Consensus standards and performance indicators for prevention and control of healthcare-associated infection in Europe

Cookson, Barry; MacKenzie, D.; Coutinho, André P.; Russell, Ian; Fabry, J.

doi:10.1016/j.jhin.2011.07.008

Cited by 14 publications

(5 citation statements)

References 5 publications

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“…More efforts are required to implement consensus standards such as the 13+13 set of performance indicators for the prevention and control of HAIs and antimicrobial resistance in Greek ICUs. 33 Another interesting finding in the present study was the high ICU mortality rate in the patients admitted without HAI who did not acquire a DA-HAI in by carbapenem-resistant A baumannii appropriately, as well as to revise the antimicrobial prescribing policies. 41 ICU health care professionals have been educated through focused seminars about the risk factors and the adequate measures for preventing HAIs in their units.…”

Section: Discussionmentioning

confidence: 61%

Surveillance of Device-Associated Infection Rates and Mortality in 3 Greek Intensive Care Units

Apostolopoulou¹,

Raftopoulos²,

Filntisis³

et al. 2013

American Journal of Critical Care

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Background Several studies suggest that device-associated, health care-associated infections (DA-HAIs) affect the quality of care in intensive care units, increasing patients' morbidity and mortality and the costs of patient care. Objectives To assess the DA-HAIs rates, microbiological profile, antimicrobial resistance, and crude excess mortality in 3 intensive care units in Athens, Greece. Methods A prospective cohort, active DA-HAI surveillance study was conducted in 3 Greek intensive care units from July 2009 to June 2010. The rates of mechanical ventilator-associated pneumonia (VAP), central catheter-associated bloodstream infection (CLABSI), and catheter-associated urinary tract infection (CAUTI) were calculated along with microbiological profile, antimicrobial resistance, and crude excess mortality. Results During 6004 days in intensive care, 152 of 294 patients acquired 205 DA-HAIs, an overall rate of 51.7% of patients or 34.1 DA-HAIs per 1000 days (95% CI,). The VAP rate was 20 (95% CI, 16.3-23.7) per 1000 ventilator-days, the CLABSI rate was 11.8 (95% CI: 9.2-14.8) per 1000 catheter-days, and the CAUTI rate was 4.2 (95% CI, 2.5-5.9) per 1000 catheter-days. The most frequently isolated pathogen was Acinetobacter baumannii among patients with CLABSI (37.8%) and Candida species among patients with CAUTI (66.7%). Excess mortality was 20.3% for VAP and CLABSI and 32.2% for carbapenem-resistant A baumannii CLABSI. Conclusion High rates of DA-HAIs, device utilization, and antimicrobial resistance emphasize the need for antimicrobial stewardship, the establishment of an active surveillance program of DA-HAIs, and the implementation of evidence-based preventive strategies. (American Journal of Critical Care. 2013;22:e12-e20) Several studies suggest that DA-HAIs are among the factors that affect the quality of care in the ICU, increasing both patients' morbidity and mortality and the costs of patient care. [10][11][12] The CDC 13 and the National Healthcare Safety Network 14 (NHSN) have published standardized criteria for surveillance of DA-HAIs: those definitions and methods for the detection of DA-HAI rates per 1000 device-days and device utilization ratios can be used as benchmarks for interhospital and intrahospital comparisons. The comparison of infection rates has proven to be a key component in reducing infection risk. 15 The device utilization ratio constitutes an extrinsic risk factor for DA-HAI and can serve as a marker for severity of illness or the patient's intrinsic susceptibility to infection. If the device utilization ratio is greater than the 90th percentile, a specific hospital is considered a high outlier and further investigation of that specific practice could be warranted. 16 Similar standards have been implemented in Europe, and national ICU surveillance networks have been developed. 17In contrast, data on DA-HAIs rates obtained by using standardized definitions and methods are limited in Greece. 18 The aim of this study was to perform an active targeted prospective surveillance to ass...

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Section: Discussionmentioning

confidence: 61%

Surveillance of Device-Associated Infection Rates and Mortality in 3 Greek Intensive Care Units

Apostolopoulou¹,

Raftopoulos²,

Filntisis³

et al. 2013

American Journal of Critical Care

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“…The accuracy of information on health care-associated infections and suscep tibility to antimicrobials is crucial for planning preventive strategies (3). The correct identification of agents of in fections and antimicrobial susceptibility depends on the performance of the mi crobiology laboratory (4) and is neces sary to provide goodquality health care in infectious diseases and all other fields of medicine (5,6). Therefore, quality as surance in microbiology laboratories is crucial.…”

Section: Special Reportmentioning

confidence: 99%

National prevalence survey in Brazil to evaluate the quality of microbiology laboratories: the importance of defining priorities to allocate limited resources

Costa¹,

Cardoso²,

Ferreira³

et al. 2013

Rev Panam Salud Publica

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This report describes a survey of microbiology laboratories (n = 467) serving Brazilian hospitals with ≥10 intensive care beds and/or involved in the government health care adverse event reporting system. Coordinators were interviewed and laboratories classified as follows: Level 0 (no minimal functioning conditions-85.4% of laboratories); Level 1 (minimal functioning conditions but inadequate execution of basic routine-6.7%); Level 2 (minimal functioning conditions and adequate execution of basic routine but no adequate procedures for quality control-5.8%); Level 3 (minimal functioning conditions, adequate execution of basic routine, and adequate procedures for quality control, but no direct communication with the infection control department-0.9%); Level 4 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, and direct communication with infection control, but no available advanced resources-none); and Level 5 (minimal functioning conditions, adequate execution of basic routine, adequate procedures for quality control, direct communication with infection control, and available advanced resources-0.9%). Twelve laboratories did not perform Ziehl-Neelsen staining; 271 did not have safety cabinets; and >30% without safety cabinets had automated systems. Low quality was associated with serving hospitals not participating in government adverse-event program; private hospitals; nonteaching hospitals; and those outside state capitals. Results may reflect what occurs in many other countries where defining priorities is important due to limited resources.

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“…Issues of best practice in prevention and control of healthcare-associated infections (HCAIs) are a priority in healthcare. 1 It is estimated that HCAIs cost the UK National Health Service (NHS) in excess of £1 billion every year, posing a significant economic burden. 2 In terms of human cost, it is thought that over 5000 deaths occur as a direct consequence of HCAIs each year.…”

Section: Introductionmentioning

confidence: 99%

‘And you’ll suddenly realise ‘I’ve not washed my hands’: medical students’, junior doctors’ and medical educators’ narratives of hygiene behaviours

Cresswell

Monrouxe

2018

BMJ Open

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ObjectiveCompliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students’, junior doctors’ and medical educators’ narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need.DesignA qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis.SettingTeaching hospitals in the UK.ParticipantsConvenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6).ResultsWe identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators’ behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process.ConclusionsAwareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in developing the culture of hygiene practices within their clinical domains.

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Consensus standards and performance indicators for prevention and control of healthcare-associated infection in Europe

Cited by 14 publications

References 5 publications

Surveillance of Device-Associated Infection Rates and Mortality in 3 Greek Intensive Care Units

Surveillance of Device-Associated Infection Rates and Mortality in 3 Greek Intensive Care Units

National prevalence survey in Brazil to evaluate the quality of microbiology laboratories: the importance of defining priorities to allocate limited resources

‘And you’ll suddenly realise ‘I’ve not washed my hands’: medical students’, junior doctors’ and medical educators’ narratives of hygiene behaviours

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