Incidence of healthcare-associated infections in a tertiary care hospital: results from a three-year period of electronic surveillance.

BACKGROUND: Point prevalence surveillance is widely used to monitor healthcare-associated infections (HAIs). Incidence surveillance offers more accurate information than point prevalence surveillance, but is more time consuming. Electronic surveillance systems may allow for more widespread incidence surveillance. AIM: To determine the incidence of HAI in a tertiary care hospital in Finland over a three-year period from 2011 to 2013 using an automated electronic IS programme, linked to all of the hospital's electronic databases. METHODS: The programme identified cases of HAI prospectively from initiation of antibiotic treatment. All of the cases were verified manually after discharge. In order to evaluate the sensitivity of the electronic method for the identification of surgical site infections, the medical records of all patients who underwent cardiac surgery or total joint arthroplasty were evaluated retrospectively. FINDINGS: In total, 78,211 patients, covering 321,974 patient-days, were admitted to the wards during the study period, and 29,694 antibiotic treatment initiations were registered. After manual review, 5089 (17.1%) of these were found to be for HAIs. The total time needed to undertake the surveillance for the whole hospital (353 hospital beds) was 255 days, which is the approximate total annual working time for one nurse. Sensitivity evaluation showed that the number of surgical site infections identified by manual and electronic methods was identical. The three-year incidence of HAI was 15.8 per 1000 patient-days and 4.9% of all discharged patients. CONCLUSIONS: Continuous electronic incidence surveillance based on initiation of antibiotic treatment may be a practical means of measuring hospital-wide incidence of HAI, but this method still requires personnel resources.

Short-course antibiotics for prosthetic joint infections treated with prosthesis retention.

The purpose of the present study was to evaluate the significance of shortening the antibiotic treatment duration in prosthetic joint infections (PJI) treated with debridement, antibiotics and implant retention (DAIR). In April 2006 we shortened the total antibiotic treatment duration in total knee arthroplasty (TKA) PJIs from 6 months to 3 months and in total hip arthroplasty (THA) PJIs from 3 months to 2 months. All patients with TKA or THA PJI treated with DAIR between February 2001 and August 2009 were reviewed retrospectively. There were 132 patients treated with DAIR, of whom 86 (65%) completed the antibiotic therapy and were therefore eligible for comparison concerning the length of antibiotic treatment. There were 32 (37%) THA and 54 (63%) TKA PJIs in the comparison. The treatment succeeded in 34 (89.5%) patients treated with longer antibiotic treatment and in 42 (87.5%) of those treated with shorter antibiotic treatment (p 0.78). Our conclusion is that if the patient completes the antibiotic therapy, treatment duration of 3 months in TKA PJIs and 2 months in THA PJIs is as good as longer antibiotic treatment of 6 months or 3 months, respectively, in patients treated with DAIR.

Point prevalence and risk factors for healthcare-associated infections in primary healthcare wards.

PURPOSE: The aim of this study was to document the point prevalence of healthcare-associated infections (HAIs) in the public primary healthcare wards, which treat both acute and long-term care patients. We also assessed the risk factors for HAI and the consumption of alcoholic hand rubs and antibiotics. METHODS: A cross-sectional study was performed in northern Finland in 2006 including all healthcare centers in the Oulu University Hospital district. RESULTS: There were 1,190 patients eligible for study in 44 public primary healthcare wards. The point prevalence of HAIs was 10.1%. The most common infections were urinary tract infections (30%), lower respiratory tract infections (27%), and skin and soft tissue infections (20%). The prevalence of HAIs did not depend on whether wards gave acute care, long-term care, or both acute and long-term care. In the multivariate analysis, the main risk factors for HAI were: more than three antibiotic prescriptions during the previous year, fully bedridden, renal disease, venous catheter, age over 80 years, previous hospitalization during the past six months, and implanted foreign material. A prophylactic antibiotic was a protecting factor. Antimicrobial treatment was given for 18% of the study population and another 18% received prophylactic antimicrobials. CONCLUSIONS: HAIs are common in Finnish primary healthcare wards and there is a need to improve everyday practices in the wards in order to reduce the number of HAIs. It is also important to reduce the inappropriate use of antibiotics.