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![Page 1: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/1.jpg)
Development of Outbreak Investigation Database for hospital Infections
Osaka University, Osaka University,
Faculty of Medicine, JAPANFaculty of Medicine, JAPANKiyoko Makimoto, Ph.D.,
MPH
![Page 2: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/2.jpg)
What are hospital infections?
• Two types of infections you find in the hospital– Hospital-acquired infections– Community-acquired infections
• How can we distinguish them?– By latency period– CDC definition for NIs: developm
ent of infections after 48 hours of admission
![Page 3: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/3.jpg)
Brief history of hospital infections• First well documented hospital infections
– In the middle of 1800 Lying-in Hospital in Vienna – Maternal mortality rates exceeded 10%, mainly
due to puerperal fever (child-bed fever) endemic
• Modern epidemiology of hospital infections– In 1950s, Staphylococcus aureus infection
outbreaks in hospitals all over the world
• Advances in 1970• Intensive research in the 1990s
![Page 4: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/4.jpg)
What kinds of hospital infections exit?
• Device-related– Blood stream infections (BSI)– Urinary tract infections (UTI)– Ventilator-associated pneumonia (VAP)
• Procedure-related– Surgical site infections (SSI)
• Environmental contamination– Water, disinfectant, etc.
![Page 5: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/5.jpg)
Devices and procedures as major sources of hospital infections
Surgeries
Arterial/venous catheters
Urinary catheters
Respirators
Cross-infections: 20-
40%
Changes in flora due to antibiotic therapy :20-25% Others
: 20%
Patients’ own flora:
40-60%
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Why do we need to study hospital infections?
Not all hospital infections are preventable, but they are associated with
• Excess length of hospital stay
• Excess cost
• Excess mortality
• Law suits
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Distribution of hospital infections by sites, SENIC study
Urinary tract
Surgical wound
Pneumonia
Bacteremia
Other sites
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Increases in the mean length of hospital stay due to hospital infections
in the U.S. , SENIC study
Days0 1 2 3 4 5 6 7 8
All
Other sites
Urinary tract
Pneumonia
Surgical wound
Bacteremia
![Page 9: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/9.jpg)
Excess cost of hospitalization due to hospital infections in the U.S., 1992
0 1000 2000 3000 4000 5000 6000
All
Other sites
Urinary tract
Surgical wound
Bacteremia
Pneumonia
U.S. dollars
![Page 10: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/10.jpg)
Who are at risk for acquiring hospital infections?
• Patients in Intensive Care Units– ICU (medical, surgical, burn, Neonatal
ICU、 Pediatric ICU)– Surgery department
• Immunocompromised patients– Cancer treatment, transplant, HIV infections
• Other factors– Age, smoking, chronic diseases
![Page 11: Development of Outbreak Investigation Database for hospital Infections Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH.](https://reader033.fdocuments.in/reader033/viewer/2022051516/56649ea25503460f94ba56f2/html5/thumbnails/11.jpg)
Distribution of hospital infections by infection sites and
endemic/outbreak status
Urinary tractSurgical woundPneumomiaHepatitisGastroenteritisCutaneousBacteremiaOther
EndemicOutbreak
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Why do we need an outbreak investigation database?
• Literature search is considered essential for outbreak investigation
• Difficulty in collecting relevant articles in hospitals with limited resources
• Shortage of health care workers trained in epidemiology in Japan
• Epidemiology of hospital infections is not taught in school
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Conducting Medline search
• Medline search yielded >600 articles between 1970 and 2000
• Only a small number of outbreak investigations reported all the information necessary to replicate the investigation
• Recent investigations tend to focus on DNA typing to identify epidemic strains
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What kinds of outbreaks have been reported?
• The largest number of people affected– Norwalk-like virus affected 635 employees (27%
attack rate), 79 people affected in a single day– Am J Epidemiol. 1988 Jun;127(6):1261-71.
• The longest duration– >= 10 years of unrecognized hospital
transmission of legionnaires' disease among transplant patients (25 cases)
– Infect-Control-Hosp-Epidemiol. 1998 Dec; 19(12): 898-904
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Continued• Unusual source of outbreak
– Klebsiella pneumoniae producing ESBL transmitted by gel used for ultrasonography
– 2 adults and 1 neonates were infected; 5 colonized
– J-Clin-Microbiol. 1998 May; 36(5): 1357-60
• Outbreak due to non-infectious origin– Hemolysis (discolored, pink serum visualize
d in spun serum sample) due to defect products (30 cases in 11 days)
– Kidney-Int. 2000 Apr; 57(4): 1668-74
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What kinds of fields do we need?
• Mode of transmission• Pathogens• Type of investigation• Place (NICU, ICU,
surgery, etc.)• Country• Author
• Hospital size• No. of patient affected• No. of deaths• Detail investigation
process• Infection control and
prevention strategies
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Usefulness of the Database I
• A learning tool for epidemiologic and microbiologic investigations
– Specific pathogens to look for in certain symptoms
– Guide epidemiologic investigations• Identify study design in similar situations• Types of information to collect
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Epidemiologic skills required in complex investigations
• Case definition
– Able to learn how to write a case definition to find cases
• Selection of controls in case-control studies
– Selection of controls is the most difficult part
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Usefulness of the Database II
• Provide infection prevention strategies by– pathogens
– type of service
– infectious diseases
– mode of transmission, etc.
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Searching by Pathogens: Acinetobacter
baumannii
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Any impacts of the database on Japanese culture?
• Very few Japanese professionals report outbreak investigations
• Reporting outbreaks to professional journals as professional and social obligation
• Providing information in sufficient detail to help investigations
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Challenges
• Currently 220 records have been entered
• Changes in hospital practices affecting the outbreak investigation
• Funding is necessary to complete and keep updating outbreak database
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Changes in hospital practices
• Factors related to patients– Shorter hospital stay– Increased patients’ acuity– Increases in intra- and inter-hospital transfer
• Factors related to health care workers– High turnover of nurses– Floating shift– Employment of temporary staff
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Your comments are greatly appreciate it
URL for the outbreak investigation database
http://health-db.net/infection/index.asp