Incidence of Surgical Site Infections in Multicenter Study—Implications for Surveillance Practice and Organization

Introduction: WHO core components of healthcare-associated infections (HAIs) prevention and control include their surveillance system. In Poland, there are no widespread multi-center infection surveillance networks based on continuous, targeted, active methodology. One of the most important form of HAIs are surgical site infections (SSIs). The aim of this study was to analyze the incidence of SSIs, in the context of seasonal differentiation. Seasonal differentiation could be connected with weather conditions, but it also can be affected by personnel absence due to holidays and furlough. The second aspect may influence organization of work and increased absenteeism may contribute to lowering the quality of patient care. Healthcare associated infections are the phenomenon which can be especially affected by such factors. Methods: The data used originate from the targeted, active surveillance reports obtained from the six years period, based on the ECDC recommendations. Results: Highest incidence rates of SSIs were found after operations performed in June and August, equal to 1.8% and 1.5% respectively and the lowest in October was 0.8%. These differences were statistically significant: for June incidence: OR 1.6, 95% CI 1.03–2.5, p = 0.015. Another approach showed a significant difference between the level of incidence in the period from November to January together with from June to August (1.35%), comparing to the rest of the year (1.05%). Also the rates of enterococcal and Enterobacterales infections were significantly higher for the period comprising months from November till January and from June to August. In Poland these are periods of increased number of absences associated with summer, national and religious holidays. Conclusions: Our results show that the short-term surveillance data limited to several days or months are not sufficient to obtain a valuable description of the epidemiological situation due to HAI. Efforts should be undertaken in order to implement wide net of hospital acquired infections, including SSI on the country level.

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Prevention of healthcare associated infections

Manual of Infection Prevention and Control ◽

10.1093/med/9780198815938.003.0007 ◽

2019 ◽

pp. 233-304 ◽

Cited By ~ 1

Author(s):

Nizam Damani

Keyword(s):

Prevention And Control ◽

Bloodstream Infections ◽

Surgical Site Infections ◽

Central Line ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Tract Infections ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

This chapter provides the most up-to-date advice on infection prevention and control (IPC) of the four most common healthcare-associated infections (HAIs). These are: surgical site infections; infection associated with peripheral IV line/cannula and central line-associated bloodstream infections (CLABSIs); catheter-associated urinary tract infections (CAUTI); and hospital-acquired and ventilator-acquired pneumonias (VAP). The chapter examines and summarizes various key elements and discusses implementation of HAI care bundles and high impact interventions which are necessary to reduce these infections.

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Epidemiology of Surgical Site Infections Considering the NHSN Standardized Infection Ratio in Hip and Knee Arthroplasties

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17093167 ◽

2020 ◽

Vol 17 (9) ◽

pp. 3167

Author(s):

Róża Słowik ◽

Małgorzata Kołpa ◽

Marta Wałaszek ◽

Anna Różańska ◽

Barbara Jagiencarz-Starzec ◽

...

Keyword(s):

Optimal Solution ◽

Surgical Site Infections ◽

Incidence Density ◽

Coagulase Negative Staphylococci ◽

Surveillance Network ◽

Hospital Acquired Infections ◽

Etiologic Agents ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

Introduction Surgical site infections (SSIs) are a predominant form of hospital-acquired infections in surgical wards. The objective of the study was analysis of the incidence of SSI in, both primary and revision, hip and knee arthroplasties. Material and methods: The study was conducted in 2012–2018 in a Trauma and Orthopedics Ward in Tarnów according to the methodology of the Healthcare-Associated Infections Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). Results: The surveillance comprised 2340 surgery patients, including: 1756 Hip Arthroplasties (HPRO) and 584 Knee Arthroplasties (KPRO). In the group of patients under study, 37 cases of SSI were detected, including: 26 cases of SSI after HPRO and 11 cases in KPRO. The average incidence of SSI amounted to 1.6% (1.5% HPRO and 1.9% KPRO) and in-hospital incidence density rates were 1.23 and 1.53 per 1000 patient-days, respectively. Median age of surgical patients in both HPRO and KPRO was 70 years. Women were undergoing arthroplasty surgery more often than men, HPRO (p < 0.05) and KPRO (p < 0.001). Patients with SSI stayed in the ward longer (SSI-HPRO, p < 0.001) (SSI-KPRO p < 0.01). In KPRO operations, the incidence of SSI was higher than expected, calculated according to the Standardized Infection Ratio (SIR). The most common etiologic agents isolated from SSIs in both HPRO and KPRO were coagulase-negative staphylococci. Conclusions: Establishing a thorough surveillance of hospital-acquired infections that takes into consideration epidemiological indicators is indispensable to properly assess the epidemiological situation in the ward. The optimal solution is to carry out long-term and multi-center surveillance in the framework of a uniform program, however, even results of single-center studies provide valuable data indicating challenges and needs in improving patient safety.

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Hand Hygiene Practices to Reduce Hospital Acquired Infection

10.47363/jcbr/2019(1)103 ◽

2019 ◽

pp. 1-4

Author(s):

Liana Monica DEAC Babes ◽

Keyword(s):

Hand Hygiene ◽

Personal Hygiene ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Effective Measure ◽

Hospital Acquired Infection ◽

Hygiene Practices ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

Hands are the most effective mode of transfer of microorganism in healthcare and can result in healthcare associated infections which are major causes of morbidity and mortality worldwide. Reduction of infection by this mode of transfer can be achieved by a simple but very effective measure of performing hand hygiene at the appropriate time which is one of the most fundamental principles in infection prevention and control. Good hand hygiene practices have been shown to reduce healthcare associated infections. Hand washing with soap and water has been considered a measure of personal hygiene for several years

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Hand Hygiene Practices to Reduce Hospital Acquired Infection

Journal of Gastroenterology & Digestive Systems ◽

10.33140/jgds.03.03.01 ◽

2019 ◽

Vol 3 (3) ◽

Keyword(s):

Hand Hygiene ◽

Personal Hygiene ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Effective Measure ◽

Hospital Acquired Infection ◽

Hygiene Practices ◽

Healthcare Associated ◽

Hospital Acquired ◽

And Control

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The multimodal strategy in Surgical Site Infections control and prevention in orthopaedic patients – a 10-year retrospective observational study at a Polish hospital

10.21203/rs.2.17756/v2 ◽

2020 ◽

Author(s):

Małgorzata Kołpa ◽

Róża Słowik ◽

Marta Wałaszek ◽

Zdzisław Wolak ◽

Anna Rozanska ◽

...

Keyword(s):

Hip Prosthesis ◽

Knee Prosthesis ◽

Surgical Site Infections ◽

Control Program ◽

Incidence Rates ◽

Healthcare Associated Infections ◽

Orthopaedic Patients ◽

Before And After ◽

Healthcare Associated ◽

Prevention Plan

Abstract INTRODUCTION Surgical site infections (SSIs) are among the most common healthcare-associated infections. They are associated with longer post-operative hospital stays, additional surgical procedures, treatment in intensive care units and higher mortality. MATERIAL AND METHODS Surgical site infections (SSIs) were detected in patients hospitalized in a 40-bed orthopaedics ward via continuous surveillance in 2009–2018. The total number of study patients was 15,678. The results were divided into two 5-year periods before and after the introduction of the SSI prevention plan. The study was conducted as part of a national Healthcare-Associated Infections Surveillance Programme, following the methodology recommended by the HAI-Net, European Centre for Disease Prevention and Control Program (ECDC). RESULTS 168 SSIs were detected in total, including 163 deep SSIs (SSI-D). The total SSI incidence rate was 1.1%, but in hip prosthesis: 1.2%, in knee prosthesis: 1.3%, for open reduction of fracture (FX): 1.3%, for close reduction of fracture (CR): 1.5%, and 0.8% for other procedures. 64% of SSI-D cases required rehospitalisation. A significantly reduction in incidence was found only after fracture reductions: FX and CR, respectively 2.1% vs. 0.7% (OR 3.1 95%CI 1.4-6.6, p<0.01) and 2.1 vs. 0.8% (OR 2.4 95%CI 1.0-5.9, p<0.05). SSI-Ds were usually caused by Gram-positive cocci, specially Staphylococcus aureus , 74 (45.7%); Enterobacteriaceae bacillis accounted for 14.1% and Gram-negative non-fermenting rods for 8.5%. CONCLUSIONS The implementated SSI prevention plan demonstrated a significant decrease from 2.1% to 0.7% in SSI-D incidence only in fracture reductions, without changes in epidemiology SSI incidence rates in other procedures. Depending on the epidemiological situation in the ward, it is worthwhile to surveillance of SSIs associated to different types of orthopaedic surgery to assess the risks and take preventive measures.

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Longitudinal Trends in All Healthcare-Associated Infections through Comprehensive Hospital-wide Surveillance and Infection Control Measures over the Past 12 Years: Substantial Burden of Healthcare-Associated Infections Outside of Intensive Care Units and “Other” Types of Infection

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2015.142 ◽

2015 ◽

Vol 36 (10) ◽

pp. 1139-1147 ◽

Cited By ~ 14

Author(s):

Hajime Kanamori ◽

David J. Weber ◽

Lauren M. DiBiase ◽

Emily E. Sickbert-Bennett ◽

Rebecca Brooks ◽

...

Keyword(s):

Intensive Care ◽

Tract Infection ◽

Intensive Care Units ◽

Linear Models ◽

Infection Type ◽

Tertiary Care ◽

Surgical Site Infections ◽

Control Measures ◽

Healthcare Associated Infections ◽

Healthcare Associated

OBJECTIVETargeted surveillance has focused on device-associated infections and surgical site infections (SSIs) and is often limited to healthcare-associated infections (HAIs) in high-risk areas. Longitudinal trends in all HAIs, including other types of HAIs, and HAIs outside of intensive care units (ICUs) remain unclear. We examined the incidences of all HAIs using comprehensive hospital-wide surveillance over a 12-year period (2001–2012).METHODSThis retrospective observational study was conducted at the University of North Carolina (UNC) Hospitals, a tertiary care academic facility. All HAIs, including 5 major infections with 14 specific infection sites as defined using CDC criteria, were ascertained through comprehensive hospital-wide surveillance. Generalized linear models were used to examine the incidence rate difference by infection type over time.RESULTSA total of 16,579 HAIs included 6,397 cases in ICUs and 10,182 cases outside ICUs. The incidence of overall HAIs decreased significantly hospital-wide (−3.4 infections per 1,000 patient days), in ICUs (−8.4 infections per 1,000 patient days), and in non-ICU settings (−1.9 infections per 1,000 patient days). The incidences of bloodstream infection, urinary tract infection, and pneumonia in hospital-wide settings decreased significantly, but the incidences of SSI and lower respiratory tract infection remained unchanged. The incidence of Clostridium difficile infection (CDI) increased remarkably. The outcomes were estimated to include 700 overall HAIs prevented, 40 lives saved, and cost savings in excess of $10 million.CONCLUSIONSWe demonstrated success in reducing overall HAIs over a 12-year period. Our data underscore the necessity for surveillance and infection prevention interventions outside of the ICUs, for non–device-associated HAIs, and for CDI.Infect Control Hosp Epidemiol 2015;36(10):1139–1147

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Impact of Healthcare-Associated Infections Connected to Medical Devices—An Update

Microorganisms ◽

10.3390/microorganisms9112332 ◽

2021 ◽

Vol 9 (11) ◽

pp. 2332

Author(s):

Nitin Chandra Teja Dadi ◽

Barbora Radochová ◽

Jarmila Vargová ◽

Helena Bujdáková

Keyword(s):

Medical Devices ◽

Surgical Site Infections ◽

Central Line ◽

Ventilator Associated Pneumonia ◽

Healthcare Associated Infections ◽

Care Bundles ◽

Planktonic Form ◽

Novel Approaches ◽

Healthcare Associated ◽

The Impact

Healthcare-associated infections (HAIs) are caused by nosocomial pathogens. HAIs have an immense impact not only on developing countries but also on highly developed parts of world. They are predominantly device-associated infections that are caused by the planktonic form of microorganisms as well as those organized in biofilms. This review elucidates the impact of HAIs, focusing on device-associated infections such as central line-associated bloodstream infection including catheter infection, catheter-associated urinary tract infection, ventilator-associated pneumonia, and surgical site infections. The most relevant microorganisms are mentioned in terms of their frequency of infection on medical devices. Standard care bundles, conventional therapy, and novel approaches against device-associated infections are briefly mentioned as well. This review concisely summarizes relevant and up-to-date information on HAIs and HAI-associated microorganisms and also provides a description of several useful approaches for tackling HAIs.

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Point prevalence of healthcare-associated infections and antibiotic use in a tertiary care teaching hospital in Nepal: A cross-sectional study

Journal of Infection Prevention ◽

10.1177/17571774211035827 ◽

2021 ◽

pp. 175717742110358

Author(s):

Sailesh Kumar Shrestha ◽

Swarup Shrestha ◽

Sisham Ingnam

Keyword(s):

Prevention And Control ◽

Tertiary Care ◽

Antibiotic Use ◽

Point Prevalence ◽

University Hospital ◽

Infection Prevention And Control ◽

Healthcare Associated Infections ◽

Prevalence Survey ◽

Healthcare Associated ◽

And Control

Information on the burden of healthcare-associated infections (HAIs) and patterns of antibiotic use are prerequisites for infection prevention and control (IPC) and antibiotics stewardship programmes. However, a few studies have been reported from resource-limited settings and many of them have not used standard definitions to diagnose HAI precluding benchmarking with regional or international data. This study aims to estimate the prevalence of HAIs and antibiotic use in our centre. We conducted a point prevalence survey in a 350-bed university hospital in Kathmandu, Nepal in April 2019. We reviewed all patients aged ⩾ 18 years admitted to the hospital for at least two calendar days and evaluated for the three common HAIs—pneumonia, urinary tract infection and surgical site infection. We used the clinical criteria by the European Center for Disease Prevention and Control to diagnose the HAIs. We also collected information on the antibiotics used. Of 160 eligible patients, 18 (11.25%) had HAIs and 114 (87.5%) were on antibiotics, with more than half of them (61/114 patients, 53.5%) receiving two or more antibiotics. This highlights the need for effective implementation of IPC as well as antibiotics stewardship programmes in our centre.

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Hospital-acquired Infections and Healthcare-associated Infections

Concise Handbook of Infectious Diseases ◽

10.5005/jp/books/14120_23 ◽

2018 ◽

pp. 158-158

Author(s):

MI Sahadulla

Keyword(s):

Healthcare Associated Infections ◽

Hospital Acquired Infections ◽

Healthcare Associated ◽

Hospital Acquired

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1314. From Book to Bedside: Theoretical and Applied Knowledge on the Topic of Healthcare-Associated Infections in Second-Year Nursing Students from a Croatian University

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1147 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S402-S402

Author(s):

Tomislav Mestrovic ◽

Goran Kozina ◽

Marijana Neuberg ◽

Rosana Ribic

Keyword(s):

Nursing Students ◽

Hand Hygiene ◽

Health Workers ◽

Healthcare Associated Infections ◽

Standard Precautions ◽

Significant Difference ◽

Level Of Knowledge ◽

Second Year ◽

Healthcare Associated ◽

Applied Knowledge

Abstract Background Adequate training of health workers is pivotal in the prevention of healthcare-associated infections (HAI). Our aim was to assess the theoretical and applied knowledge about the risk factors and effective measures of HAI prevention (most notably the use of standard precautions and hand hygiene practices) in second year undergraduate university nursing students that have already completed obligatory courses in microbiology, infectious diseases and epidemiology. Methods This study included a whole generation of second year undergraduate nursing students, comprised of 161 female and 25 male participants (186 in total), from a public university in Croatia (University Centre Varaždin, University North). They were given an anonymous questionnaire (developed on the model used by Tavolacci et al. in 2008) covering three domains: General Knowledge of HAI, Standard Precautions (SP) and Hand Hygiene (HH). The acceptable score overall (max. 30) and for each area (max. 10) was arbitrarily set at ≥ 20 and ≥ 7, respectively (in accordance with prior research). Results The age range of surveyed students was 19–37 (mean: 21.97, median: 21, mod: 20). An accurate definition of nosocomial infections was provided by 98.92% students (with 60.75% of them defining it as the infection occurring 48 hours after hospital admission). The overall score was 21.5, which indicates sufficient level of applied knowledge of healthcare-associated infections. Very high level of knowledge was observed for the SP area (total score of 9.5); however, the level of knowledge in HAI and HH domains was inadequate (5.9 and 6.1, respectively). There was no statistically significant difference in the overall or specific scores between male and female students (P > 0.05). Formal teaching during the curriculum was students’ primary source of information (60.22%), followed by practical learning in the ward during work (23.65%), formal teaching in the ward (9.68%) and self-learning (6.45%). Conclusion Periodical checking of nursing students’ knowledge on HAI and corresponding curriculum modifications in obligatory courses tackling this topic are advised in order to fill the knowledge gaps, improve training, reduce infection rates and increase compliance with prevention measures. Disclosures All authors: No reported disclosures.

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