Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections.
ABSTRACT In recent years, several countries have established surveillance systems for nosocomial infections (NIs) on a national basis. Limited information has been published on the effectiveness of these national surveillance systems. The aim of this study was to investigate whether participation in the German national NI surveillance system [Krankenhaus Infektions Surveillance System (KISS)] resulted in reduced rates of NIs. Three major NIs were studied: ventilator-associated pneumonia (VAP) and central-venous-catheter-related primary bloodstream infections (CR-BSIs) in intensive care units (ICUs), and surgical site infections (SSIs) in surgical inpatients. Data were collected from January 1997 until December 2003. Only institutions that had participated in KISS for at least 36 months were considered for analysis. Data from the first 12 months of surveillance were compared with data from the second and third 12-month periods. One hundred and fifty ICUs and 133 surgical departments fulfilled the inclusion criteria. In their first year of participation in KISS, the ICUs had an average VAP rate of 11.2 per 1000 ventilator-days and a CR-BSI rate of 2.1 per 1000 catheter-days. The average SSI rate in the surgical inpatients was 1.6 per 100 operations in their first year of participation. Comparing the infection rates in the third year with the first year, the relative risk (RR) for VAP was 0.71 [95% confidence intervals (CI) 0.66-0.76] and the RR for CR-BSI was 0.80 (95% CI 0.72-0.90). The corresponding RR for SSI was 0.72 [95% CI 0.64-0.80]. Participation in KISS was associated with a significant reduction in these three NIs.
- Biomédica: revista del Instituto Nacional de Salud 08/2013; 34:67. · 0.62 Impact Factor
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ABSTRACT: Citation: Elmenshawy AM, Elbadawy TH, Abu khaber H, Hafez SF, Fayed AM, Ibrahim EH. The impact of VAP staff education on VAP morbidity and mor-tality in Alexandria University. Pulm Res Respir Med Open J. 2014; 1(1): 32-45. ABSTRACT Background: Staff education had several success stories in reducing Ventilator-associated Pneumonia (VAP) rate. However, the stability of supplies and the top management support were not addressed in most of these studies. In addition, both were considered essential in several reviews. Aim: To determine the efficiency (VAP rate) and efficacy (mechanical ventilation morbidity and mortality) of VAP staff education with deficient supplies and lack of top management support. Methods: Quasi-experimental study with before and after prospective cohort in two medical/ surgical ICUs of Alexandria university affiliated hospitals during the period from September 2007 till May 2013. The intervention phase included the provision of supplementary supplies, interactive education for physicians and nurses followed by a VAP campaign. All VAP episodes not only the first one was included. Results: A total of 598 patients were enrolled in the study. The adherence to expanded VAP bundle significantly increased in the post-intervention phase as follows; head of bed elevation (from mean of 40 to 100% with p=0.001), oral care (from mean of 20 to 100% with p=0.001), daily sedation vacation (from mean of 56.5 to 91% with p=0.001), daily assessment of weaning (from mean of 9 to 25% with p=0. 03), peptic ulcer prophylaxis (from mean of 83 to 100% with p=0.001), DVT prophylaxis (from mean of 82 to 100% and p=0.001), cuff pressure measure-ment (from mean of 9 to 60% with p=0.001), and hand hygiene (from mean of 8 to 28.5% with p=0.001).The VAP rate decreased significantly by 35% (from 66.5 to 43 per 1000 MV days) with p= 0.002and CI 9.73-37.15 in spite of significant increase of the ventilator utilization ratio (p <0.001) in the post-intervention phase. The MV, antibiotic and ICU days did not change significantly in the post-intervention phase. The distribution of organisms did not differ signifi-cantly between both groups (p=0. 465). The sensitivity of most of carbapenems and β-lactam/β-lactamase inhibitors to Acinetobacter, Klebsiella andPseudomonas decreased significantly in the post intervention phase whereas the sensitivity of vancomyicin to Staphylococcus aureus remained the same. Conclusions: In spite of the lack of top management support and fluctuating supplies, VAP staff education was still efficient in reducing VAP without affecting mortality or MV days or ICU length of stay.Pulmonary research and respiratory medicine. 12/2014;
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ABSTRACT: Surgical site infection (SSI) is one of the most common surgical complications in the world, particularly in developing countries. This study aimed to estimate the incidence and distribution of SSI in mainland China. Eighty-four prospective observational studies (82 surveillance studies, 1 nested case control study, and 1 cohort study) were selected for inclusion in this meta-analysis. The average incidence of SSI in mainland China was 4.5% (95% CI: 3.1-5.8) from 2001 to 2012 and has decreased significantly in recent years. The remote western regions had a higher incidence of 4.6% (95% CI: 4.0-5.3). The most common surgical procedure was abdominal surgery (8.3%, 95% CI: 6.5-10.0). SSI occurred frequently in the elderly (5.1%, 95% CI: 2.2-8.0), patients confined to hospital for over 2 weeks (5.7%, 95% CI: 0.9-10.0), superficial incision wounds (5.6%, 95% CI: 4.4-6.8), dirty wounds (8.7%, 95% CI: 6.9-10.6), operations lasting for over 2 hours (7.3%, 95% CI: 4.9-9.7), general anaesthesia operations (4.7%, 95% CI: 2.7-6.6), emergency surgeries (5.9%, 95% CI: 4.2-7.7), and non-intra-medication operations (7.4%, 95% CI: 1.0-13.7).Scientific Reports 10/2014; 4:6783. · 5.08 Impact Factor