Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic

Background Although efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning. Aim To describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI. Methods The current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors. Results Overall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% ( P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98). Conclusion Contrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

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Healthcare-Associated Infection in Italy Annual Point-Prevalence Surveys, 2002–2004

Infection Control and Hospital Epidemiology ◽

10.1086/597596 ◽

2009 ◽

Vol 30 (7) ◽

pp. 659-665 ◽

Cited By ~ 21

Author(s):

Simone Lanini ◽

William R. Jarvis ◽

Emanuele Nicastri ◽

Gaetano Privitera ◽

Giovanni Gesu ◽

...

Keyword(s):

Intensive Care ◽

Intensive Care Units ◽

Univariate Analysis ◽

National Health System ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Tract Infections ◽

Healthcare Associated

Objective.Healthcare-associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point-prevalence surveys.Design.Three point-prevalence surveys.Methods.A total of 9,609 patients were surveyed.Results.The overall frequency of HAI was 6.7% (645 infections among the 9,609 surveyed patients). The most frequent HAIs were lower respiratory tract infections, which accounted for 35.8% (231 of 645 HAIs) of all HAIs, followed by urinary tract infections (152 [23.6%] of 645 HAIs), bloodstream infections (90 [14.0%] of 645 HAIs), and surgical site infections (79 [12.2%] of 645 HAIs). In both multivariate and univariate analysis, invasive procedures, duration of stay, chemotherapy, trauma, coma, and the location of the hospital were all factors statistically significantly associated with the occurrence of an HAL Enterobacteriaceae were the most common isolates recovered in medical and surgical wards, whereas gram-negative aerobic bacilli were the most common isolates recovered in intensive care units. Approximately one-half of all of the patients surveyed were receiving antibiotics at the time of our study; the most used antibiotic classes were fluoroquinolones in medical wards, cephalosporins in surgical wards, and penicillins and glycopeptides in intensive care units.Conclusion.Our study emphasizes the need for implementing further HAI surveillance to provide the National Health System with proper tools to prevent and manage infection in hospitalized patients.

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The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: A summary of data reported to the National Healthcare Safety Network

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.362 ◽

2021 ◽

pp. 1-14 ◽

Cited By ~ 1

Author(s):

Lindsey M. Weiner-Lastinger ◽

Vaishnavi Pattabiraman ◽

Rebecca Y. Konnor ◽

Prachi R. Patel ◽

Emily Wong ◽

...

Keyword(s):

State Level ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Infection Prevention And Control ◽

Healthcare Associated Infection ◽

National Healthcare ◽

National Healthcare Safety Network ◽

Tract Infections ◽

Healthcare Associated ◽

The Impact

Abstract Objectives: To determine the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infection (HAI) incidence in US hospitals, national- and state-level standardized infection ratios (SIRs) were calculated for each quarter in 2020 and compared to those from 2019. Methods: Central–line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), select surgical site infections, and Clostridioides difficile and methicillin-resistant Staphylococcus aureus (MRSA) bacteremia laboratory-identified events reported to the National Healthcare Safety Network for 2019 and 2020 by acute-care hospitals were analyzed. SIRs were calculated for each HAI and quarter by dividing the number of reported infections by the number of predicted infections, calculated using 2015 national baseline data. Percentage changes between 2019 and 2020 SIRs were calculated. Supporting analyses, such as an assessment of device utilization in 2020 compared to 2019, were also performed. Results: Significant increases in the national SIRs for CLABSI, CAUTI, VAE, and MRSA bacteremia were observed in 2020. Changes in the SIR varied by quarter and state. The largest increase was observed for CLABSI, and significant increases in VAE incidence and ventilator utilization were seen across all 4 quarters of 2020. Conclusions: This report provides a national view of the increases in HAI incidence in 2020. These data highlight the need to return to conventional infection prevention and control practices and build resiliency in these programs to withstand future pandemics.

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Healthcare-associated infections over an eight year period in a large university hospital in Sicily (Italy, 2011–2018)

Journal of Infection Prevention ◽

10.1177/17571774211012448 ◽

2021 ◽

pp. 175717742110124

Author(s):

Giusy Russo Fiorino ◽

Marialuisa Maniglia ◽

Valentina Marchese ◽

Luigi Aprea ◽

Maria V Torregrossa ◽

...

Keyword(s):

Risk Factors ◽

Data Entry ◽

Antimicrobial Treatment ◽

University Hospital ◽

Healthcare Associated Infection ◽

Fatal Disease ◽

Klebsiella Species ◽

Hospitalised Patients ◽

Healthcare Associated ◽

The Impact

Background: Up to 7% of hospitalised patients acquire at least one healthcare-associated infection (HAI). The aim of the present study was to quantify the burden of HAIs in an Italian hospital, identifying involved risk factors. Methods: Prevalence point study carried out from 2011 to 2018. For each recruited patient, a data entry form was compiled including information on demographics, hospital admission, risk factors, antimicrobial treatment, and infection if present. Results: A total of 2844 patients were included and 218 (7.03%) reported an infection. HAI prevalence rates showed a significant increase (average annual per cent change (AAPC) +33.9%; p=0.018) from 2011 to 2014 whereas from 2014 to 2018 a gradual decline was observed (AAPC –6.15%; p=0.35). Urinary tract infection was the most common HAI (25.2%) and a total of 166 (76.1%) pathogens were isolated from 218 infections. Enterococcus and Klebsiella species were the most prevalent pathogens, causing 15.1% and 14.5% of HAIs, respectively. A significant higher risk of HAIs was found in patients exposed to central catheter (adjusted odds ratio (adj-OR)=5.40), peripheral catheter (adj-OR=1.89), urinary catheter (adj-OR=1.46), National Healthcare Safety Network surgical intervention (adj-OR=1.48), ultimately fatal disease (adj-OR=2.19) or rapidly fatal disease (adj-OR=2.09) and in patients with longer hospital stay (adj-OR=1.01). Conclusion: Intervention programmes based on guidelines dissemination and personnel training can contribute to reduce the impact of HAI. Moreover, McCabe score can be a very powerful and efficient predictor of risk for HAI. Finally, an unexpected very high burden of disease due to Enterobacteriaceae and Gram positive cocci that could be related to the frequent use of carbapenems and third generation cephalosporins in this hospital was found.

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A Risk Assessment of Clostridium Difficile Infection after Antibiotherapy for Urinary Tract Infections in the Urology Department for Hospitalized Patients

Revista de Chimie ◽

10.37358/rc.17.7.5694 ◽

2017 ◽

Vol 68 (7) ◽

pp. 1453-1456

Author(s):

Nicolae Grigore ◽

Maria Totan ◽

Valentin Pirvut ◽

Sebastian Ioan Cernusca Mitariu ◽

Radu Chicea ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Clostridium Difficile ◽

Urinary Tract Infections ◽

Preventive Measures ◽

Healthcare Associated Infection ◽

Duration Of Treatment ◽

Antibiotic Associated Diarrhea ◽

Tract Infections ◽

Healthcare Associated

Antibiotherapy is the treatment of choice for the urinary tract infections in hospitalized urological patients. Antibiotic associated diarrhea (ADD) caused by the Clostridium difficile cytotoxin producer represents one of the most severe side effects of the antibiotic treatment. It is important to evaluate the risk factors for a hospitalized patient to develop a C. difficile healthcare associated infection during hospitalization in order to put in practice effective preventive measures. The aim of the study is to analyzed the risk factors associated with the demographic status: age, sex, and also risk factors related to healthcare conditions: use of antibiotics (number, type, duration of treatment), other significant medication taken prior to the onset of diarrhea (histamine-2-receptor antagonists and proton-pump inhibitors, comorbidities, possible contamination from other in-patients who developed ADD in the same period and data about in-hospital mortality.

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Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work?

Southern African Journal of Infectious Diseases ◽

10.4102/sajid.v33i5.150 ◽

2018 ◽

Vol 33 (5) ◽

Author(s):

Anne L. Armour ◽

Mark E. Patrick ◽

Zelda Reddy ◽

Wilbert Sibanda ◽

Logandran Naidoo ◽

...

Keyword(s):

Urinary Tract ◽

Infection Control ◽

Bloodstream Infections ◽

Venous Catheter ◽

Control Programme ◽

Healthcare Associated Infections ◽

Healthcare Associated Infection ◽

Tract Infections ◽

Healthcare Associated ◽

Infection Control Programme

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.

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Comparison of Data Collection for Healthcare-Associated Infection Surveillance in Nursing Homes

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2016.200 ◽

2016 ◽

Vol 37 (12) ◽

pp. 1440-1445 ◽

Cited By ~ 3

Author(s):

Lauren Epstein ◽

Nimalie D. Stone ◽

Lisa LaPlace ◽

Jane Harper ◽

Ruth Lynfield ◽

...

Keyword(s):

Risk Factors ◽

Nursing Homes ◽

Data Collection ◽

Clinical Risk Factors ◽

Healthcare Associated Infection ◽

Screening Criteria ◽

Clinical Risk ◽

Level Data ◽

Healthcare Associated ◽

The Impact

OBJECTIVETo facilitate surveillance and describe the burden of healthcare-associated infection (HAI) in nursing homes (NHs), we compared the quality of resident-level data collected by NH personnel and external staff.DESIGNA 1-day point-prevalence surveySETTING AND PARTICIPANTSOverall, 9 nursing homes among 4 Centers for Disease Control and Prevention (CDC) Emerging Infection Program (EIP) sites were included in this study.METHODSNH personnel collected data on resident characteristics, clinical risk factors for HAIs, and the presence of 3 HAI screening criteria on the day of the survey. Trained EIP surveillance officers collected the same data elements via retrospective medical chart review for comparison; surveillance officers also collected available data to identify HAIs (using revised McGeer definitions). Overall agreement was calculated among residents identified by both teams with selected risk factors and HAI screening criteria. The impact of using NH personnel to collect screening criteria on HAI prevalence was assessed.RESULTSThe overall prevalence of clinical risk factors among the 1,272 residents was similar between NH personnel and surveillance officers, but the level of positive agreement (residents with factors identified by both teams) varied between 39% and 87%. Surveillance officers identified 253 residents (20%) with ≥1 HAI screening criterion, resulting in 67 residents with an HAI (5.3 per 100 residents). The NH personnel identified 152 (12%) residents with ≥1 HAI screening criterion; 42 residents had an HAI (3.5 per 100 residents).CONCLUSIONWe identified discrepancies in resident-level data collection between surveillance officers and NH personnel, resulting in varied estimates of the HAI prevalence. These findings have important implications for the design and implementation of future HAI prevalence surveys.Infect Control Hosp Epidemiol 2016;1440–1445

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Identifying the risk factors for catheter-associated urinary tract infections: a large cross-sectional study of six hospitals

BMJ Open ◽

10.1136/bmjopen-2018-022137 ◽

2019 ◽

Vol 9 (2) ◽

pp. e022137 ◽

Cited By ~ 21

Author(s):

Allison S Letica-Kriegel ◽

Hojjat Salmasian ◽

David K Vawdrey ◽

Brett E Youngerman ◽

Robert A Green ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Urinary Tract Infections ◽

Large Data ◽

Time Range ◽

Healthcare Associated Infection ◽

Cross Sectional ◽

Data Set ◽

Paediatric Hospital ◽

Tract Infections

MotivationCatheter-associated urinary tract infections (CAUTI) are a common and serious healthcare-associated infection. Despite many efforts to reduce the occurrence of CAUTI, there remains a gap in the literature about CAUTI risk factors, especially pertaining to the effect of catheter dwell-time on CAUTI development and patient comorbidities.ObjectiveTo examine how the risk for CAUTI changes over time. Additionally, to assess whether time from catheter insertion to CAUTI event varied according to risk factors such as age, sex, patient type (surgical vs medical) and comorbidities.DesignRetrospective cohort study of all patients who were catheterised from 2012 to 2016, including those who did and did not develop CAUTIs. Both paediatric and adult patients were included. Indwelling urinary catheterisation is the exposure variable. The variable is interval, as all participants were exposed but for different lengths of time.SettingUrban academic health system of over 2500 beds. The system encompasses two large academic medical centres, two community hospitals and a paediatric hospital.ResultsThe study population was 47 926 patients who had 61 047 catheterisations, of which 861 (1.41%) resulted in a CAUTI. CAUTI rates were found to increase non-linearly for each additional day of catheterisation; CAUTI-free survival was 97.3% (CI: 97.1 to 97.6) at 10 days, 88.2% (CI: 86.9 to 89.5) at 30 days and 71.8% (CI: 66.3 to 77.8) at 60 days. This translated to an instantaneous HR of. 49%–1.65% in the 10–60 day time range. Paraplegia, cerebrovascular disease and female sex were found to statistically increase the chances of a CAUTI.ConclusionsUsing a very large data set, we demonstrated the incremental risk of CAUTI associated with each additional day of catheterisation, as well as the risk factors that increase the hazard for CAUTI. Special attention should be given to patients carrying these risk factors, for example, females or those with mobility issues.

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Surveillance of healthcare-associated infections in a Tunisian university hospital

European Journal of Public Health ◽

10.1093/eurpub/ckz186.513 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Hannachi ◽

A Ben Cheikh ◽

S Bhiri ◽

H Ghali ◽

S Khefacha ◽

...

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Intensive Care ◽

University Hospital ◽

Healthcare Associated Infections ◽

Drug Resistant ◽

Healthcare Associated Infection ◽

Carbapenem Resistant ◽

Independent Risk Factors ◽

Healthcare Associated

Abstract Introduction Healthcare -associated infections has become a worldwide public health problem. The aim of this study was to estimate the incidence of healthcare- associated infections in a university hospital of Tunisia. Methods This was a cohort study conducted in six intensive care units in a university hospital of Tunisia during three months (from august to October 2018). Data was provided from patients’ files. Data entry and analysis was done using SPSS version 22. Multivariate analysis was used in order to identify independent risk factors for healthcare associated infection. Results A total of 202 patients were enrolled in this study. The incidence rate of healthcare-associated infections was 53,96%(109/202). The ratio infection/infected was estimated to 1.65(109/66). The incidence of multi-drug resistant pathogens was 21,28% (43/202). The most common resistant pathogens included pseudomonas aeruginosa resistant to cefdazidime in 13,76%(15/109) followed by those resistant to extended spectrum cephalosporin 11.92% (13/109), followed by carbapenem-resistant acinetobcater baumanii 6,42%(7/109) then by carbapenem resistant pathogens and enterococcus resistant to vancomycin 2.75%(3/109) and finally staphylococcus aureus resistant to methicillin 2.1%(2/1.83). The multivariate analysis showed that long duration of central line catheterisation (RR = 7.44; 95%CI[2.79-19.82]), tracheotomy(RR = 8.61;95%CI[2.09-35,39]) and length of stay (RR = 1.08; 95%CI[1.04-1.13]) were found as independent risk factors for healthcare -associated infection. Conclusions The emergence of mutli-drug resistant pathogens needs to be deeply studied and effective measures have to be taken in order to detect and prevent transmission of resistant strains and/or their resistance determinants, especially those with phenotypes having the fewest viable treatment options. Key messages The incidence of healthcare associated infection in the intensive care unit was high. Effective measures have to be taken in the intensive care unit to detect and prevent transmission of resistant pathogens.

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Costs of ambulatory pediatric healthcare-associated infections: Central-line–associated bloodstream infection (CLABSIs), catheter-associated urinary tract infection (CAUTIs), and surgical site infections (SSIs)

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.305 ◽

2020 ◽

Vol 41 (11) ◽

pp. 1292-1297

Author(s):

Michael L. Rinke ◽

Suzette O. Oyeku ◽

William J. H. Ford ◽

Moonseong Heo ◽

Lisa Saiman ◽

...

Keyword(s):

Urinary Tract ◽

Ambulatory Surgery ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Healthcare Associated Infections ◽

Retrospective Case ◽

Additional Costs ◽

Tract Infections ◽

Healthcare Associated

AbstractObjective:Ambulatory healthcare-associated infections (HAIs) occur frequently in children and are associated with morbidity. Less is known about ambulatory HAI costs. This study estimated additional costs associated with pediatric ambulatory central-line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTI), and surgical site infections (SSIs) following ambulatory surgery.Design:Retrospective case-control study.Setting:Four academic medical centers.Patients:Children aged 0–22 years seen between 2010 and 2015 and at risk for HAI as identified by electronic queries.Methods:Chart review adjudicated HAIs. Charges were obtained for patients with HAIs and matched controls 30 days before HAI, on the day of, and 30 days after HAI. Charges were converted to costs and 2015 USD. Mixed-effects linear regression was used to estimate the difference-in-differences of HAI case versus control costs in 2 models: unrecorded charge values considered missing and a sensitivity analysis with unrecorded charge considered $0.Results:Our search identified 177 patients with ambulatory CLABSIs, 53 with ambulatory CAUTIs, and 26 with SSIs following ambulatory surgery who were matched with 382, 110, and 75 controls, respectively. Additional cost associated with an ambulatory CLABSI was $5,684 (95% confidence interval [CI], $1,005–$10,362) and $6,502 (95% CI, $2,261–$10,744) in the 2 models; cost associated with a CAUTI was $6,660 (95% CI, $1,055, $12,145) and $2,661 (95% CI, −$431 to $5,753); cost associated with an SSI following ambulatory surgery at 1 institution only was $6,370 (95% CI, $4,022–$8,719).Conclusions:Ambulatory HAI in pediatric patients are associated with significant additional costs. Further work is needed to reduce ambulatory HAIs.

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The Impact of COPD in Trends of Urinary Tract Infection Hospitalizations in Spain, 2001–2018: A Population-Based Study Using Administrative Data

Journal of Clinical Medicine ◽

10.3390/jcm9123979 ◽

2020 ◽

Vol 9 (12) ◽

pp. 3979

Author(s):

Javier de Miguel-Diez ◽

Romana Albaladejo-Vicente ◽

Domingo Palacios-Ceña ◽

David Carabantes-Alarcon ◽

José Javier Zamorano-Leon ◽

...

Keyword(s):

Urinary Tract ◽

Protective Factor ◽

Multivariable Analysis ◽

Population Based ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Men And Women ◽

Tract Infections ◽

The Impact ◽

Over Time

(1) Background: To examine trends in incidence and outcomes of urinary tract infections (UTIs) among men and women with or without chronic obstructive pulmonary disease (COPD), and to identify the predictors for in-hospital mortality (IHM). (2) Methods: We included patients (aged ≥40 years) who were hospitalized with UTIs between 2001 and 2018. Data were collected from the Spanish National Hospital Discharge Database. (3) Results: We identified 748,458 UTI hospitalizations, 6.53% with COPD. The UTIs incidence increased over time. It was 1.55 times higher among men COPD patients than among non-COPD men (incidence rate ratio (IRR) 1.55; 95% CI 1.53–1.56). The opposite happened in women with COPD compared to non-COPD women (IRR 0.30; 95% CI 0.28–0.32). IHM was higher in men with COPD than non-COPD men (5.58% vs. 4.47%; p < 0.001) and the same happened in women (5.62% vs. 4.92%; p < 0.001). The risk of dying increased with age and comorbidity, but the urinary catheter was a protective factor among men (OR 0.75; 95% CI 0.64–0.89). Multivariable analysis showed a significant reduction in the IHM over time for men and women with COPD. Suffering from COPD only increased the risk of IHM among men (OR 1.07; 95% CI 1.01–1.13). (4) Conclusions: The incidence of UTIs increased over time. Suffering COPD increased the risk of IHM among men, but not among women.

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