Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units.

Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was to investigate the epidemiology and microbiology of HAIs and to assess the effectiveness of surveillance conducted in two hospital units. Both hospitals ran (since 2012) the unified prospective system, based on continuous surveillance of HAIs designed and recommended by the European Centre for Disease Prevention and Control (protocol version 4.3) in the Healthcare-Associated Infections Surveillance Network (HAI-Net). In study hospitals, HAIs were detected by the Infection Prevention Control Nurse (IPCN). The surveillance of healthcare infections in hospital A was based mainly on analysis of microbiological reports and telephone communication between the epidemiological nurse and the neurosurgery unit. HAI monitoring in hospital B was an outcome of daily personal communication between the infection prevention and control nurse and patients in the neurosurgery unit (HAI detection at the bedside) and assessment of their health status based on clinical symptoms presented by the patient, epidemiological definitions, microbiological and other diagnostic tests (e.g., imaging studies). In hospital A, HAI monitoring did not involve personal communication with the unit but was rather based on remote analysis of medical documentation found in the hospital database. Results: A total of 12,117 patients were hospitalized. There were 373 HAIs diagnosed, the general incidence rate was 3.1%. In hospital A, the incidence rate was 2.3%, and in hospital B: 4.8%. HAI types detected: pneumonia (PN) (n = 112, 0.9%), (urinary tract infection (UTI) (n = 108, 0.9%), surgical site infection (SSI) (n = 96, 0.8%), bloodstream infection (BSI) (n = 57, 0.5%), gastrointestinal system infection (GI) (n = 13, 0.1%), skin and soft tissue (SST) (n = 9, 0.1%). HAI with invasive devices: 44 ventilator-associated pneumonia (VAP) cases (45.9/1000 pds with ventilator); catheter-associated urinary tract infection (CA-UTI): 105 cases (2.7/1000 pds with catheter); central venous catheter (CVC-BSI): 18 cases (1.9/1000 pds with CVC). The greatest differences between studied units were in the incidence rate of PN (p < 0.001), UTI (p < 0.001), and SSI (p < 0.05). Conclusions: The way HAIs are diagnosed and qualified and the style of work of the infection control team may have a direct impact on the unit epidemiology with the application of epidemiological coefficients. Prospective surveillance run by the infection prevention and control nurse in hospital B could have been associated with better detection of infections expressed in morbidity, especially PN and UTI, and a lower risk of VAP. In hospital A, the lower incidence might have resulted from an inability to detect a UTI or BSI and less supervision of VAP. The present results require further profound research in this respect.

Five-Year Analysis of Surgical Site Infections in Three Orthopaedics and Trauma Wards under HAI-Net from the South of Poland in 2014-2018 Considering the Standardized Infection Ratio.

Background and Objectives: Surgical site infections (SSIs) are the most common healthcare-associated infections (HAIs) in surgical wards. The highest risk of developing SSI is carried by operations involving implants, such as: hip prosthesis (HPRO), knee prosthesis (KPRO), open reduction of fracture (FX), and closed reduction of fracture with internal fixation (CR). Objectives. The objective of the study was to assess the incidence of SSI in patients subjected to HPRO, KPRO, FX, and CR procedures in orthopaedics and trauma wards in 2014-2018 considering risk factors included in the SIR index. Materials and Methods: The study included 6261 patients who were subjected to orthopaedic surgery in 2014-2018. The investigation covered three hospitals with orthopaedics and trauma wards. The research was conducted in the framework of the national HAI surveillance programme according to the methodology of the HAI-Net, ECDC. Results: A total of 6261 surgeries were investigated, of which 111 cases of SSI were detected. The incidence was 1.8%; HPRO (incidence 2.1%, median (Me) surgery duration 90 min, and standardized infection ratio (SIR) above 1 in all units tested); KPRO (incidence 2.0%, Me 103 min, and SIR above 1 for all units tested); FX (incidence 1.9%, Me 70 min, and SIR above 1 for two units tested and below 1 in one unit); CR (incidence 1.0%, Me 55 min, and SIR-not calculated). The etiological agents that were most frequently isolated from patients with SSI were Staphylococcus aureus, coagulase-negative Staphylococcus, and Klebsiella pneumoniae. Conclusions: HPRO, KPRO, and FX operations performed in the studied wards carried a higher risk of developing SSI than that predicted by SIR. SSIs accounted for a significant percentage of the overall infection pool in CR surgeries. Actions should be undertaken to reduce the incidence of SSI in these surgeries. There should be a hospital network which facilitates cooperation in order to better monitor and analyse the incidence of SSI.

[Effectiveness of hand disinfection depending on the type of nail plate coating - a study among nurses working in a specialist hospital]. / Skutecznosc dezynfekcji rak w zaleznosci od rodzaju pokrycia plytki paznokciowej ­ badanie wsród pielegniarek szpitala specjalistycznego.

BACKGROUND: Keeping short, unpainted nails is a significant element of effective hand disinfection among nurses. The aim of the study was to examine the qualitative microbiological purity of painted nails after hand disinfection, taking into account the type of the nail varnish. MATERIAL AND METHODS: Materials were collected from 188 nurses. The results were compiled according to the type of the nail varnish applied on the nail plate. The control group consisted of 24 nurses with natural nails. An indicator of the effectiveness of hand disinfection was the number and type of bacteria grown from the materials collected from the participants' hands - from the nail plate, from under the nail plate and from the skin around the nail plate. RESULTS: In the case of the nail plate swab method, the highest percentage of pathogenic microorganisms grew on the nails covered with a regular varnish (21.7%, p < 0.05). A long-lasting (10 days on average) regular nail varnish was likely to result in ineffective hand disinfection (p < 0.001). In the test involving dipping the finger in tryptic soy broth combined with the technique of collecting swabs from under the nail plate, the highest percentage of pathogenic microorganisms was grown from the nail plate coated/extended with gel and then painted with a 14.8% hybrid varnish (p < 0.05). CONCLUSIONS: The risk of growing a pathogenic microorganism after hand disinfection due to nails coated with a conditioner or a hybrid varnish was similar to that of natural nails. A long-lasting regular nail varnish increases the risk of ineffective hand disinfection. Modeling and/or extending the nail plate with a LED/UV light curing gel, and then painting it with a hybrid varnish, also increases the risk of ineffective hand disinfection. Med Pr. 2021;72(1):29-37.

Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

INTRODUCTION: Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. MATERIAL AND METHOD: A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. RESULTS: 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. CONCLUSIONS: In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

Hospital knowledge and practice of doctors and nurses regarding hand hygiene in a survey.

INTRODUCTION: The guidelines issued by the World Health Organization (WHO) in 2009 regarding hand hygiene (HH) in health care provided health care professionals with scientific evidence that argued that HH principles should be respected when dealing with patients. Despite the passage of years and strenuous attempts to introduce these recommendations to the Polish health care facilities for the prevention of healthcare-associated infections (HAI), these principles are still not being implemented in an optimal way for the patient's safety. OBJECTIVE OF WORK: The aim was to examine the views and attitudes of physicians (L) and nurses (P) towards the WHO rules of hand hygiene. MATERIAL AND METHODS: The study was performed by means of a diagnostic survey using a questionnaire of our own design; random sampling was used. The study involved 231 LP: 173 (74.9%) women, 58 (25.1%) men, including 93 (40.3%) doctors and 138 (59.7%) nurses. The study was conducted in a multiprofile hospital in Malopolska in 2017. The difference between what the respondents think (their views) and what they do in reality (what attitudes they display) was examined in relation to WHO principles, such as wearing natural short nails and jewelry on their hands. RESULTS: Negative practice of observing these HH principles in relation to views was detected (R = -0.014, p<0.05, R2 = 0.016). Respondents supported the view that the ring could affect HAI and rarely used it in practice, the practice was positive (R = 0.298, p <0.001, R2 = 0.085). Women strongly emphasized the view that wearing long nails has an impact on HAI spread, but in practice they often declared keeping long nails, practice was negative (R = -0.241, p <0.01, R2 = 0.054). In response to the question about the impact of nail painting on the spread of HAI, this view was poorly represented, in practice some of them wore painted nails, the practice was negative (R = -0.226, p <0.01, R2 = 0.045). CONCLUSION: Despite high support for the principles of hand hygiene, in practice, these principles were not always respected, the impact on the practice was negative in areas such as: general adherence to the HH principles, wearing long and painted nails. The compatibility of views with practice was detected in relation to wearing a wedding ring.

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

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.

Multimodal strategy in surgical site infections control and prevention in orthopaedic patients - a 10-year retrospective observational study at a Polish hospital.

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, risk of treatment in intensive care units and higher mortality. Material and methods: SSIs were detected in patients hospitalized in a 40-bed orthopaedics ward 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: One hundred sixty eight 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 implemented 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 of SSI and take preventive measures.

Epidemiology of Surgical Site Infections and Non-Surgical Infections in Neurosurgical Polish Patients-Substantial Changes in 2003⁻2017.

Introduction: The objective of the analysis was to determine the epidemiology of healthcare-associated infections (HAIs) in neurosurgical patients, paying special attention to two time points, 2003 and 2017, in order to evaluate the effectiveness of a surveillance program introduced in 2003 and efforts to reduce infection rates. Materials and methods: Continuous surveillance during 2003⁻2017 carried out using the HAI-Net methodology allowed us to detect 476 cases of HAIs among 10,332 patients staying in a 42-bed neurosurgery unit. The intervention in this before⁻after study (2003⁻2017) comprised standardized HAI surveillance with regular analysis and feedback. Results: The HAI incidence during the whole study was 4.6%. Surgical site infections (SSIs) accounted for 33% of all HAIs with an incidence rate of 1.5%. The remaining infections were pneumonia (1.1%) and bloodstream infections (0.9%). The highest SSI incidence concerned spinal fusion (FUSN, 2.2%), craniotomy (1.9%), and ventricular shunt (5.1%) while the associated total HAI incidence rates were 4.1%, 8.0%, and 18.6%, respectively. A significant reduction was found in HAI incidence between 2003 and 2017 in regard to the most common surgery types: laminectomy (4.5% vs. 0.8%); FUSN (11.8% vs. 0.8%); and craniotomy (10.1% vs. 0.4%). Significant changes were also achieved in selected elements of the unit's work: pre-hospitalization duration, hospital stay, and surgery length reductions. Simultaneously, the general condition of patients became significantly worse: there was an increase in patients' age and decreases in their general condition as expressed by ASA scores (The American Society of Anesthesiologists physical status classification system). Conclusions: HAI epidemiology changed substantially during the study period. Among the main types of HAI, SSIs were slightly predominant, but non-surgical HAIs accounted for almost two thirds of all infections; this indicates the need for surveillance of infection types other than SSIs in surgical patients. The implementation of active surveillance based on regular analysis and feedback led to a significant reduction in HAI incidence.

Hospital-Wide Surveillance of Healthcare-Associated Infections as a Source of Information about Specific Hospital Needs. A 5-Year Observation in a Multiprofile Provincial Hospital in the South of Poland.

Healthcare-associated infections (HAIs) are adverse complications of hospitalisation resulting in delayed recovery and increased costs. The aim of this study was an analysis of epidemiological factors obtained in the framework of constant, comprehensive (hospital-wide) infection registration, and identification of priorities and needs in infection control, both with regard to targeted surveillance, as well as preventative actions. The study was carried out according to the methodology recommended by the HAI-Net (Surveillance Network) coordinated by the European Centre for Disease Prevention and Control, in the multiprofile hospital in Southern Poland, between 2012 and 2016. A total of 159,028 patients were under observation and 2184 HAIs were detected. The incidence was 1.4/100 admissions (2.7/1000 patient-das of hospitalisation) and significantly differed depending on the type of the patient care: in intensive care units (ICU) 16.9%; in surgical units, 1.3%; non-surgical units, 1.0%; and paediatric units, 1.8%. The most common HAI was gastrointestinal infections (GIs, 28.9%), followed by surgical site infections (SSIs, 23.0%) and bloodstream infections (BSIs, 16.1%). The vast majority of GIs, BSIs, urinary tract infections, and incidents of pneumonia (PN) were detected in non-ICUs. As many as 33.2% of cases of HAI were not confirmed microbiologically. The most frequently detected etiologic agent of infections was Clostridium difficile-globally and in GI (49%). Comprehensive analysis of the results allowed to identify important elements of surveillance of infections, i.e., surveillance of GI, PN, and BSI not only in ICU, but also in non-ICU wards, indicating a need for implementing rapid actions to improve compliance with HAI prevention procedures.

Foot longitudinal arches in obese, overweight and normal weight females who differ in age.

Nowadays, excessive body weight is the cause of death of more people than malnutrition. Obesity is a growing health problem worldwide, which also results in a considerable number of movement dysfunctions, including degenerative changes and foot pain. The study aimed to assess the effect of overweight and obesity on the height of foot arches in females aged 10-84 years, as well as to establish which factor - age or BMI - affected the height of medial longitudinal arch (MLA) to a greater extent. Three groups of females (96 pupils, 86 young adults and 88 seniors) were selected to participate in the study. The participants' height and weight were measured, their BMI calculated and their body weight status categorized as normal weight, overweight or obesity. The height of foot arches was assessed using the Arch Index (AI). According to the value of the AI, the foot was defined as high-arched, normal or flat. Differences in participants' AI were determined in their age and weight status groups. Correlations between BMI and AI were calculated for the whole study sample and age groups. The analysis used the Shapiro-Wilk test, the Kruskal-Wallis test and Pearson's linear correlation. Overweight or obesity prevailed in 31% of pupils, 4.7% of young adults and in 77% of seniors. Pupils and young adults had often the high-arched foot. Flat feet were mostly observed in seniors and were common in obese individuals. BMI significantly correlated with the height of the foot arch but their age did not. Excessive body weight contributes to the development of flat feet to a greater extent than age.

Patient as a Partner in Healthcare-Associated Infection Prevention.

OBJECTIVES: The objective of the study was getting to know the knowledge and attitudes towards hand hygiene (HH) among Polish patients and healthcare workers (HCWs). METHODS: 459 respondents replied to the survey: 173 (37.6%) patients and 286 (62.3%) HCWs; 57 HCWs were additionally interviewed. RESULTS: Few HCWs knew and used the "5 moments for HH" in the required situations. Both patients and HCWs rated HH of other HCWs poorly: only 75% of patients and 54% of HCWs noticed the application of HH before blood sample collection, but 1/2 of interviewed HCWs did not encounter a request for HH from a patient. According to interviews, 23 (40%) HCWs did not admonish others when they did not use HH. Seventy-five percent of patients and HCWs claimed that, in the past, in schools the toilets were poorly stocked, but the situation improved with the passage of time. CONCLUSIONS: There are barriers with resspect to treating patients as partners in HH in Polish hospitals and HCWs' lack of compliance with the "5 moments for HH" significantly reduces patients' safety. PRACTICE IMPLICATIONS: Education regarding HH should be conducted for the whole society from an early age: lack of proper supplies in school bathrooms impedes the development of positive HH habits.

Practice of hand hygiene and use of protective gloves: Differences in the perception between patients and medical staff.

This study investigated differences in perceptions of hand hygiene and protective glove use among patients and health care workers (HCWs) in Poland. We conducted a survey using an original questionnaire among 462 respondents, including 173 (37.4%) patients and 289 (62.6%) HCWs; HCWs demonstrated poor familiarity with the My 5 Moments for Hand Hygiene. The role of protective gloves in preventing health care-associated infection was overestimated by both patients and HCWs.

Incidence, Microbiological Profile and Risk Factors of Healthcare-Associated Infections in Intensive Care Units: A 10 Year Observation in a Provincial Hospital in Southern Poland.

Healthcare-associated infections (HAIs) occurring in patients treated in an intensive care unit (ICU) are serious complications in the treatment process. Aetiological factors of these infections can have an impact on treatment effects, treatment duration and mortality. The aim of the study was to determine the prevalence and microbiological profile of HAIs in patients hospitalized in an ICU over a span of 10 years. The active surveillance method was used to detect HAIs in adult patients who spent over 48 h in a general ICU ward located in southern Poland between 2007 and 2016. The study was conducted in compliance with the methodology recommended by the Healthcare-associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC). During the 10 years of the study, 1849 patients hospitalized in an ICU for a total of 17,599 days acquired 510 with overall HAIs rates of 27.6% and 29.0% infections per 1000 ICU days. Intubation-associated pneumonia (IAP) posed the greatest risk (15.2 per 1000 ventilator days), followed by CLA-BSI (8.0 per 1000 catheter days) and CA-UTI (3.0 per 1000 catheter days). The most common isolated microorganism was Acinetobacter baumannii (25%) followed by Coagulaase-negativ staphylococci (15%), Escherichia coli (9%), Pseudomonas aeruginosa (8%), Klebsiella pneumoniae (7%), Candida albicans (6%). Acinetobacter baumannii in 87% and were classified as extensive-drug resistant (XDR). In summary, in ICU patients pneumonia and bloodstream infections were the most frequently found. Acinetobacter baumannii strains were most often isolated from clinical materials taken from HAI patients and showed resistance to many groups of antibiotics. A trend of increasing resistance of Acinetobacter baumannii to carbapenems was observed.

The effect of subglottic secretion drainage on the incidence of ventilator associated pneumonia.

BACKGROUND: Ventilator-Associated Pneumonia (VAP) is an undesired side effect of mechanical ventilation in intensive care units (ICUs). AIM: We evaluated whether endotracheal tubes with subglottic secretion drainage (SSD) would reduce the incidence of VAP among patients undergoing mechanical ventilation in an ICU. METHODS: The analysis of medical records of patients undergoing mechanical ventilation exceeding 48 h who were hospitalised in ICUs between 2007 and 2014 led to separating two groups of patients: those in whom no subglottic drainage was applied (NSSD) (records dating from 2007-2010) and those whose treatment involved endotracheal tubes with subglottic secretion drainage (SSD) (records dating from 2011-2014). RESULTS: Analysis of 1807 patients hospitalised in ICUs (804 NSSD patients and 1003 SSD patients). A difference was found in the frequency of VAP incidence between the groups (P<0.001). In the NSSD group as many as 84 cases were reported (incidence: 10.7%), and in the SSD group - 43 cases (incidence: 5.2%). The odds ratio (OR) and relative risk (RR) was 2.5. The probability of VAP was significantly higher in the NSSD group. The risk factors of VAP incidence (P<0.001) included the correlation between reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). CONCLUSION: Use of endotracheal tubes with subglottic secretion drainage in patients in the ICU on mechanical ventilation significantly reduced the incidence of VAP.

Poor Hand Hygiene Procedure Compliance among Polish Medical Students and Physicians-The Result of an Ineffective Education Basis or the Impact of Organizational Culture?

Objective: The objective of the study was to examine the knowledge of Polish physicians and medical students about the role of hand hygiene (HH) in healthcare-associated infection (HAI) prevention. Study design: A survey was conducted using an author-prepared questionnaire, which was filled out on the first day of hospital work (or internship) by newly admitted physicians who had worked in other hospitals and students of different medical schools in Poland. Methods: 100 respondents participated in the study: 28 students, 18 medical interns and 54 physicians. Results: As many as 3/4 of physicians and students did not use the HH techniques correctly. The respondents declared that they perform HH in the following situations: 74.4% of respondents before an aseptic task; 60.8% before patient contact; 57.0% after patient contact; 11.5% after body fluid exposure risk, and only two respondents (1.1%) after contact with patient surroundings. 64% of respondents declared that their supervisor checked their knowledge of the HH technique when they were touching patients, but their supervisors checked the five instances for HH only in the case of 27 respondents (27%). Students experienced any control of HH in the workplace less often. Interns and physicians mentioned that the most important preventive action in HAI is HH, but for students it is the use of gloves. Conclusions: The level of knowledge and skills of physicians and students in the field of HH is insufficient. Deficiencies in skills and knowledge of HH were identified as early as at the level of the first internship.

Assessment of the occurrence of nosocomial infections in the Intensive Care Unit in the St. Lukas District Hospital in Tarnów in 2012-2016

INTRODUCTION: Healthcare-Associated Infections (HAI) are the cause of complications in the treatment process. The possibility of infecting a sick person in the Intensive Care Unit (ICU) is many times greater than in other hospital departments OBJECTIVES: The objective of the study was to investigate the epidemiological indicators and to determine the clinical types of HAI that are present in the ICU during the 5-year period in the St. Lukas District Hospital in Tarnów MATERIALS AND METHODS: HAI has been detected and documented in patients in ICU in the years 2012-2016 by the use of the active monitoring method. We studied patients who spent over 2 days in ICU with a general profile. These studies were conducted in accordance with the methodology recommended by Healthcare-Associated Infections Surveillance Network (HAI-Net) European Center for Disease Prevention and Control (ECDC) RESULTS: Among 886 patients who were hospitalized for a total of 6711 days, HAI was diagnosed in 195 patients (22.0% incidence rate), the incidence density rate was 29.1 per 1000 person-days of hospitalization. The rate for Ventilator-Associated Pneumonia (VAP) was 12.5 per 1000 ventilator days, for Central Line Associated Bloodstream Infection (CA-BSI) the rate was 8.2 per 1000 central line days, for Catheter-Associated Urinary Tract Infection (CA-UTI) the rate was 3.3 per 1000 urinary catheter days. The average duration of a patient stay in ICU was 24 days (19 days for patients without HAI and 43 days for patients with HAI). The following microorganisms isolated from HAI were prevailing: Acinetobacter baumannii 46 (27%), Staphylococcus aureus 12 (21%), Enterococcus faecalis 17 (10%) CONCLUSIONS: A five-year HAI study in ICU showed that the most common types of infections were bloodstream infections and pneumonia. The incidence rate of VAP remained at similar levels in subsequent years. The CA-BSI rates were reduced over the next three years of the study, but their rise in the last year can prove the lack of stability of the preventive actions. CA-UTI was detected twice less frequently, which can suggest poor detection of this type of infection

High-Normal Arterial Blood Pressure in Children With Excess Body Weight.

BACKGROUND: Childhood overweight and obesity are common causes of metabolic disorders that persist until adulthood. OBJECTIVES: The purpose of this study was to determine the prevalence of high-normal arterial blood pressure (ABP) in children with excess body weight. MATERIAL AND METHODS: A total of 1,093 schoolchildren aged 10 - 12 years (51% girls and 49% boys) participated in the study. The children's weight, height, body fat percentage (BFP), waist and hip circumference, and ABP were measured. The waist-to-height ratio (WHtR) and body mass index (BMI) were calculated and compared to the normative reference values accepted by the International obesity task force (IOTF). RESULTS: Excess weight was identified in 20% of the participants, and obesity in 5%. A total of 35.5% of overweight children had above-normal ABP, which implied hypertension. In obese children, that proportion equaled 59.3%. BFP was 6.5% greater in children with hypertension than in those with normal BP. The children with hypertension also had a 7.6-cm larger waist circumference, a 7.6-cm larger hip circumference, and a greater WHtR (by 0.04). CONCLUSIONS: Excess body weight was identified in 25% of children aged 10 - 12 years, significantly increasing their risk of developing hypertension.

The risk factors for hospital-acquired pneumonia in the Intensive Care Unit.

INTRODUCTION: Patients in the intensive care units (ICU) are exposed to many factors that may cause hospital acquired pneumonia (HAP), a particular type of which is ventilator-associated pneumonia (VAP). The specific risk factors for developing VAP affect patients already on the day of their admission to a unit and are associated with their underlying diseases and invasive medical procedures, which they undergo. The aim of this study was to evaluate the risk factors for VAP associated with a patient and the used invasive treatment. MATERIAL AND METHODS: 1227 patients were subject to the retrospective analysis. These patients were hospitalized between 2010 and 2014 in Intensive Care Unit (ICU) in the St. Luke District Hospital in Tarnów. Data about procedures used in ICU were obtained from the electronic hospital registration system and the decursus from each day when a patient stayed in the hospital, while information about hospital infections was obtained from the periodic department reports prepared by the Infection Control Team. In the diagnosis of VAP infections the definitions of nosocomial infections issued by CDC (Centers for Disease Control and Prevention) and ECDC (European Center for Disease Prevention and Control) were used. RESULTS: In the analyzed unit, 58 cases of VAP were detected in patents who underwent mechanical ventilation. Infections were more common among men (43 cases, that is 6%) than in women (15 cases, that is 3%). Mechanical ventilation longer than 20 days was a major determinant of VAP (p < 0.001). Patient's underlying diseases (which are the reason for patient's admission to a unit) had an impact on the incidence of VAP, and the most important of them are: multiple trauma (20 cases of VAP per 217 patients (9.2% incidence)), sepsis (3 cases of VAP per 31 patients (9.7% incidence)), central nervous system disease (10 cases of VAP per 124 patients (8.1% incidence)), endocrine system (1 case of VAP per 12 patients (8.3% incidence)), respiratory diseases (11 cases of VAP per 168 patients (6.5% incidence)). Invasive medical procedures performed in the patients' respiratory tract were significant risk factors (p < 0.001) for developing VAP: reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). In the period from 2010 to 2014 VAP incidence was 4.7% and incidence density per 1000 ventilation-days was 10.5 and the mortality rate with VAP was 32.8%. The most common etiological factors of VAP were Acinetobacter Baumannie (21 isolates, that is 36.4%), Pseudomonas aeruginosa (8 isolates, that is 13.8%), Escherichia coli (7 isolates, that is 12%).

Level of knowledge among medical personnel about infections transferred through direct contact--results of questionnaire survey.

INTRODUCTION: Nosocomial infections are an important issue all over the world. The most important vector for transmitting infections in a hospital are the hands of the medical personnel, which is why their adequate hygiene is an essential prevention method. THE AIM OF THE STUDY: was to evaluate the medical personnel's level of knowledge on the prevention of nosocomial infections transferred through direct contact. MATERIAL AND METHODS: The diagnostic survey method with a proprietary questionnaire was used for the research. The research was conducted between May and June 2013 on a group of 100 randomly chosen medical workers of one of Cracow hospitals (nurses, doctors and paramedics). The age of the interviewees ranged from 23 to 60 years old. RESULTS: Despite the fact that most of the respondents took part in courses related to nosocomial infections and declared the will to take part in more courses related to this issue, the level of knowledge of the medical personnel on the prevention of nosocomial infections transferred through direct contact and the post-exposure procedures is insufficient. Only 28.0% of the respondents knew that the dominant hand decontamination method according to WHO is disinfection, 22.0% of the surveyed medical personnel admitted that they put covers on needles after they performed the injection and 11.0% of the interviewees mentioned that they change the gloves before contact with the patient only sometimes. CONCLUSIONS: The surveyed group has not demonstrated a sufficient knowledge of the rules of preventing infections transferred through direct contact and the post-exposure procedures. The level of knowledge of the surveyed medical personnel was dependent on, e.g., years of experience and taking part in courses on nosocomial infections.