Prevalence and incidence of surgical site infections in the European Union/European Economic Area: how do these measures relate?

BACKGROUND: In 2011-2012, the European Centre for Disease Prevention and Control (ECDC) initiated the first European point prevalence survey (PPS) of healthcare-associated infections (HCAIs) in addition to targeted surveillance of the incidence of specific types of HCAI such as surgical site infections (SSIs). AIM: To investigate whether national and multi-country SSI incidence can be estimated from ECDC PPS data. METHODS: In all, 159 hospitals were included from 15 countries that participated in both ECDC surveillance modules, aligning surgical procedures in the incidence surveillance to corresponding specialties from the PPS. National daily prevalence of SSIs was simulated from the incidence surveillance data, the Rhame and Sudderth (R&S) formula was used to estimate national and multi-country SSI incidence from the PPS data, and national incidence per specialty was predicted using a linear model including data from the PPS. FINDINGS: The simulation of daily SSI prevalence from incidence surveillance of SSIs showed that prevalence fluctuated randomly depending on the day of measurement. The correlation between the national aggregated incidence estimated with R&S formula and observed SSI incidence was low (correlation coefficient = 0.24), but specialty-specific incidence results were more reliable, especially when the number of included patients was large (correlation coefficients ranging from 0.40 to 1.00). The linear prediction model including PPS data had low proportion of explained variance (0.40). CONCLUSION: Due to a lack of accuracy, use of PPS data to estimate SSI incidence is recommended only in situations where incidence surveillance of SSIs is not performed, and where sufficiently large samples of PPS data are available.

Prevalence of healthcare-associated infections in Lithuania.

AIM: To compare point prevalence surveys of healthcare-associated infections (HCAI) performed in 2003, 2005 and 2007 in half of the acute care hospitals in Lithuania. FINDINGS: The prevalence of HCAI decreased slightly from 2003 to 2007 (from 4.3% to 3.4%). The rate decreased for each surveyed year in intensive care, surgical and paediatric units, and increased in rehabilitation-nursing units. The proportion of lower respiratory tract infections increased (from 26.3% to 32.3%), while the proportion of urinary tract infections and bloodstream infections decreased (from 11.6% to 6.7% and from 8.9% to 2.3%, respectively). The proportion of microbiologically investigated HCAI cases decreased from 2003 to 2007 (from 56.0% to 41.0%, P<0.02). Gram-positive organisms accounted for most cases of HCAI. Approximately one-third of patients were on antimicrobial therapy (31.1%, 29.3% and 32.1% in 2003, 2005 and 2007, respectively), including penicillins, broad-spectrum penicillins, first-/second-generation cephalosporins and aminoglycosides. CONCLUSION: Repeated surveys allowed determination of trends in HCAI prevalence, risk factors and antibiotic usage. The surveys established infection control priorities in Lithuania, and resulted in changes to the national HCAI surveillance system.

Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?

BACKGROUND: The prevalence of hospital-acquired Methicillin-resistant Staphylococcus aureus (MRSA) infections shows a huge variety across Europe. Some countries reported a reduction in MRSA frequency, while in others countries increasing MRSA rates have been observed. To reduce the spread of MRSA in the healthcare setting, a sufficient MRSA management is essential. In order to reflect the MRSA management across Europe, MRSA prevention policies were surveyed in ten countries. MATERIALS AND METHODS: The survey was performed by questionnaires in European intensive care units (ICUs) and surgical departments (SDs) in 2004. Questionnaires asked for availability of bedside alcohol hand-disinfection, isolation precautions, decolonization and screening methods. The study was embedded in the Hospital in Europe Link for Infection Control through Surveillance (HELICS) Project, a European collaboration of national surveillance networks. HELICS was initiated in order to harmonize the national surveillance activities in the individual countries. Therefore, HELICS participants developed surveillance modules for nosocomial infections in ICUs and for surgical site infections (SSI). The coordination of this surveillance has now been transferred to the European Centre for Disease Prevention and Control (ECDC). RESULTS: A total of 526 ICUs and 223 SDs from ten countries sent data on organisational characteristics and policies, demonstrating wide variations in care. Substantial variation existed in availability of bedside alcohol hand-disinfection, which was much higher in participating ICUs rather than in SDs (86 vs. 59%). Surveillance cultures of contact patients were obtained in approximately three-fourths of all SDs (72%) and ICUs (75%). Countries with decreasing MRSA proportions showed especially strict implementation of various prevention measures. CONCLUSION: The data obtained regarding MRSA prevention measures should stimulate infection control professionals to pursue further initiatives. Particularly, the vigorous MRSA management in countries with decreasing MRSA proportions should encourage hospitals to implement preventive measures in order to reduce the spread of MRSA.

National hand hygiene campaigns in Europe, 2000-2009.

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.

National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project.

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003--2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383444 patient days, 969897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5-10.2; to OR: 12.8; 95% CI: 4.4-37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital 'university' (OR: 2.08; 95% CI: 1.02-4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.

Prevalence of nosocomial infections in two Latvian hospitals.

The first point prevalence survey of the nosocomial infection (NI) rate was conducted in two Latvian hospitals. At the time of the survey 17.5% (226/1291) patients had symptoms or were being treated for infection. The overall prevalence rate was 5.6% (72/1291) for NI and 12.7% for community acquired infections (164/1291). Surgical site infection (SSI) was the most common NI (62%) followed by respiratory tract infection (RTI) (7.5%), and urinary tract infection (UTI) (6.4%). NI rate was higher with increasing age of patients, in intensive care units and surgical wards, and among those who had an intravenous device or urinary catheter. Microbiological investigation yielded positive results in 29% (21/72) of patients with NIs. Antibacterial treatment was given to 22.3% (288/1291) of hospitalised patients and in 62% (182/288) of these, cefazolin was prescribed. Results from this study will be used to plan a national prevalence survey.

Prevalence of hospital-acquired infection in a Lithuanian hospital.

A prevalence survey in the biggest Lithuanian hospital was undertaken as part of the hospital infection control programme in Lithuania, in collaboration with Statens Seruminstitut, Denmark, to introduce modern methods and technologies in infection control. It aimed to test the methodology of prevalence studies identifying features of community- and hospital-acquired infections, use of clinical microbiology and antibiotics. It was found that 27.3% of all patients had an infection at the time of the survey. The prevalence rate of community-acquired infection (CAI) was 20.5% and of hospital-acquired infection (HAI), 9.2%. Almost one third of all HAI were acquired in other hospitals but still active at the time of the survey. HAIs were more prevalent in children (14.9%) than in adult patients (7.7%). The prevalence of HAI varied from 1.0% in neurological departments to 61.5% in the burns unit. Respiratory tract infections were the most common accounting up to 49.1% of all HAI and 28.3% of CAI. At the time of survey 26.0% of patients were receiving antibiotic treatment although more than one third of these were recorded as having no infection. Microbiological investigations were performed in 41.1% cases of HAI. In this hospital, the survey data indicated an array of preventive priorities which will be exploited during the current hospital infection control programme. A national prevalence study is planned using the experience gained.