H. Rüden

Reduction of surgical site infection rates associated with active surveillance.

OBJECTIVEnTo evaluate whether surgical site infection (SSI) rates decrease in surgical departments as a result of performing active SSI surveillance.nnnDESIGNnRetrospective multiple logistic regression analyses.nnnSETTINGnA group of 130 surgical departments of German hospitals participating in the Krankenhaus Infektions Surveillance System (KISS).nnnMETHODSnData for 19 categories of operative procedures performed between January 1997 and June 2004 were included (119,114 operations). Active SSI surveillance was performed according to National Nosocomial Infections Surveillance system (NNIS) methods and definitions. Departments SSI rates were calculated individually for each year of surveillance and for each operative procedure category, taking into account when the individual departments had begun their surveillance activities. Multiple logistic regression analyses on a single operation basis were carried out with stepwise variable selection to predict outcomes for patients with SSI. The variables included were as follows: the departments year of participation, NNIS risk index variables, patients age and sex, and the hospitals structural characteristics, such as yearly operation frequency, number of beds, and academic status.nnnRESULTSnFor 14 of 19 operative procedure categories analyzed, there was a tendency toward lower SSI rates that was associated with increasing duration of SSI surveillance. In multiple logistic regression analyses of pooled data for all operative procedures, the departments participation in the surveillance system was a significant independent protective factor. Compared with the surveillance year 1, the SSI risk decreased in year 2 (odds ratio, 0.84; 95% confidence interval, 0.77-0.93) and in year 3 (odds ratio, 0.75; 95% confidence interval, 0.68-0.82), and there was no change in year 4.nnnCONCLUSIONnThe SSI incidence was reduced by one quarter as a result of the surveillance-induced infection control efforts, which indicates the usefulness of a voluntary surveillance system.

Device‐Associated Infection Rates for Non–Intensive Care Unit Patients

BACKGROUNDnReference data from intensive care units (ICUs) are not applicable to non-ICU patients because of the differences in device use rates, length of stay, and severity of underlying diseases among the patient populations. In contrast to the huge amount of data available for ICU patients, appropriate surveillance data for non-ICU patients have been missing in Germany.nnnOBJECTIVEnTo establish a new module (DEVICE-KISS) of the German Nosocomial Infection Surveillance System for generating stratified reference data for non-ICU wards.nnnSETTINGnNon-ICU patients from 42 German hospitals.nnnMETHODSnMonthly patient-days, device-days and nosocomial infections (NIs) (using Centers for Disease Control and Prevention definitions) were counted. Device use rates were calculated, and NI rates were stratified by different medical specialities.nnnRESULTSnFrom July 2002 through June 2004, among the 77 wards, there were a total of 536,955 patient-days and 74,188 device-days (for CVC-associated primary bloodstream infections, there were 181,401 patient-days and 8,317 central vascular catheter [CVC]-days in 29 wards; for urinary catheter-associated urinary tract infections, there were 445,536 patient-days and 65,871 urinary catheter-days in 65 wards) and 483 NIs (36 bloodstream infections and 447 urinary tract infections). The mean device use rates were 4.6 device-days per 100 patient-days for CVCs (29 wards) and 14.8 device-days per 100 patient-days for urinary catheters (65 wards), respectively. Mean device-associated NI rates were 4.3 infections per 1,000 CVC-days for CVC-associated bloodstream infections and 6.8 infections per 1,000 urinary catheter-days for catheter-associated urinary tract infections.nnnCONCLUSIONSnDEVICE-KISS allows non-ICUs to recognize an outlier position with regard to NIs by providing well-founded reference data for non-ICU patients.

Risk Factors for Death Due to Nosocomial Infection in Intensive Care Unit Patients: Findings From the Krankenhaus Infektions Surveillance System

OBJECTIVEnTo determine risk factors for death among patients with nosocomial pneumonia and patients with primary bloodstream infections (BSI) in intensive care units (ICUs).nnnDESIGNnProspective cohort study.nnnSETTINGnData collected from January 1997 through June 2003 from ICUs registered with the Krankenhaus Infektions Surveillance System in Germany.nnnPATIENTSnA total of 8,432 patients with nosocomial pneumonia from 202 ICUs and 2,759 patients with nosocomial primary BSI from 190 ICUs.nnnMETHODSnThe following risk factors were considered in the analysis: age, sex, time in the ICU before onset of infection, type of ICU, type and size of hospital, intubation, central venous catheter use, total parenteral nutrition, and type of pathogen.nnnRESULTSnA total of 750 patients (8.9%) with nosocomial pneumonia and 302 patients (10.9%) with nosocomial primary BSI died. Multiple logistic regression analysis identified treatment in a medical or surgical ICU (odds ratio [OR], 1.55 [95% confidence interval {CI}, 1.32-1.82]) or a hospital with more than 1,000 beds (OR, 2.14 [95% CI, 1.81-2.56]), age older than 65 years (OR, 1.54 [95% CI, 1.31-1.81]), and infection with methicillin-resistant Staphylococcus aureus (OR, 2.39 [95% CI, 1.81-3.12]) or multidrug-resistant Pseudomonas aeruginosa (OR, 3.00 [95% CI, 1.90-4.63]) as independent determinants of death from nosocomial pneumonia. Age older than the median of 63 years (OR, 1.44 [95% CI, 1.12-1.86]) and methicillin-resistant S. aureus as the causative agent (OR, 2.98 [95% CI, 1.81-5.82]) were both associated with increased mortality from primary BSI. The types of infecting pathogens, particularly those resistant to multiple drugs, were also strong outcome predictors among ICU patients.nnnCONCLUSIONSnThe study results underline the need for further investigations of the role of antimicrobial resistance in the outcome of patients with nosocomial pneumonia and patients with primary BSI.

Trends in ventilator-associated pneumonia rates within the German nosocomial infection surveillance system (KISS).

OBJECTIVEnTo investigate trends in ventilator-associated pneumonia (VAP) rates during participation in the German nosocomial infection surveillance system (Krankenhaus-Infektions-Surveillance-System [KISS]).nnnMETHODSnA total of 71 ICUs that began participating in KISS in 1999 or later and continued participation for at least 36 months were selected. Beginning with the first month of participation, the pooled mean rate of VAP in the ICUs was calculated for each year of participation. The incidence densities for the 3 years of participation were compared using the Pearson chi (2) test. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated. VAP rates were calculated for each ICU and year of participation, and rates for years 1 and 3 were compared using the Wilcoxon test for paired samples.nnnRESULTSnTwenty-nine medical-surgical, 18 medical, 20 surgical, 2 neurosurgical, and 2 pediatric ICUs met the selection criteria. Surveillance data were available on 181,275 patients, for whom there were 613,098 patient-days and 224,138 ventilator-days. A total of 2,043 cases of VAP were reported. The ICUs had a pooled VAP rate of 10.5 cases per 1,000 ventilator-days during year 1 of KISS surveillance. In year 2, the rate decreased by 19%, to 8.7 cases per 1,000 ventilator-days (RR, 0.81 [95% CI, 0.73-0.90]). In year 3, the rate decreased by 24% from year 1, to 8.0 cases per 1,000 ventilator-days (RR, 0.76; 95% CI, 0.68-0.85). Both results were significant (P<.001 by the Pearson chi (2) test). Comparison of the VAP rates of the ICUs did not show a significant difference between years 1 and 3 of KISS participation.nnnCONCLUSIONnSurveillance was associated with a significant reduction in the pooled rate of VAP during years 1-3 of KISS participation.

Inducibility and potential role of MecA-gene-positive oxacillin-susceptible Staphylococcus aureus from colonized healthcare workers as a source for nosocomial infections

To determine the carrier rate of methicillin-susceptible mecA-positive Staphylococcus aureus (dormant MRSA) among healthcare workers (HCWs), 447 nurses and physicians from 13 general wards and intensive care units were investigated for nasal or oropharyngeal S. aureus carriage during one year whenever an MRSA patient was treated. Induction of phenotypic resistance in all mecA-positive oxacillin-susceptible aureus was attempted by 24 h exposure to oxacillin and cefotaxime. Organisms from the broth tube with the highest antibiotic concentration and visible growth after incubation were re-exposed for a total of seven repetitive exposures. Two mecA-negative oxacillin-susceptible S. aureus served as negative control. A population analysis before and after antibiotic exposure was performed. A third of the HCWs were found to be S. aureus carriers. Only three nurses were MRSA positive (0.7%). Seven isolates of dormant MRSA were isolated in six nurses and one doctor (1.6%). After four days of repetitive antibiotic exposure six of seven dormant MRSA were highly resistant to oxacillin. Resistance of the two control S. aureus without the mecA gene was not changed by repetitive antibiotic exposure. Two of the seven dormant MRSA were clonally related as shown by pulsed-field gel electrophoresis (PFGE). The PFGE pattern of one dormant MRSA (HCW) was identical to an MRSA (HCW). The pattern of another dormant MRSA was indistinguishable from an MRSA isolated from a patient who was treated at the same time on the same ward suggesting transmission from the HCW to the patient. Dormant MRSA may be isolated twice as often as MRSA from HCWs. Transmission to patients is possible, which may lead to clinical infections. It might be useful to screen methicillin-susceptible S. aureus isolates from HCWs for the mecA gene when recurrent infections with MRSA occur on a ward and a source cannot be found.

Validation of surveillance in the intensive care unit component of the German nosocomial infections surveillance system.

A validation study was performed for the intensive care unit component of the German nosocomial infections surveillance system (Krankenhaus Infektions Surveillance System [KISS]). A total of 286 reported infections and 1,195 medical records with no reported infection from 20 randomly selected KISS intensive care units were reviewed by trained physicians. The mean sensitivity was 66% (median, 81%), and the mean specificity was 99.4% (median, 99.6%).

Hygienemaßnahmen auf Intensivstationen

ZusammenfassungHintergrundZiel dieser Befragung ist es zu ermitteln, inwieweit auf deutschen Intensivstationen (ITS) evidenzbasierte Empfehlungen zur Prävention nosokomialer Infektionen umgesetzt werden.MethodeEs wurden 230 deutsche ITS des Krankenhaus-Infektions-Surveillance-Systems (KISS) zum Umgang mit Beatmungstuben, zentralen Gefäßkathetern (ZVK), Harnwegkathetern (HWK) und Methicillin-resistentem-Staphylococcus-aureus- (MRSA-)positiven Patienten befragt.ErgebnisseAuf 9% der ITS wird überwiegend nasal intubiert. Alle Präventionsmaßnahmen zur ZVK-Anlage werden auf 43% der ITS eingehalten. Jede dritte ITS betreibt ein mikrobiologisches Routinescreening an Urin. Harnwegkatheter werden auf 37% der ITS routinemäßig gewechselt. MRSA positive Patienten werden auf 5% der ITS nicht isoliert. Ein Aufnahmescreening von MRSA-Risikopatienten unterbleibt auf 16% der ITS.SchlussfolgerungenAuf vielen deutschen ITS sind evidenzbasierte Empfehlungen nicht implementiert. Fortbildung zur Qualitätssicherung ist unerlässlich.AbstractBackgroundAim of this study was to determine to what extent evidence-based infection control recommendations are applied in German intensive care units (ICUs).MethodsA questionnaire concerning handling of tubes, central vascular catheters (CVC), urinary tract catheters and methicillin-resistant Staphylococcus aureus (MRSA) positive patients was sent to 230 participants of the German Nosocomial Infection Surveillance System (KISS).ResultsNasal intubation is routinely performed in 9% of ICUs, all recommended measures for CVC insertion were obeyed by 43% of ICUs and one-third of ICUs conduct regular screening of urine in catheterized patients. Urinary tract catheters are replaced at defined time intervals in 37% of ICUs. MRSA positive patients are not isolated in 5% of ICUs. MRSA screening on admission is not performed for high risk patients in 16% of ICUs.ConclusionsThere are still many German ICUs in which evidence-based recommendations are not implemented. Training of staff is necessary to improve quality of patient care.

Costs due to urinary tract infections in Germany. An estimation based on the data from the German National Nosocomial Infections Surveillance System

ZusammenfassungHintergrundBasierend auf den Daten des „Krankenhaus-Infektions-Surveillance-Systems“ (KISS) wurde das Einsparungspotential für nosokomiale Harnweginfektionen (HWI) in Deutschland hochgerechnet.Material und MethodenDie HWI-Inzidenz wurde den KISS-Referenzdaten entnommen. Die Gesamtzahl aller Patiententage wurde über das Statistische Bundesamt bezogen. Die zu erwartenden Kosten für ein Krankenhaus pro HWI wurden durch eine Literaturrecherche ermittelt.ErgebnisseAuf Intensivstationen (ITS) ereignen sich im Mittel 1,87 HWI und auf peripheren Stationen 0,81 HWI pro 1000xa0Patiententage. 4,5% der jährlichen 146,1xa0Mio. Patiententage in Deutschland entfallen auf ITS. Insgesamt ereignen sich jährlich etwa 155.000 nosokomiale HWI. Jede HWI kostet etwa 1000xa0Euro. 20% aller nosokomialen Infektionen sind vermeidbar.SchlussfolgerungenEin Krankenhaus in Deutschland könnte durch verbesserte Hygiene – nur für vermiedene HWI – jährlich 14.500xa0Euro einsparen.AbstractBackgroundWe estimated the avoidable costs due to nosocomial urinary tract infections (UTI) based on the data of the German National Nosocomial Infections Surveillance System (KISS).MethodsThe incidence of nosocomial UTI derived from KISS reference data. The overall number of patient days was obtained from the “Statistische Bundesamt” (German Federal Office of Statistics). Expected costs for a single UTI were estimated according to data published in the medical literature.ResultsOn average, there were 1.87 UTI on intensive care units (ICU) and 0.81 UTI on peripheral wards per 1,000 patient days; 4.5% of the annual 146.1 million patient days in German hospitals were contributed by ICUs. In total, there are approximately 155,000 nosocomial UTI every year. Each UTI leads to costs of about 1,000 euros; 20% of all nosocomial infections are preventable.ConclusionsJust for nosocomial UTI, appropriate infection control measures may reduce the annual health care costs by 14,500 euros for every German hospital.

Kosten durch Harnweginfektionen in Deutschland

ZusammenfassungHintergrundBasierend auf den Daten des „Krankenhaus-Infektions-Surveillance-Systems“ (KISS) wurde das Einsparungspotential für nosokomiale Harnweginfektionen (HWI) in Deutschland hochgerechnet.Material und MethodenDie HWI-Inzidenz wurde den KISS-Referenzdaten entnommen. Die Gesamtzahl aller Patiententage wurde über das Statistische Bundesamt bezogen. Die zu erwartenden Kosten für ein Krankenhaus pro HWI wurden durch eine Literaturrecherche ermittelt.ErgebnisseAuf Intensivstationen (ITS) ereignen sich im Mittel 1,87 HWI und auf peripheren Stationen 0,81 HWI pro 1000xa0Patiententage. 4,5% der jährlichen 146,1xa0Mio. Patiententage in Deutschland entfallen auf ITS. Insgesamt ereignen sich jährlich etwa 155.000 nosokomiale HWI. Jede HWI kostet etwa 1000xa0Euro. 20% aller nosokomialen Infektionen sind vermeidbar.SchlussfolgerungenEin Krankenhaus in Deutschland könnte durch verbesserte Hygiene – nur für vermiedene HWI – jährlich 14.500xa0Euro einsparen.AbstractBackgroundWe estimated the avoidable costs due to nosocomial urinary tract infections (UTI) based on the data of the German National Nosocomial Infections Surveillance System (KISS).MethodsThe incidence of nosocomial UTI derived from KISS reference data. The overall number of patient days was obtained from the “Statistische Bundesamt” (German Federal Office of Statistics). Expected costs for a single UTI were estimated according to data published in the medical literature.ResultsOn average, there were 1.87 UTI on intensive care units (ICU) and 0.81 UTI on peripheral wards per 1,000 patient days; 4.5% of the annual 146.1 million patient days in German hospitals were contributed by ICUs. In total, there are approximately 155,000 nosocomial UTI every year. Each UTI leads to costs of about 1,000 euros; 20% of all nosocomial infections are preventable.ConclusionsJust for nosocomial UTI, appropriate infection control measures may reduce the annual health care costs by 14,500 euros for every German hospital.

Nosokomiale Infektionen und multiresistente Erreger

Die Probleme, die mit nosokomialen Infektionen, also in Einrichtungen des Gesundheitswesens erworbenen Infektionen zusammenhangen, existieren zweifellos bereits solange, wie Patienten behandelt werden. Mit der Entwicklung der modernen Medizin werden allerdings immer haufiger invasive diagnostische und therapeutische Verfahren angewendet, um das Leben zu verlangern. Zudem werden die Patienten alter oder sie haben verminderte Abwehrmechanismen. Dadurch treten nosokomiale Infektionen immer mehr in den Vordergrund, und ihre Ursachen und Ubertragungswege mussen untersucht werden. Hinzu kommt die Entwicklung von Antibiotikaresistenzen bei Staphylokokken, Enterokokken oder den gramnegativen Bakterien wie den Enterobakterien, die haufige Erreger nosokomialer Infektionen sind.