Nosokomiale Infektionen im Visier Surveillance in Europa

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1 Nosokomiale Infektionen im Visier Surveillance in Europa Dr. Luigi Segagni Lusignani Universitätsklinik für Krankenhaushygiene & Infektionskontrolle Medizinische Universität Wien

2 Late 19th century surgery, done according to Lister's methods. There's a carbolic acid sprayer on the stool, but the surgeons are still wearing street clothing.

3 The impact of HCAI HCAI can cause: more serious illness prolongation of stay in a healthcare facility long-term disability excess deaths high additional financial burden high personal costs on patients and their families

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5 Surveillance US 1960s- hospital surveillance 1970s- training courses/nniss SENIC Study 1991 HICPAC NHSN

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7 The national/regional systems for surveillance of healthcare-associated infections within EU Country Coordinated network AUSTRIA BELGIUM CROATIA FINLAND FRANCE FR-EAST FR-PARIS-NORD FR-SOUTH-EAST FR-SOUTH-WEST FR-WEST GERMANY HUNGARY ITALY LITHUANIA LUXEMBOURG NETHERLANDS NORWAY POLAND SPAIN UK-ENGLAND UK-NORTHERN IRELAND UK-SCOTLAND UK-WALES ANISS NSIH (Reference Centre for Hospital Infection) SIRO RAISIN C.CLIN Est C.CLIN Paris-Nord C.CLIN Sud-Est C.CLIN Sud-Ouest C.CLIN Ouest KISS NNSR SPIN-UTI ( NOSIX PREZIES NOIS pshi ENVIN (ICU), EPINE (prevalence) SSISS (SSI) HISC SSHAIP WHAIP

8 The surveillance loop Health care system Surveillance centre Event Reporting Data Action Feedback, recommendations Information Analysis, interpretation

9 Surveillance von HAI in Europa ECDC HAI-Net The main objective is the health care improvement in Europa (Carl Suetens, ECDC)

10 Council Recommendation of 9. June 2009 on patient safety, including the prevention and control of healthcare-associated infections (2009/C 151/01) The European HAI surveillance needs to cover other types of nosocomial infections besides surgical site infections and ICUacquired infections in order to estimate and monitor the complete HAI disease burden Since the implementation of an expanded continuous incidence surveillance is very resource demanding, hospital-wide prevalence surveys are efficient approaches to address it.

11 Kontinuierliche Beobachtung Infektionen - HAI Postoperative Wundinfektionen (Indikator- OP) Katheterassoziierte Harnwegsinfektionen Katheterassoziierte Septikämien Beatmungsassoziierte Pneumonien CDI. Multiresistente Erreger MRSA Extended-Betalactamasesproduzierende Enterobakterien Carbapenemase prod. Bakterien Clostridium difficile Vancomycin-resistente Enterokokken Multi-resistenter Acinetobacter.

12 Punkt Prävalenz Case 1 Case 2 Case 3 Case 4 Case 5 Case 6 Case 7 Jan 09 May Sept Dec 09 PPS performed

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14 Hintergrund Review von PPS aus 19 EU-Staaten HAI 7.1% Sehr unterschiedliche Methodik Standardisierte Methodik ECDC HAI-Net final protocol 2010 EU-weite Definition Training: Train the trainer

15 2012 Point Prevalence survey

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17 HAI Atemwegsinfektionen (23.5%) Postop Wundinfektionen (19.1%) Harnweginfektionen (19%) Sepsis (10.7%) GI-Trakt Infektionen 7.7%) Clostridium difficile (3.6%)

18 EU HAI distribution by speciality Surgery Medicine Paediatrics ICU Gynaeco/Obstetrics Geriatrics Psychiatry Pneumonia/LRTI Urinary tract Surgical site infection Bloodstream Gastrointestinal Systemic Skin/Soft tissue Other Rehabilitation/other Percentage of HAIs ECDC PPS

19 Erreger Escherichia coli Staphylococcus aureus MRSA Enterococcus sp Pseudomonas aeruginosa Klebsiella spp. Koagulase-neg. Staphylokokken Candida spp. 15.9% 12.3% 41.2% 9.6% 8.9% 8.7% 7.5% 6.1%

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21 Verwendung von Antimikrobiellen Substanzen

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25 Top 7 HAIs UT-I 19,3 21,3 Pneumonia 19,7 20,6 SS-I 17,4 19,1 GI 7,7 10,5 EU Ö SYS 6,3 8,7 BSI 5,9 10,7 CRI 1,

26 Percentage of most frequently reported microorganisms in HAI 14,8 15,9 12,3 13,1 11,4 8,5 9,6 8,9 8,7 6,8 10,2 7,5 8,0 6,1 9,7 5,4 5,7 4,2 3,8 3,6 2,8 Ö EU 0,6

27 Top 10 antimicrobials agents (1425 pts) Ciprofloxacin Amoxicillin and enzyme ihn. Ampicillin und enzyme ihn. 8,4 8,3 8,7 Clindamycin Cefazolin Piperacillin and enzime ihn. 6,5 6,4 6,4 Cefuroxime 5,9 Metronidazole 5,2 Meropenem Moxifloxacin 4,2 4,1

28 Antimicrobials indication ÖSTERREICH EU TREATMENT INTENTION ,5% ,4 Community infection ,4% ,6 Hospital infection ,4% ,1 Other healthcare-ass. infection 13 0,7% ,8 SURGICAL PROPHYLAXIS % ,3 Single dose 61 3,4% ,1 One day 29 1,6% ,6 >1 day % ,7 MEDICAL PROPHYLAXIS 162 9% ,3 OTHER INDICATION 24 1,3% ,5 UNKNOWN INDICATION, VERIFIED 2 0,1% ,3 UNKNOWN/MISSING 54 3% ,3 Total

29 HAI RISIKOFAKTOREN RISIKOFAKTOR OR P INTUBATION (for Pneumonia) 23.3 [12.62;42.92] <0,0001 CVC in situ (for Blood Stream Infections) 10.5 [3.74;29.76] <0,0001 URINARY CATHETER (for Urinary Tract Infections) 12.8 [7.18;22.95] <0,0001

30 HAI RISIKOFAKTOREN RISIKOFAKTOR OR P 55 Jahre Aufenthalt >7 days 1.85 ( ) 9.11 ( ) <0,0001 <0,0001 ICU Aufnahme Chirurgische Intervention Mc Cabe Score Fatal 4.91 ( ) <0, ( ) <0, ( ) <0,0001

31 Zusammenfassung PPS Enorme Datenmenge Methodik identisch Relativ einfach durchzuführen Erlaubt den Vergleich zwischen Staaten und Krankenanstalten Öffentliche Daten Grundlagen für gezielte Surveillance und angepasste Intervention erlaubt uns den Fokus zu legen