Pneumonia and SSI represented each one more than a quarter of all the HAIs, as reported also in literature. There is a strong association between length of stay at the moment of detection and HAIs but it is hard to understand which one is the cause of the other. Key messages Point prevalence from 2013 to 2018 seems to be stable. An accurate incidence survey is needed in order to identify the main risk factors of HAI and to realize more specific hospital programmes. Length of stay at the moment of detection is useful to meaningfully predict HAIs prevalence although the cause-and-effect relationship is still not clear.

Evolution of Healthcare-associated infections over five years: results of prevalence surveys

Abstract Background Tunisia is not spared from the scourge of healthcare associated infections (HAIs). National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. We aimed to describe bacteriological profile as well as treatment modalities of HAIs in Sahloul Hospital for the last five years. Methods We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Results Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2015, 17 germs were identified, and in 88.2% of cases (n = 5), isolated pathogens were also gram-negative bacilli, the most frequent were Pseudomonas aeroginosa (n = 4) and Acinetoobacter baumanii (n = 3). Besides, cephalosporin 3rd generation was the most frequent antibiotic used for the treatment. However, in 2016, Klebsiella Pneumoniae was the most frequent germ isolated. Among those infected patients, 26 were treated (92.8%). In 2017, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%), mostly Escherichia coli and Pseudomonas aerginosa, followed by Acinetobacter baumanii. in 2018, 16 germs were identified, the most frequent were Gram Negative Bacilli (55.5%), mostly Klebsiella Pneumoniae. Conclusions The challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms. Key messages Our study helped us to have an insight into the most common isolates identified throughout the last five years. An incidence survey was carried out to better highlight the impact of healthcare associated infections in our hospital.

Establishing a baseline for a national paediatric antimicrobial stewardship programme.

The majority of antimicrobial stewardship programmes focus on prescribing in adult populations; however, there is a recognized need for targeted paediatric antimicrobial stewardship to improve the quality and safety of prescribing amongst this patient group. To describe the current epidemiology of antimicrobial prescribing in paediatric inpatient populations in Scotland to establish a baseline of evidence and identify priority areas for quality improvement to support a national paediatric antimicrobial stewardship programme. A total of 559 paediatric inpatients were surveyed during the Scottish national point prevalence survey of healthcare-associated infections and antimicrobial prescribing, 2016. The prevalence of antimicrobial prescribing was calculated and characteristics of antimicrobial prescribing were described as proportions and compared between specialist hospitals and paediatric wards in acute hospitals. Prevalence of antimicrobial use in paediatric inpatients was 35.4% (95% CI = 31.6%-39.4%). Treatment of community- and hospital-acquired infections accounted for 47.1% and 20.7% of antimicrobial use, respectively, with clinical sepsis being the most common diagnosis and gentamicin the most frequently prescribed antimicrobial for the treatment of infection. The reason for prescribing was documented in the notes for 86.5% of all prescriptions and, of those assessed for compliance against local policy, 92.9% were considered compliant. Data from national prevalence surveys are advantageous when developing antimicrobial stewardship programmes. Results have highlighted differences in the prescribing landscape between paediatric inpatient populations in specialist hospitals and acute hospitals, and have informed priorities for the national antimicrobial stewardship programme, which reinforces the need for a targeted paediatric antimicrobial stewardship programme.

Association between antimicrobial resistance among Enterobacteriaceae and burden of environmental bacteria in hospital acquired infections: analysis of clinical studies and national reports

BackgroundWHO has named three groups of gram-negative bacteria “our critical antimicrobial resistance-related problems globally”. It is thus a priority to unveil any important covariation of variables behind this three-headed epidemic, which has gained alarming proportions in Low Income Countries, and spreads rapidly. Environmental bacteria including Acinetobacter spp. are common nosocomial pathogens in institutions that have high rates of antimicrobial resistance among other groups of gram-negative bacteria. MethodsBased on two different data sources, we calculated the correlation coefficient (Pearson's r) between pathogenic burden of Acinetobacter spp. and antimicrobial resistance among Enterobacteriaceae in European and African nosocomial cohorts. Clinical reportsDatabase search for studies on nosocomial sepsis in Europe and Africa was followed by a PRISMA-guided selection process. National reportsData from Point prevalence survey of healthcare-associated infections published by European Centre for Disease Prevention and Control were used to study the correlation between prevalence of Acinetobacter spp. and antimicrobial resistance among K. pneumoniae in blood culture isolates. FindingsThe two approaches both revealed a strong association between prevalence of Acinetobacter spp. and rates of resistance against 3. generation cephalosporins among Enterobacteriaceae. In the study of clinical reports (13 selected studies included), r was 0.96 (0.80–0.99) when calculated by proportions on log scale. Based on national reports, r was 0.80 (0.56–0.92) for the correlation between resistance rates of K. pneumoniae and proportion of Acinetobacter spp. InterpretationThe critical antimicrobial resistance-related epidemics that concern enteric and environmental gram-negative bacteria are not independent epidemics; they have a common promoting factor, or they are mutually supportive. Further, accumulation of antimicrobial resistance in nosocomial settings depends on the therapeutic environment. Burden of Acinetobacter spp. as defined here is a candidate measure for this dependence.