Alert microorganisms isolated from patients hospitalized in Małopolskie province in 2010-2012

Abstract

Objective:
Healthcare centers undertake supervisory activities to control health care-associated infections (HCAIs) by elaborating procedures, identifying alert microorganisms and analyzing data collected. The aim of the study was to analyze the prevalence of alert microorganisms in hospital wards in 2010-2012.

Material and methods:
Legislation which is in force since several years introduced the principles of health care-associated infections control and reporting system. Analysis was based on annual reports on alert microorganisms provided by 19 District Sanitary and Epidemiological Stations from Małopolskie province. The data discuss positive tests results for alert microorganisms in patients who stayed in hospitals supervised by the Sanitary and Epidemiological Stations.

Results:
Compared to 2010-2011, the number of tests per hospital bed in 2012 was lower, amounting to 24 (2010 - 44, 2011 - 34). Of these tests, the majority was performed in the following wards: transplantology (2010 - 339, 2011 - 354, 2012 - 330), burn care (2010 - 354, 2011 - 148, 2012 - 113) and ICUs for adults (2010 - 155, 2011 - 157, 2012 - 140). In 2010-2012, an increase in the number of positive test results for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL+) and Clostridium difficile as well as slight decrease in the number of positive test results for other alert microorganisms were noted. The highest number of microorganisms was identified in neonatal and neonatal pathology (Enterobacteriaceae ESBL+); pediatric and infectious diseases (Rotavirus); infectious diseases (Rotavirus, C.difficile); burn care (Acinetobacter baumanii, Pseudomonas sp.) and ophthalmic and hemodialysis wards (MRSA).

Conclusion:
Irrespective of a decrease in the number of tests per hospital bed in 2012, a high number of positive test results for alert microorganisms was observed. It suggests the necessity for wider application of collected data as to improve monitoring of infections and reduce resulting threats.

Full text

PRZEGL EPIDEMIOL 2014; 68: 443 - 450 Problems of infections
© National Institute of Public Health – National Institute of Hygiene
Michał Seweryn, Katarzyna Bandoła, Małgorzata Bała, Sylwia Sroka,
Magdalena Koperny, Magdalena Wszołek
ALERT MICROORGANISMS ISOLATED FROM PATIENTS HOSPITALIZED IN
MAŁOPOLSKIE PROVINCE IN 2010-2012
Provincial Sanitary and Epidemiological Station in Cracow
ABSTRACT
OBJECTIVE. Healthcare centers undertake supervisory activities to control health care-associated infections
(HCAIs) by elaborating procedures, identifying alert microorganisms and analyzing data collected. The aim of
the study was to analyze the prevalence of alert microorganisms in hospital wards in 2010–2012.
MATERIAL AND METHODS. Legislation which is in force since several years introduced the principles of
health care-associated infections control and reporting system. Analysis was based on annual reports on alert
microorganisms provided by 19 District Sanitary and Epidemiological Stations from Małopolskie province. The
data discuss positive tests results for alert microorganisms in patients who stayed in hospitals supervised by the
Sanitary and Epidemiological Stations.
RESULTS. Compared to 2010–2011, the number of tests per hospital bed in 2012 was lower, amounting to 24
(2010 – 44, 2011 – 34). Of these tests, the majority was performed in the following wards: transplantology (2010
– 339, 2011 – 354, 2012 – 330), burn care (2010 – 354, 2011 – 148, 2012 – 113) and ICUs for adults (2010 – 155,
2011 – 157, 2012 – 140). In 2010–2012, an increase in the number of positive test results for extended-spectrum
beta-lactamase-producing Enterobacteriaceae (ESBL+) and Clostridium difficile as well as slight decrease in the
number of positive test results for other alert microorganisms were noted. The highest number of microorganisms
was identified in neonatal and neonatal pathology (Enterobacteriaceae ESBL+); pediatric and infectious diseases
(Rotavirus); infectious diseases (Rotavirus, C.difficile); burn care (Acinetobacter baumanii, Pseudomonas sp.)
and ophthalmic and hemodialysis wards (MRSA).
CONCLUSION. Irrespective of a decrease in the number of tests per hospital bed in 2012, a high number of
positive test results for alert microorganisms was observed. It suggests the necessity for wider application of
collected data as to improve monitoring of infections and reduce resulting threats.
Key words: alert microorganisms, hospital wards, health care-associated infections, microbiological test
INTRODUCTION
Health care-associated infections (HCAIs) and anti-
microbial therapy are one of the most serious concerns
for modern medicine. Their prevalence is inseparably
associated with treatment of patients in hospital settings.
Therefore, total elimination of HCAIs is not feasible.
Activities undertaken within the surveillance aim at
reducing the prevalence of infections by strengthening
the supervision and efficacy of procedures applied. Sur-
veillance over infections consists a constant, systematic
collection of data, their analysis and interpretation based
on standard scientific methods, including standardized
infection definitions. The basic objective of surveil-
lance is to identify etiological agents of HCAIs which
consequently enables to determine the most prevalent
microorganisms being the threat for both patient and
hospital environment (1). Obligation to report HCAIs
allows for early detection of epidemics and identifica-
tion of single cases in high risk groups (2).
Executive documents in force issued by the Ministry
of Health, regulating the principles of HCAI control,
imposed the obligation of complex epidemiological
surveillance in stationary health care centers, including
adherence to preventive procedures based on current
medical knowledge and monitoring of HCAIs associ-
ated with rendering of medical services. Act on Prevent-
ing and Combating Human Infections and Infectious

Michał Seweryn, Katarzyna Bandoła et al.
444 No 3
Diseases of 5th December 2008 (3) and regulations in
force (4-7) introduced the principles of basic elements
of control of HCAIs. They determine the composition
of HCAI control team, the range of internal control
over execution of activities set up, methods of report-
ing and the scope of reporting in case of suspicion or
occurrence of infection within the routine evaluation of
epidemiological situation in hospital.
System of data collection using HCAI records is
based on standardized definitions, constituting reli-
able statistic tool and allowing for complex analysis of
data. Methods which are applicable in Poland include
passive and active reporting system. In case of passive
system, reporting of cases and their recording belong
to the responsibilities of medical personnel of a ward.
Information is usually analyzed retrospectively, using
hospital documentation and HCAI records. This method
is hardly effective and detects ca 25% of all infections
occurring in hospital. Active system consists in a daily,
prior standardized qualification of infections by the
members of HCAI team, with sensitivity of infection
detection amounting to 95%. Therefore, systematic
evaluation of infection incidence in a particular group of
patients is feasible. Irrespective of the system adopted,
collected data are a basis for developing recommenda-
tions and introducing modification into procedures ap-
plied in healthcare centers as to enhance the surveillance
over patient colonization (8, 9).
So far, no one from Małopolskie province has pub-
lished the results of analysis of alert microorganisms
isolated from hospitalized patients with presentation
of etiological agents.
This paper aimed at analyzing the prevalence of
alert microorganisms isolated from hospitalized patients
with regard to the specialization of hospital wards in
Małopolskie province. It enabled to determine which
alert microorganisms are highly prevalent and attract
the attention of hospital personnel to the problem of
patient colonization.
MATERIAL AND METHODS
Reports sent by 19 State District Sanitary Inspectors
to the State Provincial Sanitary Inspector of Małopolskie
province were subject to analysis. These annual reports
included the data on the number of positive test results
for alert microorganisms in patients hospitalized in
Małopolskie province in 2010–2012.
The number of hospitals amounted to 72 (6,797
hospital beds), 70 (6,930) and 69 (6,838) in 2012,
2011 and 2010, respectively according to the register
of healthcare centers of the governor of Małopolskie
province. Alteration of the number of supervised centers
resulted from organizational changes with the examples
being: hospital mergers, occurrence of new hospitals or
termination of hospital operation in a given territory.
Definition of HCAIs is pursuant to the Act of 5th
December 2008 (3), which is analogical to the definition
adopted by the World Health Organization (WHO). It is
defined as: ”infection acquired during hospital care or
associated with stay at hospital, which is secondary to
the health status of a patient preceding hospitalization.
It is with regard to both patient and medical personnel.
It is an infection occurring more than 48 hours after
patient admission to hospital, until 10 days follow-
ing his discharge, until 30 days and a year following
surgery and transplantation, respectively” (10, 3). A
list of alert microorganisms which are monitored in
healthcare centers was provided in the appendix 1 to the
regulation of the Minister of Health (7). The following
microorganisms were subject to analysis: methicyllin-
resistant Staphylococcus aureus (MRSA), extended-
spectrum beta-lactamase-producing Enterobacteriaceae
(ESBL+), Pseudomonas sp., Acinetobacter baumanii,
Rotavirus and Clostridium difficile.
In analysis the frequency of microbiological tests
per hospital bed per year was discussed which enabled
to evaluate the monitoring system of etiological agents
of HCAIs.
RESULTS
In hospitals localized in Małopolskie province, an
average number of microbiological tests per hospital
Table I. Number of microbiological tests per hospital bed
per year in patients hospitalized in selected hospital
wards in Małopolskie province in 2010–2012.
Ward 2010 2011 2012
ICU/IT for adults 155 157 140
ICU/IT for neonates and children 108 124 189
Surgical for adults 37 40 22
Orthopedic and traumatology 37 25 29
Non-surgical 37 38 27
Hematology and oncology 52 56 26
Obstetrics and gynecology 22 26 17
Neonatal 19 20 24
Neonatal pathology 40 65 75
Pediatric 46 41 35
Surgical for children 38 45 27
Psychiatric 8 6 0.8
Rehabilitation 2 2 1.3
Ophthalmic 20 30 15
Nursing/ geriatric / palliative care 3 4 6
Burn care 354 148 113
Infectious diseases 54 57 39
Transplantology 339 354 330
Hemodialysis 51 55 25
Other – beyond hospital structure 113 32 26
Total 33 34 24

Alert microorganisms isolated from patients 445No 3
bed in 2012 amounted to 24, 34 and 33 in 2012, 2011
and 2010, respectively. Table 1 provides the number of
tests with regard to the type of hospital wards.
Based on the analysis of percentage distribution of
particular alert microorganisms with regard to a total
number of positive test results of patients hospitalized
in Małopolskie province, it was concluded that the most
prevalent microorganisms in 2012 were Enterobacte-
riaceae ESBL+, Rotavirus and Acinetobacter baumanii
(Fig. 1).
The highest percentage of alert microorganisms in
2010–2012 was determined in patients who were hos-
pitalized in: intensive therapy/intensive care (IT/ICU)
units for adults, non-surgical, surgical and pediatric
wards (Fig. 2).
A detailed analysis of distribution of particular alert
microorganisms isolated from hospitalized patients with
regard to the specialization of wards in 2010–2012 was
also performed (Tab. 2). The number of alert microor-
ganisms isolated from these patients amounted to 8,154;
8,191 and 8,270 in 2010, 2011 and 2012, respectively.
Of the alert microorganisms identified in neonatal
pathology, neonatal wards and ICUs for neonates and
children in 2010–2012, the most prevalent were En-
terobacteriaceae ESBL+. These microorganisms were
not detected in ophthalmic and transplantology wards.
The highest distribution of rotaviruses with regard
to positive test results was noted in wards where chil-
dren were hospitalized – pediatric, infectious diseases
and pediatric surgery wards. These microorganisms
were rather not observed in wards where adults were
hospitalized.
In all analyzed years, the highest distribution of
Acinetobacter baumanii was observed in patients hospi-
talized in burn care wards and ICUs for adults. In 2012,
these microorganisms were not identified in hemodi-
Ryc. 1 Udział procentowy drobnoustrojów alarmowych wykrytych u pacjentów hospitalizowanych w szpitalach
województwa małopolskiego w latach 2010 - 2012r
Fig. 1 Percentage contribution of alert microorganisms detected in hospitalized patients in Malopolska
voivodeship hospitals, in years 2010-2012.
* wzrost w 2012r. związany jest z pojawieniem się w wykazie w 2012r. takich drobnoustrojów jak Candida,
Norovirus, HBV, HCV, HIV
* Increase in 2012 is associated with including pathogens such as Candida, Norovirus, HBV, HCV, HIV
Ryc.2 Udział procentowy najczęściej wykrywanych drobnoustrojów alarmowych* u hospitalizowanych
pacjentów na wybranych oddziałach szpitalnych w województwie małopolskim w latach 2010-2012
Fig.2 Percentage contribution of alert microorganisms most frequently detected in hospitalized patients in
selected hospital wards in Malopolska region, in period 2010-2012.
Fig. 1 Percentage contribution of alert microorganisms detected in hospitalized patients in Malopolska province hospitals,
in years 2010–2012.
* Increase in 2012 is associated with including pathogens such as Candida, Norovirus, HBV, HCV, HIV
Fig.2 Percentage contribution of alert microorganisms most frequently detected in hospitalized patients in selected
hospital wards in Malopolska, in period 2010–2012.
* percentage contribution of most frequently detected alert microorganisms in hospitalized patients in: ICU for
adults, treatment/surgical wards for adults: Acinetobacter baumanii, Enterobacteriaceae ESBL+, Pseudomonas
sp., MRSA, non-surgical: Acinetobacter baumanii, Enterobacteriaceae ESBL+, C. difficile, MRSA, pediatrics:
Enterobacteriaceae ESBL+, Pseudomonas sp., Rotavirus, MRSA.
Ryc. 1 Udział procentowy drobnoustrojów alarmowych wykrytych u pacjentów hospitalizowanych w szpitalach
województwa małopolskiego w latach 2010 - 2012r
Fig. 1 Percentage contribution of alert microorganisms detected in hospitalized patients in Malopolska
voivodeship hospitals, in years 2010-2012.
* wzrost w 2012r. związany jest z pojawieniem się w wykazie w 2012r. takich drobnoustrojów jak Candida,
Norovirus, HBV, HCV, HIV
* Increase in 2012 is associated with including pathogens such as Candida, Norovirus, HBV, HCV, HIV
Ryc.2 Udział procentowy najczęściej wykrywanych drobnoustrojów alarmowych* u hospitalizowanych
pacjentów na wybranych oddziałach szpitalnych w województwie małopolskim w latach 2010-2012
Fig.2 Percentage contribution of alert microorganisms most frequently detected in hospitalized patients in
selected hospital wards in Malopolska region, in period 2010-2012.

Michał Seweryn, Katarzyna Bandoła et al.
446 No 3
Table II. Distribution of alert microorganisms isolated from patients hospitalized in different wards in Małopolskie province 2010–2012.
2010
TOTAL
2011
TOTAL
2012
TOTAL
ward
Acinetobacter baumanii
C. difcile
Enterobacteriaceae ESBL+
Pseudomonas sp.
Rotavirus
MRSA
Acinetobacter baumanii
C. difcile
Enterobacteriaceae ESBL+
Pseudomonas sp.
Rotavirus
MRSA
Acinetobacter baumanii
C. difcile
Enterobacteriaceae ESBL+
Pseudomonas sp.
Rotavirus
MRSA
ICU/IT for adults 719 21 586 277 0 276 1879 631 22 552 289 0 272 1766 658 47 657 222 0 273 1857
ICU/IT for neonates and children 3 0 81 1 9 15 109 2 0 69 7 7 16 101 0 2 40 5 11 14 72
Surgical for adults 137 19 267 106 4 171 704 157 56 289 110 12 178 802 106 59 370 66 0 120 721
Orthopedic and traumatology 35 24 42 11 2 46 160 35 7 42 21 1 36 142 28 16 69 15 0 32 160
Non-surgical 234 199 772 163 12 252 1632 225 359 800 161 34 274 1853 207 414 962 115 23 235 1956
Hematology and oncology 3 12 34 4 32 5 90 7 29 20 9 16 6 87 6 15 52 4 26 10 113
Obstetrics and gynecology 2 0 47 5 2 15 71 1 3 55 3 1 15 78 3 7 59 1 2 10 82
Neonatal 4 0 33 3 0 11 51 0 0 44 1 1 9 55 1 0 85 2 0 12 100
Neonatal pathology 0 0 12 3 0 1 16 001816025 0080008
Pediatric 1 26 123 47 2224 63 2484 4 13 124 47 1837 47 2072 0 4 163 15 1880 33 2095
Surgical for children 0 1 26 1 60 6 94 0 0 11 1 36 8 56 1 1 13 1 32 6 54
Psychiatric 0050016125001902800010
Rehabilitation 313952959 8 4 49 8 2 7 78 8 6 46 9 1 8 78
Ophthalmic 000000000000111100024
Nursing/ geriatric / palliative care 10 1 33 13 0 14 71 22 7 23 11 01477 3 10 30 5 0 10 58
Burn care 160230324 130211017 24 0 8 7 0 4 43
Infectious diseases 9 89 51 6 470 23 648 7 108 58 16 455 32 676 5 180 59 7 537 22 810
Transplantology 001030403003060000000
Hemodialysis 021200822 04510515 0020035
Other – beyond hospital structure 1 0 11 12 6 30 0 36 18 4 209 8 275 7 1 25 2 0 9 44
TOTAL 1177 395 2177 648 2832 925 8154 1113 653 2184 691 2621 929 8191 1058 765 2656 476 2512 803 8270

Alert microorganisms isolated from patients 447No 3
alysis, transplantology, psychiatric, pediatric, neonatal
pathology, anaesthetic and ICU wards.
In 2012, the highest prevalence of MRSA was iden-
tified in hemodialysis and ophthalmic wards while in
2011 only one case was detected in the latter. In 2012,
these microorganisms were not detected in transplantol-
ogy, psychiatric and neonatal pathology wards.
In 2010, the highest prevalence of Pseudomonas sp.
was determined in burn care wards while this pathogen
predominated in neonatal pathology wards and ICUs for
adults in 2010 and 2011, respectively. These microor-
ganisms were not detected in transplantology, ophthal-
mic, psychiatric and hemodialysis wards. In 2010, it
was identified in neonatal pathology ward.
C. difficile was predominantly observed in ophthal-
mic, infectious diseases and non-surgical wards. These
microorganisms were not identified in hemodialysis,
transplantology, burn care, neonatal pathology as well
as neonatal wards.
Of the alert microorganisms, Enterobacteriaceae
ESBL+ and then Rotavirus (rotavirus was predomi-
nant in 2010–2011) and Acinetobacter Baumanii
were predominantly observed in 2012. Compared to
the previous years, the number of positive test results
for C. difficile increased. As with the previous years,
the highest number of alert microorganisms in 2012
occurred in pediatric, non-surgical wards, IT/ICUs
for adults and then infectious diseases and surgical
wards for adults.
DISCUSSION
Having considered the specialization of medical
services and population of patients, the number of
HCAIs and the type of occurring alert microorganisms
is highly modifiable.
There is a lack of papers which would provide data
on the prevalence of alert microorganisms in in-patient
healthcare centers in particular provinces. Only little
information may be found at sanitary and epidemiologi-
cal station websites.
Compared to 2011 and 2010, an increase in the
distribution of Enterobacteriaceae ESBL+ (Klebsiella
sp., Escherichia coli, Enterobacter sp. with their re-
spective share being: 30%, 27% and 27%), Rotavirus
(28%, 26% and 35%) and C. difficile (9%, 8% and 5%)
was observed in Małopolskie province in 2012. Similar
increasing tendency with regard to the distribution of
Enterobacteriaceae ESBL+ (24.6%, 16.8% and 17.3%)
and C. difficile (6.6%, 2.2% and 2,2%) (11) was ob-
served in these years in Wielkopolska province. One
of the reasons which contributed to an increase of the
positive test results for Enterobacteriaceae ESBL+ is
a change introduced in 2012 to annual report, where
the number of identified strains of Enterobacteriaceae
ESBL+ was to be additionally provided. Compared to
2011 and 2010, the number of infections with Acineto-
bacter baumanii slightly decreased in Małopolskie
province (12%, 14% and 14%, respectively). The
percentage of patients infected with MRSA in 2012
was comparable in both provinces (ca 10%). Having
analyzed crude cumulative data for 2010 and 2011,
Rotavirus, Enterobacteriaceae ESBL+ and Acineto-
bacter Baumannie were predominantly identified as
with 2009 (unpublished paper; Bandoła K. Analysis of
annual reports on health care-associated infections and
alert microorganisms in 2009 from healthcare centers
in Małopolskie province, Provincial Sanitary and Epi-
demiological Station in Cracow 2010).
Studies conducted in France, Germany and Italy,
included in WHO systematic review on the prevalence
of endemic health care-associated infections (12) proved
that out of 13,954 alert microorganisms, the most fre-
quently notified microorganisms were MRSA (21.8%),
Enterobacteriaceae ESBL+ (20.2%), Pseudomonas sp.
(17.2%), Enterococcus sp. (10.0%), E. coli, (9.1%) and
Candida sp. (8.8%).
In 2006–2007, the most frequently isolated microor-
ganisms in 621 American hospitals were i.a. coagulase-
negative staphylococci, MRSA, Enterococcus sp.,
Candida sp. and E. coli (13).
From the point-prevalence survey conducted in
62 German hospitals in 2012 transpires that the most
commonly reported pathogen was MRSA (1.53%)
(14). According to Polish available data, rotavirus pre-
dominated in pediatric and infectious diseases wards
in Zachodniopomorskie province (25.8%) (15). These
data are comparable to the data obtained in Małopolskie
province (28%) and St. Luke’s hospital in Tarnow,
where the distribution of gastrointestinal infections,
mainly those caused by Rotavirus with regard to all
HCAIs amounted to 29.3% in 2011 (16). According to
Kuchar et al., the exact number of HCAIs caused by
rotaviruses is unknown in pediatric wards. However,
they constitute a significant percentage of viral diarrheas
(17). Based on the meta-analysis of 11 Polish studies,
it was concluded that the frequency of infections with
rotaviruses in population of hospitalized children was
0.72% while the percentage of gastrointestinal infec-
tions caused by these viruses amounted to 22.6% (18).
According to Ołdak et al., the distribution of rotavirus
infections with regard to all HCAIs in 2006–2009 was
31.4% (19). These data is similar to the results obtained
in this paper. However, different percentages regarding
the distribution of rotaviruses were obtained in Wiel-
kopolskie province (31.6% – 2012, 41.13% – 2011,
38.5% – 2010) (5).
Frequency of rotavirus infections may be affected
by many factors such as i.a. number of hospital beds

Michał Seweryn, Katarzyna Bandoła et al.
448 No 3
in wards (the higher the number of beds, the greater
the risk of infection is), patient movements (between
wards), hospitalization duration, season (increase of
infections in winter season) as well as health status
of medical personnel (20-22). Patient’s age is also of
importance. Infants aged less than 24 months belong
to the highest risk group as they lack or have very poor
immunity. Infections caused by rotaviruses constitute
a high percentage of HCAIs (ranging from 23.8% to
43%). Since many years, this tendency remains stable
in Poland (21) as well as in other European countries
such as France, Germany, Italy, Spain or Great Britain,
especially in population of hospitalized children (22).
Therefore, the discrepancies in the prevalence of rota-
viruses between provinces confirmed in this paper may
result from the profile of hospitalized patients (age,
health status), hospitalization duration and other factors
such as organization of hospital operation (number of
hospital beds in wards, patient movements etc.).
Comparison of the types of microorganisms cultured
in particular wards in 2010–2012 enables to determine
which pathogen is the most common in a particular
ward. Furthermore, it facilitates to indicate micro-
organisms to which special attention should be paid.
For instance, high distribution of Enterobacteriaceae
ESBL+ strains in neonatal pathology wards as well as
the increase of positive test results for C. difficile (8.6%
of positive test results for alert microorganisms) should
be the reasons for concern. Increased distribution of
isolation of C. difficile in non-surgical and infectious
diseases wards was also observed in Zachodniopomor-
skie province (5.5% in 2012) (15).
It is claimed that the spread of epidemic, hyper-
virulent strain belonging to genotype NAP1/BI/PCR-
ribotype 027, which was identified in Poland for the first
time in 2005, is attributed to the increase of incidence of
diseases associated with C. difficile infections (23, 24).
Having analyzed the data from the USA and Europe, it
may be estimated that out of 30,000 and 10,000 hospi-
talizations annually, the number of intestinal infections
caused by C. difficile range from 30 to 260 and from 10
to 90 cases, respectively (23). Having considered the
results of the European study on C. difficile infections
which was conducted in selected hospitals, it was con-
cluded that the frequency of infections in Poland ranged
from 3.8 to 36.3; 12.5 cases per 10,000 person-days
and 76 per 10,000 hospital admissions on average (25).
The highest risk of infection occurrence is ob-
served in ICUs (3%, 10.4% and 9.4% in 2004, 2005
and 2006, respectively) and wards in which invasive
procedures are performed (biopsy, endoscopy, surger-
ies, long-term intravenous therapy), e.g. neurosurgery
(2.5%, 1.8% and 1.9% in 2004, 2005 and 2006, respec-
tively) or general surgery wards (1.2%, 1% and 1.5%)
(26). These data are with regard to the years earlier than
those analyzed in this paper, however, it suggests differ-
ent distribution of infections compared to the frequency
of positive test results for alert microorganisms, begin-
ning from pediatric, surgical wards for adults, IT/ICUs
and non-surgical wards. A special attention should be
paid to the fact that already infected children are admit-
ted to pediatric wards, e.g. with symptoms of rotavirus
diarrhea. However, taking into account invasive proce-
dures performed and group of patient with weakened
immunological system, the highest risk of infection is
indisputably observed in IT/ICUs.
Microbiological tests serve two basic functions:
firstly, they enable to identify the type of infection in
patients and initiate adequate treatment and secondly,
they facilitate the control and prevention of HCAIs
(27). Analysis of collected data suggests that adverse
tendency of insufficient number of microbiological
tests performed in hospitals is sustained. Furthermore,
compared to 2011 and 2010, a significant decrease of
this number (24, 34 and 33 tests per hospital bed in 2012,
2011 and 2010, respectively) was observed in 2012.
The present number is two-fold lower compared to the
value of the European standard (50 tests). Decreasing
tendency is also observed in Wielkopolskie province
(15, 19 and 19 tests/hospital bed/year) (15).
Indisputably, a positive phenomenon is that the
number of tests is higher in wards where special regime
of adherence to sanitary procedures is required. In
Małopolskie province, the number of tests comparable
to the European standard in 2012 was performed in
neonatal pathology wards (75 tests). Higher number of
tests was performed in IT/ICUs for adults (140 tests),
IT/ICUs for neonates and children (180 tests), burn
care (113 tests) and transplantology wards (330 tests).
Limitations of this paper result from the modifica-
tions introduced to the reporting system of the number
of tests per hospital bed per year, including microbio-
logical test except for serological tests which hinders
complete analysis of alterations of the number of tests
per hospital bed per year.
Nowadays, the data on the types of identified alert
microorganisms and HCAIs are obtained within routine
reporting system. In specialist literature, exclusively
epidemiological data gathered within the programmes
of the Polish Society of Hospital Infections may be
found. However, this information is based only on the
data from several dozens out of more than 700 hospi-
tals operating in Poland. The National Programme of
Antibiotic Protection, developed by the Ministry of
Health, module “Monitoring of health care-associated
infections and invasive bacterial diseases for epide-
miological, therapeutic and prophylactic purposes”
suggests an urgent necessity for introducing standards
on monitoring of alert microorganisms based on the
guidance and recommendations of WHO, Centers for

Alert microorganisms isolated from patients 449No 3
Disease Control and Prevention (CDC) and scientific
associations such as the European Society for Clinical
Microbiology and Infectious Diseases (ESCMID). Sys-
tematic reporting of alert microorganisms prevalence
in hospital settings would allow for making complete
assessment, comparisons between wards and hospitals
as well as implementing effective methods of their
elimination (28). It may be presumed that the order
on the criteria of tender evaluation in proceedings of
contracting medical services provisions issued in 2013
by the President of the National Health Fund would
contribute to the improvement of monitoring system
of alert microorganisms and HCAIs in the near future
as one of the criteria is the assessment of HCAIs and
antimicrobial therapy (29).
CONCLUSIONS
1. There is a lack of complex analyses and reports on
health care-associated infections (HCAIs) detected
in patients hospitalized in Małopolskie province.
Such documents would improve monitoring system
and could contribute to the reduction of infections.
2. It is a necessity to conduct further analyses on the
frequency of alert microorganisms in the country.
They could enhance the standards of monitoring and
effective prevention of HCAI transmission.
3. In Małopolskie province, irrespective of the insuf-
ficient number of microbiological tests per hospital
bed per year, a positive phenomenon is observed, i.e.
an increase in the number of microbiological tests
performed in wards of higher specialization.
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Received: 14.10.2013
Accepted for publication: 16.06.2014
Address for correspondence:
Michał Seweryn
Provincial Sanitary and Epidemiological Station in Cracow
Prądnicka 76, 31-202 Cracow
Tel. 12 25-49-500
e-mail: m.seweryn@wsse.krakow.pl