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

Abstract

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...

Study of Central-Line Associated Blood Stream Infections (CLABSIs) and Central-Line Related Blood Stream Infections (CRBSIs) in a Tertiary Hospital, Bangalore, India

“…Males (78.57%) were more commonly affected than females (21.43%). This correlates with the study of Khanna et al, (2013) (72.7%), and other studies such as Apostolopoulou et al, (2009), Bicudo et al, (2011 and Datta et al, (2014) where the incidence of bloodstream infections were more in males than females.…”

“…However, the reason for this high incidence in males could not be attributable to any reasons. CLABSI/CRBSI were common in the age group 51-60 years, in comparison with the study conducted by Brito et al, (2007), Apostolopoulou et al, (2009) and Datta et al, (2014). This could be attributable to the decreased immune status at that age group.…”

Fatores De Risco Às Infecções Relacionadas À Assistência Em Unidades De Terapia Intensiva*

“…Embora este estudo tenha apresentado como limitação o uso de dados retrospectivos em fontes secundárias, foi possível verificar que os fatores de risco associados à ocorrência de infecções relacionadas à assistência à saúde servem de alerta, tanto para a necessidade de um sistema nacional ativo de vigilância à infecção, como para os incentivos financeiros reduzidos para a implementação de medidas de prevenção das infecções relacionadas à assistência à saúde, tal qual a adesão insuficiente de profissionais de saúde a tais medidas; como higienização das mãos (20,29) .…”

Knowledge, attitudes, and practice on the prevention of central line-associated bloodstream infections among nurses in oncological care: A cross-sectional study in an area of southern Italy

“…Central line-associated bloodstream infections (CLABSIs), the majority related with the use of the central venous catheter (CVC) [6,7], are the most important complications in critical care [8–10] and in cancer settings [11,12]. In particular, in cancer settings, several risk factors have been identified for CLABSIs in patients who undergo chemotherapy such as, for example, a prolonged duration of catheterization, microbial colonization at the insertion site and of the catheter hub, and inadequate care/maintenance of the CVC after insertion [13–15].…”