The incidence of healthcare-associated infections, their clinical forms, and microbiological agents in intensive care units in southern Poland in a multicentre study from 2016 to 2019

Introduction. Healthcare-associated infections (HAIs) are a serious problem of modern medicine. Patients hospitalized in intensive care units (ICUs) develop HAI significantly more often than patients in other hospital units. Materials and Methods. Analysis involved HAIs from three ICUs in southern Poland. The study was conducted in 2016–2019 on the basis of methodology recommended by the Healthcare-Associated Infections Surveillance Network (HAI-Net) and European Centre for Disease Prevention and Control (ECDC). The objective was to analyse HAIs, their clinical forms, and microbiological agents. Results. The study included 3028 patients hospitalized for 26,558 person-days (pds) in ICU. A total of 540 HAIs were detected; incidence per 100 hospitalizations was 17.8%, incidence density per 1000 pds was 20.3. The mortality of patients with HAI was 16%, and in Clostridioidesdifficile infection (CDI), the mortality was 28%. The most common clinical form of HAI was bloodstream infection (BSI): 209 cases (incidence rate 6.9%), followed by pneumonia (PN): 131 (incidence rate 4.3%), and urinary tract infection (UTI): 110 cases (incidence rate 3.6%). The most frequently isolated bacteria were Klebsiella pneumoniae 16.4%, Acinetobacter baumannii 14.4%, Staphylococcus aureus 11.8%, and Escherichia coli 11.4%. Conclusions. A two-fold higher incidence rate of BSI was detected compared to the average incidence in European countries. BSI of unknown source (BSI-UNK) was predominant. K. pneumoniae and A. baumannii bacteria were the most often isolated microorganisms causing HAI. Infection control based on incidence rate for each type of infection is necessary in ICU to assess the epidemiological situation

Five-year analysis of surgical site infections in three orthopaedics and trauma wards under HAI-Net from the south of Poland in 2014-2018 considering the standardized infection ratio

Background and Objectives: Surgical site infections (SSIs) are the most common healthcare-associated infections (HAIs) in surgical wards. The highest risk of developing SSI is carried by operations involving implants, such as: hip prosthesis (HPRO), knee prosthesis (KPRO), open reduction of fracture (FX), and closed reduction of fracture with internal fixation (CR). Objectives. The objective of the study was to assess the incidence of SSI in patients subjected to HPRO, KPRO, FX, and CR procedures in orthopaedics and trauma wards in 2014–2018 considering risk factors included in the SIR index. Materials and Methods: The study included 6261 patients who were subjected to orthopaedic surgery in 2014–2018. The investigation covered three hospitals with orthopaedics and trauma wards. The research was conducted in the framework of the national HAI surveillance programme according to the methodology of the HAI-Net, ECDC. Results: A total of 6261 surgeries were investigated, of which 111 cases of SSI were detected. The incidence was 1.8%; HPRO (incidence 2.1%, median (Me) surgery duration 90 min, and standardized infection ratio (SIR) above 1 in all units tested); KPRO (incidence 2.0%, Me 103 min, and SIR above 1 for all units tested); FX (incidence 1.9%, Me 70 min, and SIR above 1 for two units tested and below 1 in one unit); CR (incidence 1.0%, Me 55 min, and SIR—not calculated). The etiological agents that were most frequently isolated from patients with SSI were Staphylococcus aureus, coagulase-negative Staphylococcus, and Klebsiella pneumoniae. Conclusions: HPRO, KPRO, and FX operations performed in the studied wards carried a higher risk of developing SSI than that predicted by SIR. SSIs accounted for a significant percentage of the overall infection pool in CR surgeries. Actions should be undertaken to reduce the incidence of SSI in these surgeries. There should be a hospital network which facilitates cooperation in order to better monitor and analyse the incidence of SSI

Healthcare-acquired infection surveillance in neurosurgery patients, incidence and microbiology, five years of experience in two Polish units

Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was to investigate the epidemiology and microbiology of HAIs and to assess the effectiveness of surveillance conducted in two hospital units. Both hospitals ran (since 2012) the unified prospective system, based on continuous surveillance of HAIs designed and recommended by the European Centre for Disease Prevention and Control (protocol version 4.3) in the Healthcare-Associated Infections Surveillance Network (HAI-Net). In study hospitals, HAIs were detected by the Infection Prevention Control Nurse (IPCN). The surveillance of healthcare infections in hospital A was based mainly on analysis of microbiological reports and telephone communication between the epidemiological nurse and the neurosurgery unit. HAI monitoring in hospital B was an outcome of daily personal communication between the infection prevention and control nurse and patients in the neurosurgery unit (HAI detection at the bedside) and assessment of their health status based on clinical symptoms presented by the patient, epidemiological definitions, microbiological and other diagnostic tests (e.g., imaging studies). In hospital A, HAI monitoring did not involve personal communication with the unit but was rather based on remote analysis of medical documentation found in the hospital database. Results: A total of 12,117 patients were hospitalized. There were 373 HAIs diagnosed, the general incidence rate was 3.1%. In hospital A, the incidence rate was 2.3%, and in hospital B: 4.8%. HAI types detected: pneumonia (PN) (n = 112, 0.9%), (urinary tract infection (UTI) (n = 108, 0.9%), surgical site infection (SSI) (n = 96, 0.8%), bloodstream infection (BSI) (n = 57, 0.5%), gastrointestinal system infection (GI) (n = 13, 0.1%), skin and soft tissue (SST) (n = 9, 0.1%). HAI with invasive devices: 44 ventilator-associated pneumonia (VAP) cases (45.9/1000 pds with ventilator); catheter-associated urinary tract infection (CA-UTI): 105 cases (2.7/1000 pds with catheter); central venous catheter (CVC-BSI): 18 cases (1.9/1000 pds with CVC). The greatest differences between studied units were in the incidence rate of PN (p < 0.001), UTI (p < 0.001), and SSI (p < 0.05). Conclusions: The way HAIs are diagnosed and qualified and the style of work of the infection control team may have a direct impact on the unit epidemiology with the application of epidemiological coefficients. Prospective surveillance run by the infection prevention and control nurse in hospital B could have been associated with better detection of infections expressed in morbidity, especially PN and UTI, and a lower risk of VAP. In hospital A, the lower incidence might have resulted from an inability to detect a UTI or BSI and less supervision of VAP. The present results require further profound research in this respect

Państwo i Społeczeństwo nr 4, 2016 : Medycyna i zdrowie publiczne : Suplement 1

Materiały konferencji naukowo-szkoleniowej „Akademia kontroli zakażeń szpitalnych