| Abstract |
Healthcare associated infections or Nosocomial infections (ΗΑΙ) tend to constitute a serious risk factor for patients, as a major contribution to increased morbidity and mortality indicators and multiply the cost of hospitalization.
In the EU every year 4.1 million patients exhibit HAI with the number of deaths associated with them to be 37,000
In hospital level most HAI, recorded in ICU (54.9%) in clinical field of pathology (27.4%) and in the surgical field clinics (17.7%). The increased incidence of N.L in ICU patients, is an intractable daily problem for clinicians and requires to solve, the systematic surveillance and immediate implementation of measures to prevent and control N.L.
This pilot study to monitor the Incidence of HAI in adult ICU of the University Hospital of Heraklion Crete based protocol ECDC EUROPEAN SURVEILLANCE OF HEALTHCARE-ASSOCIATED INFECTIONS IN INTENSIVE CARE UNITS HAIICU Protocol v1.01 STANDARD focuses on these axes.
Objective
The pilot implementation of surveillance in a hospital in the territory (University Hospital) in order to gain experience in the implementation of protocols to the ECDC, the evaluation of the Directive in terms of recording, data collection and familiarity with protocol recording, analysis of results and draw conclusions, concerning the identification of problems N.L and finally designing interventions to resolve them. This pilot study will also be the basis for recording applications on a national level.
Methodology
The study was conducted in the Adult Intensive Care Unit of the University Hospital of Heraklion, the duration was 6 months. Used the protocol of ECDC HAI ICU Protocol v1.01 Standard A prospective surveillance for all patients in the ICU of the University Hospital until their removal. Studied three categories of HAIs, pneumonias (PN), bloodstream infections (BSI) and urinary tract infections (UTI), and their correlation with invasive devices (ventilators, central intravascular catheters, and urinary catheters). Recorded frequencies pathogens identified as causative agents in the development HAI in PAGNH ICU, and their resistance to antibiotics. Also recorded the administered antibiotics and the reasons for their use
Results
The 58% of N.L recorded were pneumonia, 39.7% bloodstream infections and 2.7% urinary tract infections. The cumulative incidence was 57.1 infections per 100 patients. The incidence density was 29.81 infections per 1000 patient –days on pneumonias, 20.45 infections per 1000 s for bloodstream infections and 1.16 infections per 1000 patient –days for urinary tract infections. The crude mortality was 26.8%
The risk-adjusted infection rates, indicators for the presence of invasive devices, was for pneumonia 42.61 infections per 1000 ventilator days of use, for bloodstream infections 6.8 infections per 1,000 days using a central vascular catheter and for urinary tract infections 1.17 infections in 1000 days use bladder catheter.
Δημόσια Υγεία & Διοίκηση Υπηρεσιών Υγείας
Τμήμα Ιατρικής – Πανεπιστήμιο Κρήτης
2
Most often detectable pathogens all infections of the study was the Gram (-) negative 69.6%, while Gram (+) pathogens was 30.4%. The pathogenic species most frequently were: Acinetobacter baumani (27.9%), Klebsiella Pneumoniae (20.2%), Pseudomonas aeruginosa (10.5%) and Staphylococcus aureus (8.65%).
The index antibiotic use was 0.97. Of antibiotics used in 38.9% was used as documentary treatment, 46% as the empiric treatment and 15.1% as pharmaceutical prophylaxis. The most common antibiotics administered groups were: karvepenems (13.75%), beta-Lactamase inhibitors (12.67%), glycopeptides (12.50%) fluoroquinolones (11.78% and colistin (10.71%)
Conclusions
This study a) Confirm the high frequencies HAI, prevailing in ICUs of Greek hospitals and therefore the high risk faced by patients hospitalized in them.
b) Highlights the risk factors HAI development including use of invasive devices, underlying diseases, while the correlation of HAI, extending the hospitalization of these patients. c) Describes the frequency of use of antibiotics in the ICU of PAGNI Hospital, as well as the strength of the predominant pathogens HAI. d) Estimate the frequency of pathogens endemic in the ICU of the PAGNI Hospital, and highlights the differences HAIs frequency with relevant national and European studies.
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