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1.
Antimicrobial Resistance & Infection Control ; 11(1):67, 2022.
Article in English | MEDLINE | ID: covidwho-1833352

ABSTRACT

BACKGROUND: The COVID-19 pandemic may have had a substantial impact on the incidence of device-associated healthcare-associated infections (HAI), in particular in intensive care units (ICU). A significant increase of HAI was reported by US hospitals when comparing incidence rates from 2019 and 2020. The objective of this study was to investigate the development of the most relevant device-associated HAI in German ICUs during the year 2020 as compared to 2019. METHODS: We utilized the data of the ICU component of the German National Reference Center for Surveillance of Nosocomial Infections (KISS = Krankenhaus-Infektions-Surveillance-System) for the period 2019-2020. We focused on central line-associated bloodstream infections (CLABSI), catheter-associated urinary tract infections (CAUTI), ventilator-associated lower respiratory infections (VALRTI) and bloodstream infections associated with the use of Extracorporeal-Life-Support-Systems (ECLSABSI). Device use was defined as the number device days per 100 patient days;device-associated infection rates as the number of device-associated infections per 1000 device days. To compare the pooled means between the years and quarters we calculated rate ratios of device-associated infection rates with 95% confidence intervals by Poisson regression models. RESULTS: The number of participating ICUs in the surveillance system decreased from 982 in 2019 to 921 in 2020 (6.2%). Device utilization rates increased significantly for central lines and ventilator use. VALRTI rates and CAUTI rates decreased in 2020 compared with 2019, however, no increase was shown for CLABSI or ECLSABSI. This result was also confirmed when the corresponding quarters per year were analyzed. CONCLUSIONS: The lack of an increase in device-associated healthcare associated infections (HAI) in German ICUs may be due to the lower overall incidence of COVID-19 cases in Germany in 2020 compared with US, to a very high availability of ICU beds per 100,000 inhabitants compared with many other countries, and a change in the ICU patient mix due to numerous elective procedures that were postponed during the first two waves. The primary reason seems to be that only 7% of all ICU patients in Germany in 2020 were COVID-19 patients.

2.
J Hosp Infect ; 122: 35-43, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1615639

ABSTRACT

BACKGROUND: As most automated surveillance (AS) methods to detect healthcare-associated infections (HAIs) have been developed and implemented in research settings, information about the feasibility of large-scale implementation is scarce. AIM: To describe key aspects of the design of AS systems and implementation in European institutions and hospitals. METHODS: An online survey was distributed via e-mail in February/March 2019 among (i) PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network members; (ii) corresponding authors of peer-reviewed European publications on existing AS systems; and (iii) the mailing list of national infection prevention and control focal points of the European Centre for Disease Prevention and Control. Three AS systems from the survey were selected, based on quintessential features, for in-depth review focusing on implementation in practice. FINDINGS: Through the survey and the review of three selected AS systems, notable differences regarding the methods, algorithms, data sources, and targeted HAIs were identified. The majority of AS systems used a classification algorithm for semi-automated surveillance and targeted HAIs were mostly surgical site infections, urinary tract infections, sepsis, or other bloodstream infections. AS systems yielded a reduction of workload for hospital staff. Principal barriers of implementation were strict data security regulations as well as creating and maintaining an information technology infrastructure. CONCLUSION: AS in Europe is characterized by heterogeneity in methods and surveillance targets. To allow for comparisons and encourage homogenization, future publications on AS systems should provide detailed information on source data, methods, and the state of implementation.


Subject(s)
Cross Infection , Urinary Tract Infections , Cross Infection/epidemiology , Cross Infection/prevention & control , Delivery of Health Care , Hospitals , Humans , Infection Control/methods , Urinary Tract Infections/epidemiology , Urinary Tract Infections/prevention & control
3.
Anaesthesist ; 70(Suppl 1): 19-29, 2021 12.
Article in English | MEDLINE | ID: covidwho-1574765

ABSTRACT

Since December 2019 a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The immense challenges for clinicians and hospitals as well as the strain on many healthcare systems has been unprecedented.The majority of patients present with mild symptoms of coronavirus disease 2019 (COVID-19); however, 5-8% become critically ill and require intensive care treatment. Acute hypoxemic respiratory failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to intensive care unit (ICU) admission. At this point bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS).So far, remdesivir and dexamethasone have shown clinical effectiveness in severe COVID-19 in hospitalized patients. The main goal of supportive treatment is to ascertain adequate oxygenation. Invasive mechanical ventilation and repeated prone positioning are key elements in treating severely hypoxemic COVID-19 patients.Strict adherence to basic infection control measures (including hand hygiene) and correct use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be carried out with utmost precaution and preparation.


Subject(s)
COVID-19 , Critical Illness , Humans , SARS-CoV-2
4.
Antimicrobial Resistance and Infection Control ; 10(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1448438

ABSTRACT

Introduction: Candida auris is an emerging pathogen in hospital infections that can present multi-resistance to antifungals and causes outbreaks. Objectives: The aim is to describe the infection prevention and control for C. auris. Methods: Identification of yeast isolates was performed by MALDITOF and confirmed by ITS sequencing. Infection control measures were decided by a multi-disciplinary ad hoc outbreak panel. Patient screening once or twice a week and extensive environmental testing for C. auris was conducted. Results: C. auris was isolated from a urine sample of a COVID-19 patient who had been transferred from an Egyptian hospital to our COVID-19 intensive care unit (ICU). Immediately, disinfection routine was changed, because C. auris is insensitive to quaternary ammonium compounds. The patient had already been isolated from admission due to evidence of 4MRGN Klebsiella pneumoniae. Six days after confirmation of C. auris in the index patient, a second COVID-19 patient was identified with C. auris. Both patients were isolated in a separated area of the ICU. Strict hygiene and infection control measures were implemented promptly. In the nine weeks from initial confirmation of C. auris and discharge of the two affected patients, C. auris was repeatedly identified in clinical samples of them. However, it was not detected in any other patient on the ICU (n = 7) or discharged from it (n = 13) nor in any environmental sample (n = 129). The two C. auris patients had been intubated using the same video laryngoscope seven days apart. Although the equipment and the spatulas had been manually reprocessed using chlorine dioxide-soaked wipes they might serve as transmission vehicle. Therefore, it was recommended to use disposable spatulas. Conclusion: A rapid confirmation of a C. auris in the lab and the immediate implementation of adequate hygiene measures at the ward are crucial in order to prevent transmission of C. auris to other patients.

5.
Pharmazeutische Zeitung ; 166(3):32-37, 2021.
Article in German | EMBASE | ID: covidwho-1268905
7.
Pneumologie ; 75(2): 88-112, 2021 Feb.
Article in German | MEDLINE | ID: covidwho-1033360

ABSTRACT

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.


Subject(s)
COVID-19 , Respiratory Distress Syndrome , Humans , Inpatients , Pandemics , Practice Guidelines as Topic , SARS-CoV-2
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