Evaluation of the efficiency of hospital antibiotic policy applied Dr Jan Biziel University Hospital No 2 in Bydgoszcz in 2009-2013.

UNLABELLED: The Hospital Infection Control Team (HICT) of Dr Jan Biziel University Hospital No 2 in Bydgoszcz developed and implemented the principles of a rational antibiotic therapy in 2008. A behavior algorithm has worked since 01.10.2008. Implementation of the principles of a rational antibiotic therapy was part of the hospital antibiotic policy. THE AIM OF THE STUDY: is to evaluate either introductory principles of the rational antibiotic therapy, after five-year experience lived up to expectations in the range specified by the authors. MATERIAL AND METHODS: Hospital microbiological maps, comparisons of antibiotic cost, specification of microbiological tests made before and after introduction of the principles of a rational antibiotic therapy have been analyzed. Annual antibiotic consumption has been counted according to the defined daily dose (DDD) index created by the WHO. RESULTS: After 6 years of implementation of the rational antibiotic therapy principles, the decrease in number of isolated strains which are resistant to Klebsiella pneumoniae ESBL and Acinetobacter baumanii (resistant to carbapenems) has been indicated. The number of the Pseudomonas aeruginosa isolates has increased approximately three times, and the number of resistant isolates to carbapenem has grown six times. The cost of antibiotics has been gradually decreased in 2012 in order to represent 9,66% of all drug budget (without drug programs). Detailed analysis of antibiotic consumption has showed that after the implementation of rational antibiotic therapy principles the consumption of meropenem has increased twice in comparison to the all drugs. The number of microbiological tests grew from 0,20 to 0,29 per one patient, which means material to microbiological tests has been taken from every third patient. Annual DDD index calculated on 100 person-days has been reduced from 59,552 in 2007 to 39,90 in 2009, and it is 47,88 in 2013. The principles of rational antibiotic therapy in comparison with the other elements of antibiotic policy in hospital have caused positive changes in antibiotic ordinance. CONCLUSIONS: 1. It is required to adhere to the principles of a rational antibiotic therapy by medical staff mainly on the administrative restriction of access to antibiotics. 2. Monitoring changes in drug resistance of hospital flora is an essential element of the principles of a rational antibiotic therapy modification.

[Molecular epidemiology of Acinetobacter baumannii strains isolated in the years 2008-2010 in University Hospital no. 2 in Bydgoszcz]. / Epidemiologia molekularna szczepów acinetobacter baumannii izolowanych w latach, 2008-2010 w szpitalu uniwersyteckim nr 2 w bydgoszczy.

INTRODUCTION: Hospital infection registers prepared by Anaesthesiology and Intensive Care Unit (AICU) of J. Biziel University Hospital no. 2 in Bydgoszcz in the years 2007-2010 indicated to high incidence of bacterial infections of Acinetobacter baumannii aetiology. The specificity of the Unit poses the risk of hospital infection with environmental bacteria constituting the bacterial flora of the Unit to other units of the hospital in accordance with the direction of the patients relocation. MATERIAL AND METHODS: [corrected] In order to determine the aforementioned risk, the authors had collected and stored (in frozen state) Acinetobacter strains of similar phenotype as regards the resistance (146 isolates were collected in total) for 3 years and then the genotype of 12 selected isolates was determined. Differential molecular diagnosis was performed using pulsed field gel electrophoresis (PFGE). RESULTS. Results of the molecular tests of Acinetobacter strains (isolated from clinically significant material) were analysed in the context of epidemiologic investigations. On the basis of the results, the authors found out that there are at least two epidemic strains of Acinetobacter baumannii; one of them was isolated from patients treated in AICU only. It is alarming that genotype has been isolated from the patient who has never been treated in AICU. Transfer of hospital infections caused by Acinetobacter baumannii strains isolated so far from AICU

[Score method evaluation of the sanitary condition of the University Hospital in Bydgoszcz and personnel education in 2007 - 2010]. / Punktowa metoda oceny stanu sanitarno-higienicznego i wyszkolenia personelu Szpitala Uniwersyteckiego w Bydgoszczy w latach 2007-2010.

UNLABELLED: The Quality Management System ISO 9001:2008 introduced by the Management Board of the hospital in the year 2007 resulted in change of the methods used by the Hospital Infection Control Team (HICT) to assess the sanitary-and-hygienic condition. The inspection protocol used by HICT was modified as part of the Quality Management System. It was supplemented by the score sheet which made the inspection results more objective. The purpose of the study was to assess the results of the supervision over the sanitary and epidemiologic condition of the hospital as well as personnel training carried out in the years 2007-2010 by the Hospital Infection Control Team (HICT) of Szpital Uniwersytecki nr 2 im. dr. J.Biziela (J.Biziel University Hospital no. 2). 407 inspection protocols issued in the years 2007-2010 were analysed. The sanitary/hygienic condition indicators and personnel education indicators were calculated based on the analysed data. The sanitary/hygienic condition indicator for the entire hospital in the years 2008-2010 amounted to over 91.50% and only in the year 2007 it was 89.33%. While the personnel education indicator for the entire hospital increased from 90.35% in 2007 to 93.75% in 2010. CONCLUSIONS: the assessment of hospital units performed on the basis of the new protocol of the sanitary/hygienic condition has been proven in practice, i.e. insufficient personnel education as regards hospital hygiene is efficiently detected by HICT at individual workstations and the Management Board of the hospital is notified on the ongoing basis on the results of supervision provided by HICT.

[Practical aspects of implementation quality management system ISO 9001:2000 by hospital infection control team]. / Praktyczne aspekty wdrazania systemu zarzadzania jakoscia ISO 9001:2000 przez Zespól Kontroli Zakazen Szpitalnych.

In 2006 the Board of the Jan Biziel Hospital in Bydgoszcz decided to include procedures of health services in the implementation process within the confines of ISO 9001:2000 certification. The hospital infection control team that has operated in the hospital since 1989 performed the analysis of the forms of activities to date and on that basis the team prepared original plan of quality management. In April 2007, this plan was successfully accepted by the certifying team. The aim of this study is to present the aforementioned plan which is the result of 18 years experience of the team. At the same time, I hope that this study will be very helpful for all professionals interested in hospital epidemiology, especially in the context of implementing quality management systems.