Comparing national point prevalence surveys of healthcare-associated infection and antimicrobial prescribing: a methodological approach to adjust for differences in case-mix

Background: National point prevalence surveys (PPS) of healthcare-associated infection (HAI) and antimicrobial prescribing in hospitals were conducted in 2011 and 2016 in Scotland. When comparing results of PPS, it is important to adjust for any differences in patient case-mix that may confound the comparison. Aim: To describe the methodology used to compare prevalence for the two surveys and illustrate the importance of taking case-mix (patient and hospital stay characteristics) into account. Methods: Multivariate models (clustered logistic regression) that adjusted for differences in patient case-mix were used to describe the difference in prevalence of six outcomes (HAI, antimicrobial prescribing and four devices: central vascular catheter, peripheral vascular catheter, urinary catheterisation and intubation) between the 2011 and 2016 PPS. Univariate models that did not adjust for these differences were also developed for comparison to show the importance of adjusting for confounders. Results: Without adjustment for case-mix, HAI and intubation prevalence estimates were not significantly different in 2016 compared with 2011 although with adjustment, the prevalence of both was significantly lower ( P=0.03 and P=0.02, respectively). These associations were only identified after adjustment for confounding by case-mix. Conclusions: While prevalence surveys do not provide intelligence on temporal trends as an incidence-based surveillance system would, if limitations and caveats are acknowledged, it is possible to compare two prevalence surveys to describe changing epidemiology. Adjusting for differences in case-mix is essential for robust comparisons. This methodology may be useful for other countries that are conducting large, repeated prevalence surveys.

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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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Point prevalence surveys of healthcare-associated infection in 13 hospitals in Hubei Province, China, 2007–2008

Journal of Hospital Infection ◽

10.1016/j.jhin.2010.04.003 ◽

2010 ◽

Vol 76 (2) ◽

pp. 150-155 ◽

Cited By ~ 32

Author(s):

Duo-shuang Xie ◽

Wei Xiong ◽

Li-li Xiang ◽

Xiang-yun Fu ◽

Yuan-hua Yu ◽

...

Keyword(s):

Hubei Province ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Healthcare Associated

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Prevalence of device use and transmission based precautions in nineteen large Australian acute care public hospitals: Secondary outcomes from a national healthcare associated infection point prevalence survey

Infection Disease & Health ◽

10.1016/j.idh.2020.05.006 ◽

2020 ◽

Vol 25 (4) ◽

pp. 262-267

Author(s):

Philip L. Russo ◽

Andrew J. Stewardson ◽

Allen C. Cheng ◽

Tracey Bucknall ◽

Brett G. Mitchell

Keyword(s):

Acute Care ◽

Public Hospitals ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Prevalence Survey ◽

National Healthcare ◽

Point Prevalence Survey ◽

Secondary Outcomes ◽

Device Use ◽

Healthcare Associated

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Antimicrobial Consumption and Resistance in a Tertiary Care Hospital in Jordan: Results of an Internet-Based Global Point Prevalence Survey

Antibiotics ◽

10.3390/antibiotics9090598 ◽

2020 ◽

Vol 9 (9) ◽

pp. 598

Author(s):

Khawla Abu Hammour ◽

Esraa AL-Heyari ◽

Aya Allan ◽

Ann Versporten ◽

Herman Goossens ◽

...

Keyword(s):

Teaching Hospital ◽

Point Prevalence ◽

Antibiotic Prescribing ◽

Prescription Data ◽

Care Hospital ◽

Antimicrobial Consumption ◽

Healthcare Associated Infection ◽

Prevalence Survey ◽

Point Prevalence Survey ◽

Healthcare Associated

Background: The Global Point Prevalence Survey (Global-PPS) provides a standardised method to conduct surveillance of antimicrobial prescribing and resistance at hospital level. The aim of the present study was to assess antimicrobial consumption and resistance in a Jordan teaching hospital as part of the Global-PPS network. Methods: Detailed antimicrobial prescription data were collected according to the Global Point Prevalence Survey protocol. The internet-based survey included all inpatients present at 8:00 am on a specific day in June–July 2018. Resistance data were based on microbiological results available on the day of the PPS. Results: Data were collected for 380 patients admitted to adult wards, 72 admitted children, and 36 admitted neonates. The overall prevalence of antimicrobial use in adult, paediatric, and neonatal wards was 45.3%, 30.6%, and 22.2% respectively. Overall, 36 patients (7.4%) were treated for at least one healthcare-associated infection (HAI). The most frequent reason for antimicrobial treatment was pneumonia. Cephalosporins and carbapenems were most frequent prescribed among adult (50.6%) and paediatric/neonatal wards (39.6%). Overall resistance rates among patients treated for a community or healthcare-associated infection was high (26.0%). Analysis of antibiotic quality indicators by activity revealed good adherence to treatment guidelines but poor documentation of the reason for prescription and a stop/review date in the notes. Conclusion: The present study has established baseline data in a teaching hospital regarding the quantity and quality of prescribed antibiotics in the hospital. The study should encourage the establishment of tailor-made antimicrobial stewardship interventions and support educational programs to enhance appropriate antibiotic prescribing.

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

INQUIRY The Journal of Health Care Organization Provision and Financing ◽

10.1177/00469580211067930 ◽

2021 ◽

Vol 58 ◽

pp. 004695802110679

Author(s):

Hela Ghali ◽

Asma Ben Cheikh ◽

Sana Bhiri ◽

Selwa Khefacha ◽

Houyem Said Latiri ◽

...

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Protective Factor ◽

Bloodstream Infections ◽

Point Prevalence ◽

University Hospital ◽

Healthcare Associated Infection ◽

Tract Infections ◽

Healthcare Associated ◽

The Impact

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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Point-Prevalence of Healthcare-Associated Infection in China in 2010: A Large Multicenter Epidemiological Survey

Infection Control and Hospital Epidemiology ◽

10.1086/678433 ◽

2014 ◽

Vol 35 (11) ◽

pp. 1436-1437 ◽

Cited By ~ 11

Author(s):

Chunhui Li ◽

Ximao Wen ◽

Nan Ren ◽

Pengcheng Zhou ◽

Xun Huang ◽

...

Keyword(s):

Epidemiological Survey ◽

Point Prevalence ◽

Healthcare Associated Infection ◽

Healthcare Associated

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Healthcare-associated infection, antimicrobial prescribing, and antimicrobial resistance

10.1093/med/9780198810858.003.0024 ◽

2021 ◽

pp. 893-902

Author(s):

Nicole Stoesser

Keyword(s):

Antimicrobial Resistance ◽

Healthcare Associated Infection ◽

Antimicrobial Prescribing ◽

Healthcare Associated

Healthcare-associated infection, Principles of antimicrobial prescribing, Antimicrobial resistance

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Fall in Vitamin D Levels during Hospitalization in Children

International Journal of Pediatrics ◽

10.1155/2014/291856 ◽

2014 ◽

Vol 2014 ◽

pp. 1-6 ◽

Cited By ~ 9

Author(s):

Devi Dayal ◽

Suresh Kumar ◽

Naresh Sachdeva ◽

Rakesh Kumar ◽

Meenu Singh ◽

...

Keyword(s):

Vitamin D ◽

Hospital Stay ◽

Vitamin D Supplementation ◽

Healthcare Associated Infection ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

The Mean ◽

The Difference ◽

Healthcare Associated

Plasma levels of 25-hydroxyvitamin D [25(OH)D] were measured by competitive Electrochemiluminescence Immunoassay (ECLIA) in 92 children (67 boys, 25 girls) aged 3 months to 12 years at admission to hospital (timepoint 1, T1) and at discharge (timepoint 2, T2). There was a significant fall in the mean 25(OH)D from T1 (71.87 ± 27.25 nmol/L) to T2 (49.03 ± 22.25 nmol/L) (mean change = 22.84 nmol/L,Pvalue = 0.0004). Proportion of patients having VDD (levels <50 nmol/L) at admission (25%, 23/92) increased significantly at the time of discharge (51.09%, 47/92) (P=0.0004). There was a trend towards longer duration of hospital stay, requirement of ventilation and inotropes, development of healthcare-associated infection, and mortality in vitamin D deficient as compared to nondeficient patients though the difference was statistically insignificant. In conclusion, vitamin D levels fall significantly and should be monitored during hospital stay in children. Large clinical studies are needed to prospectively evaluate the effect of vitamin D supplementation in vitamin D deficient hospitalized children on various disease outcome parameters.

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