HEALTHCARE-ASSOCIATED INFECTIONS AND … PPS/NSIH_symposium... · SURVEILLANCE IN ACUTE CARE...
Transcript of HEALTHCARE-ASSOCIATED INFECTIONS AND … PPS/NSIH_symposium... · SURVEILLANCE IN ACUTE CARE...
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HEALTHCARE-ASSOCIATED INFECTIONS AND ANTIMICROBIAL USE
IN ACUTE CARE HOSPITALS and LONG-TERM CARE FACILITIES
ECDC PPS - HALT-3
NSIH SYMPOSIUM – APRIL 2017
Ben Abdelhafidh L, Latour K,
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium T +32 2 642 57 62 | email: [email protected]
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CONTENT Framework of the surveillance
• European Point Prevalence Surveys (PPS) • Objectives • Methodologies
Results in acute care hospitals Main 2011 results 2017 PPS
Results in long-term care facilites (LTCFs) Main 2016 results 2017 PPS in psychiatric LTCFs
Conclusion
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SURVEILLANCE IN ACUTE CARE HOSPITALS AND IN LTCFs
European Center for Disease prevention and Control Point Prevalence Survey (PPS) of Healthcare-Associated Infections (HAI) and Antimicrobial use (AU)
• In hospital: ECDC PPS (National team)
• In LTCFs: Healthcare-associated infections and Antimicrobial use in European Long-Term care facilities (HALT-3) (Management team)
Implementation of the Council Recommendation of 9 June 2009 on patient safety, including the prevention and control of healthcare-associated infections (2009/C 151/01).
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ECDC PPS ECDC PPS 2011-2012 ECDC PPS 2016-2017
HALT-3
www.ecdc.europa.eu
HALT-1: May-September 2010 HALT-2: April-May 2013 HALT-3: 2016-2017
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OBJECTIVES
To estimate the total burden (prevalence) of HAI and AU.
To describe patients, infections (sites, micro-organisms incl. limited AMR
markers) and antimicrobials prescribed (compounds, indications).
To disseminate results to those who need to know at local, regional,
national and EU level.
To develop a simple tool to identify targets of quality improvement and
to evaluate the effect of interventions.
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Methodology
Standardized methodology for a combined PPS on HAIs and AU:
• AU use: Systemic AU received on the PPS day Exclude: antivirals, antimicrobial for local use
• Active HAI: signs/symptoms are present on PPS day or were present and patient still receive a treatment for this infection.
Variables collected at national, hospital/LTCFs and patient level
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Methodology
• Data collected on a single day per LTCFs (if possible)
• Data collected on a single day per ward and 2-3 weeks per hospital
In hospitals In LTCFs
• Data collected by infection control and/or antimicrobial team
• Data collected by nurses and/or coordinating physicians
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ECDC PPS: Results 2011
In Belgium 52 were randomly sampled to avoid overrepresentation
Number of patients: 13758
Median size (number of beds): 275
Median average length of stay (days): 7.7
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ECDC PPS: Results 2011
Belgian : 7.1 % European : 6.0 % (country range 2.3%-10.8%)
Figure 1. Belgian distribution of types of HAI
HAI Prevalence
24%
18%
18%
14%
8%
8%
7% 3% Pneumonia/LRT
Urinary tract
Surigical site
Bloodstream
Gastrointestinal
Other/unspecified
Systemic
Skin/soft tissue
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ECDC PPS: Results 2011
Belgian : 28.9% European : 35.0 % (country range 21.4-54.7)
Figure 2. Prevalence for antimicrobial use distribution (% of patients receiving antimicrobials)
AU prevalence
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ECDC PPS: Results 2011 Figure 3. Site of diagnosis for antimicrobial treatment in acute care hospitals in Belgium (n=3 825 infections)
34.3%
12.8% 14.4%
5.7%
7.2%
15.6%
7.0% 3.0%
Respiratory tract
Urinary tract
Gastrointestinal tract
Bacteremia
Systemic infections
Skin, soft tissue, bone, joint
Other sites
Undefined/unknown
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ECDC PPS: Results 2011 Figure 4. Distribution of antibacterials for systemic use (ATC group J01) prescribed for treatment in acute care hospitals in Belgium (n=3 518 antimicrobial agents)
0.9% 0.0%
47.7%
15.9% 1.6%
4.1%
3.1%
16.3%
0.3% 10.2%
J01A Tetracyclines
J01B Amphenicols
J01C Beta-lactam antibacterials, penicillins
J01D Other beta-lactam antibacterials
J01E Sulfonamides and trimethoprim
J01F Macrolides, lincosamides and streptogramins
J01G Aminoglycoside antibacterials
J01M Quinolone antibacterials
J01R Combinations of antibacterials
J01X Other antibacterials
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ECDC PPS 2016-2017
In Belgium : Data collection between September and November 2017 So far 31 hospitals expected At the same time: Global-PPS (University of Antwerp) Inclusion criteria now include chronic care wards in acute care hospitals.
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HALT-3 results
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HALT-3: Results 2016
Characteristics of the participating LTCFs and the eligible study population Belgium
Number of LTCFs 165 Nursing homes 158 Revalidation centers 4 Psychiatric LTCFs 3
Number of eligible residents 16858 LTCF size (mean; min-max) 112.4 (25-335) Total number of resident rooms 17211 % single occupancy (SO) resident rooms (mean; min-max) 90.5% (14.6-100.0) % SO rooms with individual toilet & washing facilities (mean; min-max) 87.5% (0.0-100.0) Qualified nurse present 24h/24 in the LTCF 98.1%
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HALT-3: Results 2016
Prevalence evolutions
2016
2013
2010
BE BE EU BE EU
Prevalence of residents with at least one antimicrobial (%) 5.4 5.1 4.4 4.3 4.3
Prevalence of residents with at least one HAI (%) 3.5 3.6 3.4 2.7 2.4
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HALT-3: Results 2016 Figure 5. Belgian indications for AU by site
42.4%
33.8%
11.9%
9.7% 2.3%
Respiratory tract
Urinary tract
Skin or wound
Other (specify)
Surgical site
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HALT-3: Results 2016 Figure 6. Distribution of Belgian HAI infection site
31.2%
43.2%
16%
3.3% 3.3% 3.2%
Respiratory tract infections
Urinary tract infections
Skin infections
Eye, ear, nose, mouthinfectionsGastrointestinal infections
Other infections
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HALT-3: 2017
HALT-3 PSY in Septembre – Novembre 2017: Involvement of Belgian psychiatric facilities.
Adaption of risk factors and care load indicators
• E.g. automutilation, primary psychiatric diagnosis
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Conclusion
HAI prevalence (%) in Belgium
• Hospitals: 7.1 • LTCFs: 3.5
Estimated number of patients per year with an HAI in Belgium
• Hospital: 111 276 • LTCFs: 170 090
Important to follow up trends in HAI occurrence in healthcare facilities Challenge for LTCFs
• Limited resources for infection prevention and control • Home-like facilities