Healthcare-associated infections in Estonia – epidemiology and surveillance of bloodstream and surgical site infections
Date
2015
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Abstract
Haiglatekkese infektsiooni (HI) teke on seotud arstiabi osutamisega, kuid üheks oluliseks riskiteguriks on ka patsiendi enda tervislik seisund. HI avaldub kas haiglas viibides või pärast sealt lahkumist. Euroopas diagnoositakse HI igal aastal 3,2 miljonil patsiendil. Kõige enam on ohustatud intensiivravi osakonna patsiendid. Üheks sagedasemaks HI liigiks on operatsioonipiirkonna infektsioon (OPI) ning kõige raskemaks on vereringeinfektsioon (VRI). HI järelevalve on infektsioonide vältimise nurgakiviks, kuna see võimaldab leida parimat viisi HI ennetamiseks.
Oma töös selgitasime haiglatekkese VRI ja keisrilõikejärgse OPI haigestumust, surmavusmäära, riskitegureid ning haigustekitajaid. Samuti hindasime keisrilõikejärgse OPI haiglavälise järelevalve meetodi sobivust kasutades erinevaid võimalusi nagu patsientidele helistamine, küsimustik arstidele ning ambulatoorsete kaartide analüüs.
Viisime läbi kolm uuringut: VRI uuringu nii kolmes Eesti haiglas kui ka Tartu Ülikooli Kliinikumi (TÜK) lasteintensiivravi osakonnas (LIRO) ning keisrilõikejärgse OPI uuringu TÜK naistekliinikus.
Leidsime, et kolme haigla VRI haigestumus, surmavusmäär ja haigustekitajad ei erine oluliselt mujal maailmas läbi viidud uuringute tulemustest. Samas võeti uuringuperioodil vähe verekülve, mis võis mõjutada tulemust. LIRO VRI haigestumus oli kõrge, mida muuhulgas võisid mõjutada kaks bakteriaalset puhangut uuringuperioodil. Samuti mõjutasid puhangud haigustekitajate spektrit ja antibakteriaalse tundlikkuse andmeid. VRI surmavusmäär oli madal võrreldes teiste uuringutega. Peamiseks riskiteguriks mõlemas töös olid veresoonesisesed kateetrid.
Keisrilõikejärgne OPI tekkis 6% patsientidel, mis on madalam võrreldes teiste uuringutega. Pärast haiglast lahkumist saime informatsiooni 95% patsientide kohta. Peaaegu pooled OPI juhud diagnoositi pärast haiglas viibimist, mis rõhutab haiglajärgse järelevalve olulisust. Riskiteguriks osutus lootekestade põletik, invasiivne loote jälgimine ja kirurgiline haavaklass III ja IV.
Edaspidi on HI vähendamisel oluline tegeleda nii leitud riskiteguritega kui ka puhangute vältimisega. VRI diagnostikaks tuleb parandada verekülvide võtmise praktikat. Meie valitud meetod osutus sobivaks keisrilõikejärgse OPI haiglaväliseks järelevalveks.
Healthcare-associated infection (HAI) is an infection that patients acquire while receiving treatment for medical or surgical conditions. However, one important risk factor is the patient`s comorbidities. HAI may occur in patients during their hospitalization or after discharge. In Europe HAI is diagnosed in 3.2 million patients every year. The risk of acquiring HAI is significantly higher in intensive care units. The most frequent types of HAI are surgical site infections (SSI) and the severest are bloodstream infections (BSI). HAI surveillance is the cornerstone of prevention since it facilitates the development of appropriate intervention measures. The aim of the present study was to identify infection rates, outcome, risk factors and etiology of BSI and post-cesarean SSI in Estonia. We also evaluated a multimethod approach to postdischarge surveillance of SSI using a combination of telephone calls to the patients, healthcare worker’s questionnaire, and outpatient chart review. We conducted three studies: BSI study in three Estonian hospitals as well as the pediatric intensive care unit (PICU) of Tartu University Hospital (TUH), and the study of post-cesarean SSI in the Women’s Clinic of TUH. We found that infection and case-fatality rates and pathogens of BSI in these three hospitals were consistent with previous investigations. However, our findings may be influenced by low blood culture sampling rate. In PICU we observed high incidence of BSI, which could have been affected by two bacterial outbreaks during the study period. The outbreaks also influenced the spectrum of pathogens and antimicrobial susceptibility data. Case-fatality rate of BSI was low compared to other studies. The main risk factors in both studies were intravascular catheters. The incidence of post-cesarean SSI was 6%, being lower compared to other studies. After hospital discharge we received information about 95% of patients. Almost half of the cases of SSI were detected during postdischarge surveillance, which emphasises the importance of this approach. We found three risk factors: chorioamnionitis, internal fetal monitoring and surgical wound classes III and IV. In order to decrease HAI, in the future it is essential to work with the risk factors found as well as to avoid the outbreaks. Implementation of appropriate blood culture sampling practices will increase the quality of diagnostics of BSI. The method we used is suitable for postdischarge surveillance of post-cesarean SSI.
Healthcare-associated infection (HAI) is an infection that patients acquire while receiving treatment for medical or surgical conditions. However, one important risk factor is the patient`s comorbidities. HAI may occur in patients during their hospitalization or after discharge. In Europe HAI is diagnosed in 3.2 million patients every year. The risk of acquiring HAI is significantly higher in intensive care units. The most frequent types of HAI are surgical site infections (SSI) and the severest are bloodstream infections (BSI). HAI surveillance is the cornerstone of prevention since it facilitates the development of appropriate intervention measures. The aim of the present study was to identify infection rates, outcome, risk factors and etiology of BSI and post-cesarean SSI in Estonia. We also evaluated a multimethod approach to postdischarge surveillance of SSI using a combination of telephone calls to the patients, healthcare worker’s questionnaire, and outpatient chart review. We conducted three studies: BSI study in three Estonian hospitals as well as the pediatric intensive care unit (PICU) of Tartu University Hospital (TUH), and the study of post-cesarean SSI in the Women’s Clinic of TUH. We found that infection and case-fatality rates and pathogens of BSI in these three hospitals were consistent with previous investigations. However, our findings may be influenced by low blood culture sampling rate. In PICU we observed high incidence of BSI, which could have been affected by two bacterial outbreaks during the study period. The outbreaks also influenced the spectrum of pathogens and antimicrobial susceptibility data. Case-fatality rate of BSI was low compared to other studies. The main risk factors in both studies were intravascular catheters. The incidence of post-cesarean SSI was 6%, being lower compared to other studies. After hospital discharge we received information about 95% of patients. Almost half of the cases of SSI were detected during postdischarge surveillance, which emphasises the importance of this approach. We found three risk factors: chorioamnionitis, internal fetal monitoring and surgical wound classes III and IV. In order to decrease HAI, in the future it is essential to work with the risk factors found as well as to avoid the outbreaks. Implementation of appropriate blood culture sampling practices will increase the quality of diagnostics of BSI. The method we used is suitable for postdischarge surveillance of post-cesarean SSI.
Description
Väitekirja elektrooniline versioon ei sisalda publikatsioone.
Keywords
haiglanakkus, patogeensed mikroobid, epidemioloogia, operatsioonijärgne periood, nahahooldus, uroloogilised haigused, südame-veresoonkonna haigused, riskitegurid, ennetav meditsiin, hospital infection, pathogenic microbes, epidemiology, postoperative period, skin care, urinary tract diseases, cardiovascular diseases, risk factors, preventive medicine