Hospital acquired infection, evaluation of point of prevalence in a 147 beds italian hospital

Abstract Background Hospital Acquired Infections (HAI) have become a public health priority worldwide, leading to higher medical costs, prolonged hospital stays, and increased mortality. The point of prevalence analysis (PPA) of HAI and antibiotics (ATB) consumption is extremely relevant for its social and economic impact. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in 147 beds hospital. Material and Methods This prevalence study was conduced on March 23, 2018, we analyzed the clinical documentation of 78 patients hospitalized in the Hospital of Val D’Elsa, Siena, Italy and searched for evidence of HAI and for all indication of ATB therapy in all hospital wards. HAI were defined according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) using Stata 12. Results We analyzed a total of 78 patients (51,3% female), average age was 71,6 (sd ± 23,4) years, mean lenght of stay 7,2 (sd ± 7,9) days. Patients included in the study were recovered mostly in General Medicine ward (62,8%); 23% of patients underwent surgery. Fifty-one point three of patients had Peripheral Venous Catheter, 17,9% Central Venous Catheter and 47,4% Urinary Catheter. Three infections were discovered (PPA 3,8%); 2 HAIs were found in Medicine ward, the third one in the Intensive Care Unit. The chi-square test did not show statistically significant differences with the last year’s results in the same wards (p = 0.3305). Fifty-four percent of all patients received ATB, the most used class were third generation Cephalosporines (50%), followed by Carbapenems (19%) and Fluoroquinolones (7%). Conclusions PPA of HAI was 3,8%, comparable to last year’s (3,5%). This is a positive result when compared to regional and national point prevalence study realized by ECDC in 2012 (6,2% in Tuscany Region, 6% in Italy). Our analysis showed that ATB consumption was quite high: and it is in agreement with those provided by the Tuscany Region. Key messages in our hospital we report an excellent result about the pint of prevalence of hospital acquired infections 3,8%. The antibiotics consumption in our hospital is quite high, the most frequently used antibiotic class is the third generation Cephalosporines.

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Faculty Opinions recommendation of Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1010471.155407 ◽

2002 ◽

Author(s):

Lance Peterson

Keyword(s):

Prevalence Study ◽

National Surveillance ◽

Hospital Acquired Infections ◽

Hospital Acquired ◽

Greek Hospitals

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O083: Prohibit (preventing hospital-acquired infections by intervention and training): preliminary results of a European multi-center study on the effectiveness of a hand hygiene campaign and a central venous catheter bundle

Antimicrobial Resistance and Infection Control ◽

10.1186/2047-2994-2-s1-o83 ◽

2013 ◽

Vol 2 (S1) ◽

Cited By ~ 1

Author(s):

T van der Kooi ◽

◽

M Wolkewitz ◽

B van Benthem ◽

S de Greeff ◽

...

Keyword(s):

Central Venous Catheter ◽

Hand Hygiene ◽

Venous Catheter ◽

Central Venous ◽

Hospital Acquired Infections ◽

Hand Hygiene Campaign ◽

Multi Center Study ◽

Hospital Acquired ◽

And Training ◽

Center Study

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Antibiotic consumption and healthcare associated infection in a third level Italian hospital

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.696 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

F Gori ◽

N Vonci ◽

A Tinturini ◽

C Basagni ◽

G Messina ◽

...

Keyword(s):

Infection Control ◽

Teaching Hospital ◽

General Medicine ◽

Venous Catheter ◽

Antibiotic Consumption ◽

Healthcare Associated Infection ◽

Peripheral Venous Catheter ◽

Control And Prevention ◽

Medical Wards ◽

Clinical Records

Abstract Background The extended length of stay (LoS) is one of the main causes of hospital infections (HAI), followed by an increase in antibiotics consumption. The final step is the development of multiresistant microorganisms, with a consequent increase in costs for the national healthcare system. Aim of this study is to evaluate the prevalence of HAI and to analyze ATB consumption in a teaching hospital Methods Between 17-21 June 2019 the infection control team collected the clinical records of 425 patients to perform a point of prevalence analysis (PPA). Eligible patients were hospitalized in surgical and medical wards of the teaching Hospital (615 beds) in Siena, Italy. For each patients according to guidelines of European Centers for Disease Control and Prevention (ECDC 4.2) we searched for evidence of HAI and for all indication of ATB consumption. Data were processed using Stata12 Results Overall 425 patients have been analyzed (48.24% female), mean age was 60.88 (SD 26.11) years, mean LoS 8.37 (min 1 max 86) days. Patients were admitted mostly in General Medicine wards (48.94%); 34% underwent surgery. 63.8% of patients had Peripheral Venous Catheter, 20% Central Venous Catheter and 31.06% Urinary Catheter. Twenty-nine HAI were discovered (PPA 6.82%); the higher prevalence (19.23%) was in Intensive Care Unit. LoS (OR:1.07;IC95%1.04-1.1) and devices (OR:2.17;IC95%1.39-3.37) were the two variables that significantly influenced the infection risk. Forty-six percent of all patients received ATB, the most used were third generation Cephalosporines (26,18%), followed by Penicillines (24,73%). The main use was to treat community infections (62.12%), followed by medical prophylaxis (30.81%) Conclusions PPA of HAI was 6.82%, comparable to 2017 national PPA (6.5%); prolonged LoS is probably the main cause of this result. Our analysis showed that ATB consumption was quite high, in agreement with the Italian prevalence (44.9%), but the percentage of medical prophylaxis was still high. Key messages The way to achieve the health care infection control is still long, the length of the hospitalization could be a field to be improved. High consumption of antibiotics for prophylaxis is still the main point to fight in the battle against the multiresistant microorganisms.

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FLEBITIS EN NEONATOS EN UN HOSPITAL DE LA PROVINCIA DE EL ORO. MACHALA-ECUADOR

Enfermería Investiga Investigación Vinculación Docencia y Gestión ◽

10.31243/ei.uta.v6i4.1201.2021 ◽

2021 ◽

Vol 6 (4) ◽

pp. 30

Author(s):

Elida Yesica Reyes Rueda ◽

Melvis Arteaga de Vizcaino ◽

Jorge Armando García Maldonado ◽

Tania Diciana Arévalo-Córdova ◽

Diego Orlando Lanchi Zúñiga

Keyword(s):

General Hospital ◽

Venous Catheter ◽

Chi Square ◽

Cross Sectional ◽

Peripheral Venous Catheter ◽

Prolonged Hospitalization ◽

Hospitalization Time ◽

Co Morbidity ◽

Significant Difference ◽

Hospital General

Introducción: La flebitis es la inflamación del sistema venoso, con frecuencia ocurre por el uso de catéteres vasculares. Objetivo: Establecer la relación entre la flebitis por catéter venoso periférico y la hospitalización prolongada en los recién nacidos ingresados en el Servicio de Neonatología del Hospital General Teófilo Dávila. Métodos: Estudio observacional, descriptivo, transversal y prospectivo, realizado en el Hospital General Teófilo, Cantón Machala, Ecuador señalado, durante el 2018–2019. La muestra fue de 87 neonatos y la información recogida permitió la caracterización de neonatos y sus madres, frecuencia de flebitis y factores de riesgo para su aparición. Los datos se analizaron con estadística descriptiva e inferencial chi-cuadrado (chi2). Resultados: de los 87 neonatos, el 60,92% eran varones, 56,32% pretérmino, 85,05% con peso adecuado para edad gestacional, 73,56% ingresados 6 días o más y 56,32% (49 neonatos) presentó flebitis, de estos últimos, los varones con diferencia significativa con respecto a las hembras (p<0,05) y el peso adecuado (37,93%) fue significativamente mayor (p<0,01). La co-morbilidad neonatal que predominó en los neonatos con flebitis fue la prematuridad con 42,86%( CI 95%, p<0,005) y el síndrome de dificultad respiratoria 18.37%. El 79,30% recibió solo una punción para la cateterización, 100% recibieron antibióticos, 75,55% presentaron flebitis grado 1 con una asociación significativa (p<0,001) entre el tiempo de hospitalización y la flebitis. Conclusiones: Existe un predominio de niños prematuros que desarrollan flebitis y una relación significativamente estadística, entre el tiempo de hospitalización de los niños recién nacidos y aparición de flebitis. Palabras clave: Flebitis, catéter, neonato, recién nacido, hospitalización prolongada ABSTRACT Introduction: Phlebitis is the inflammation of the venous system, frequently occurs due to the use of vascular catheters. Objective: To establish the relationship between peripheral venous catheter phlebitis and prolonged hospitalization in newborns admitted to the Neonatology Service of the Teófilo Dávila General Hospital. Methods: Observational, descriptive, cross-sectional and prospective study, carried out at the Teófilo General Hospital, Cantón Machala, Ecuador indicated, during 2018-2019. The sample consisted of 87 neonates and the information collected allowed the characterization of neonates and their mothers, frequency of phlebitis and risk factors for its appearance. The data were analyzed with descriptive and inferential chi-square (chi2) statistics. Results: of the 87 neonates, 60.92% were male, 56.32% preterm, 85.05% with adequate weight for gestational age, 73.56% admitted for 6 days or more, and 56.32% (49 neonates) presented phlebitis, of the latter, males with a significant difference compared to females (p<0.05) and adequate weight (37.93%) was significantly higher (p <0.01). The neonatal co-morbidity that predominated in neonates with phlebitis was prematurity with 42.86% (CI 95%, p<0.005) and respiratory distress syndrome 18.37%. 79.30% received only one puncture for catheterization, 100% received antibiotics, 75.55% presented grade 1 phlebitis with a significant association (p <0.001) between hospitalization time and phlebitis. Conclusions: There is a predominance of premature children who develop phlebitis and a statistically significant relationship between the hospitalization time of newborn children and the appearance of phlebitis. Keywords: Phlebitis, catheter, neonate, newborn, prolonged hospitalization

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Hospital-acquired infective endocarditis during Covid-19 pandemic

10.1101/2020.05.17.20101063 ◽

2020 ◽

Author(s):

Antonio Ramos-Martinez ◽

Ana Fernndez-Cruz ◽

Fernando Dominguez ◽

Alberto Forteza ◽

Marta Cobo ◽

...

Keyword(s):

Infective Endocarditis ◽

Venous Catheter ◽

Pulmonary Involvement ◽

Progressive Increase ◽

Central Venous ◽

Peripheral Venous Catheter ◽

Source Of Infection ◽

Serious Infection ◽

Hospital Acquired

Background. The COVID pandemic has had a major impact on healthcare in hospitals, including the diagnosis and treatment of infections. Hospital-acquired infective endocarditis (HAIE) is a severe complication of medical procedures that has shown a progressive increase in recent years. Objectives. to determine whether the incidence of HAIE during the first two months of the epidemic (March-April 2020) was higher than previously observed and to describe the clinical characteristics of these cases. The probability of studied event (HAIE) during the studied period was calculate by Poisson distribution. Results. Four cases of HAIE were diagnosed in our institution during the study period. The incidence of HAIE during the study period was 2/patient-month and 0.25/patient-month during the previous 5 years (p=0.024). Two cases appeared during admission for COVID-19 with pulmonary involvement treated with metilprednisolone and tocilizumab. The other two cases were admitted to the hospital during the epidemic. All cases underwent central venous and urinary catheterization during admission. The etiology of HAIE was Enterococcus faecalis (2 cases), Staphylococcus aureus and Candida albicans (one case each). A source of infection was identified in three cases (central venous catheter, peripheral venous catheter, sternal wound infection, respectively). One patient was operated on. There were no fatalities during the first 30 days of follow-up. Conclusion. The incidence of HAIE during COVID-19 pandemic in our institution was higher than usual. In order to reduce the risk of this serious infection, optimal catheter care, appropriate use of corticosteroids and interleukin antagonists and early treatment of every local infection should be prioritized during coronavirus outbreaks.

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Effectiveness of transparent film dressing for peripheral intravenous catheter

The Journal of Vascular Access ◽

10.1177/1129729820927238 ◽

2020 ◽

pp. 112972982092723

Author(s):

Selma Atay ◽

Fatma Yilmaz Kurt

Keyword(s):

Dwell Time ◽

Venous Catheter ◽

University Hospital ◽

Control Group ◽

Transparent Film ◽

Patient Identification ◽

Intravenous Catheter ◽

Chi Square ◽

Peripheral Venous Catheter ◽

Peripheral Intravenous Catheter

Background: The intravenous applications are the most common type of such interventions. It is underlined that in cases where the peripheral intravenous catheter is not properly secured in place, even a minor movement inside the vein would result in injury of vein. Objective: The insertion of peripheral intravenous catheter is a common practice. This is a randomized controlled prospective study aiming at investigating the effectiveness of use of transparent film dressing for peripheral intravenous catheter. Methods: The universe of this study included inpatients in the Internal Diseases clinic of a University Hospital, and the sample included a total of 110 peripheral intravenous catheters that were calculated by power analysis. The patient identification form, the peripheral venous catheter and treatment information form, and the visual infusion phlebitis identification scale were used to collect data. The forms were completed by the investigators on the basis of daily observations. The data were assessed by the percentage, chi-square test, and logistic regression analysis via the software SPSS 20.00. Results: The individuals in the study group and the control group included in the sample are comparable in terms of gender, having/not having a chronic disease, the site of peripheral intravenous catheter, use of antibiotics, intravenous fluid therapy, and mean age. There were no statistically significant differences between the groups. There was a significant relationship between the dwell time for the catheter and development of any complications and the groups. Conclusion: The use of transparent film dressing for insertion of peripheral intravenous catheter can be recommended as it increases the dwell time for the catheter and reduces incidence of complications.

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Surveillance of hospital-acquired infections in Liguria, Italy: results from a regional prevalence study in adult and paediatric acute-care hospitals

Journal of Hospital Infection ◽

10.1016/j.jhin.2008.10.012 ◽

2009 ◽

Vol 71 (1) ◽

pp. 81-87 ◽

Cited By ~ 12

Author(s):

P. Durando ◽

G. Icardi ◽

F. Ansaldi ◽

P. Crimi ◽

C. Sticchi ◽

...

Keyword(s):

Acute Care ◽

Acute Care Hospitals ◽

Prevalence Study ◽

Hospital Acquired Infections ◽

Hospital Acquired

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Chlorhexidine Induces VanA-Type Vancomycin Resistance Genes in Enterococci

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02595-15 ◽

2016 ◽

Vol 60 (4) ◽

pp. 2209-2221 ◽

Cited By ~ 41

Author(s):

Pooja Bhardwaj ◽

Elizabeth Ziegler ◽

Kelli L. Palmer

Keyword(s):

Resistance Genes ◽

Venous Catheter ◽

Vancomycin Resistance ◽

Chlorhexidine Gluconate ◽

Content Type ◽

Hospital Acquired Infections ◽

Chlorhexidine Bathing ◽

Vancomycin Resistant ◽

Species Specific ◽

Hospital Acquired

ABSTRACTChlorhexidine is a bisbiguanide antiseptic used for infection control. Vancomycin-resistantE. faecium(VREfm) is among the leading causes of hospital-acquired infections. VREfm may be exposed to chlorhexidine at supra- and subinhibitory concentrations as a result of chlorhexidine bathing and chlorhexidine-impregnated central venous catheter use. We used RNA sequencing to investigate how VREfm responds to chlorhexidine gluconate exposure. Among the 35 genes upregulated ≥10-fold after 15 min of exposure to the MIC of chlorhexidine gluconate were those encoding VanA-type vancomycin resistance (vanHAX) and those associated with reduced daptomycin susceptibility (liaXYZ). We confirmed thatvanAupregulation was not strain or species specific by querying other VanA-type VRE. VanB-type genes were not induced. ThevanHpromoter was found to be responsive to subinhibitory chlorhexidine gluconate in VREfm, as was production of the VanX protein. UsingvanHreporter experiments withBacillus subtilisand deletion analysis in VREfm, we found that this phenomenon is VanR dependent. Deletion ofvanRdid not result in increased chlorhexidine susceptibility, demonstrating thatvanHAXinduction is not protective against chlorhexidine. As expected, VanA-type VRE is more susceptible to ceftriaxone in the presence of sub-MIC chlorhexidine. Unexpectedly, VREfm is also more susceptible to vancomycin in the presence of subinhibitory chlorhexidine, suggesting that chlorhexidine-induced gene expression changes lead to additional alterations in cell wall synthesis. We conclude that chlorhexidine induces expression of VanA-type vancomycin resistance genes and genes associated with daptomycin nonsusceptibility. Overall, our results indicate that the impacts of subinhibitory chlorhexidine exposure on hospital-associated pathogens should be further investigated in laboratory studies.

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