Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units
Abstract
:1. Introduction
2. Materials and Methods
- HAI incidence rate, calculated as: (N of HAI × 100)/N of operations;
- CA-HAI incidence density rate: N of CA-HAI*1000/N of catheter days (CVC or urinary catheter, respectively);
- VAP rate: N of VAP*1000/N of mechanical ventilation days;
- Invasive procedure utilization, urinary catheter or CVC or mechanical ventilation use rate: N of days with invasive procedure/N of patient–days.
- Utilization ratio (UR)–number of patient-days/number of patient-days with a given (invasive) procedure.
- The epidemiology of gastrointestinal tract infection, including Clostridioides difficile infection (GI-CDI) and skin and soft tissue infection (SST), were not analyzed due to the low number of cases detected, respectively, 13 and 9 cases.
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristics of/Hospital/Unit/Patients | Hospital A | Hospital B | Total |
---|---|---|---|
Hospital description | |||
Size (number of hospital beds) | 620 | 530 | 1150 |
Infection Prevention Control Nurse (IPCN)–full-time employment | 3 | 3 | 6 |
Hospital referral level | second | second | second |
Characteristics of neurosurgical units | |||
Number of neurosurgical beds | 35 | 28 | 63 |
Number of neurosurgical intensive surveillance beds | 5 | 3 | 8 |
Number of patients | 8347 | 3770 | 12,117 |
Number of surgeries | 7799 | 3507 | 11,306 |
Number of patient-days (pds) of hospitalization | 68,008 | 34,729 | 92,737 |
Invasive device utilization ratio | |||
Patient-days with urinary catheter | 21,187 | 18,085 | 39,272 |
Urinary catheter UR * | 0.31 | 0.4 | 0.36 |
Patient-days with central line catheter | 5296 | 4000 | 9296 |
Central line catheter UR ** | 0.08 | 0.09 | 0.09 |
Patient-days with mechanical ventilation | 580 | 379 | 959 |
Mechanical ventilation (MV) UR *** | 0.01 | 0.01 | 0.01 |
Characteristics of patients | |||
Patient age: Me/IQR, p < 0.001 | 57/45–68 | 64/42–76 | 62/50–71 |
Sex F/M, p = 0.129 | 0.7 | 0.5 | 0.6 |
Days of stay: Me/IQR, p < 0.001 | 22/10–40 | 32/22–52 | 28/17–47 |
Healthcare-associated infections (HAI) | |||
Number of HAIs: OR (95% CI): 2.1 (1.73–2.58) p < 0.001 | 192 | 181 | 373 |
Incidence per 100 hospitalisations | 2.3 | 4.8 | 3.1 |
Incidence density per 1000 pds | 2.8 | 5.2 | 4.0 |
HAI Type | Hospital A | Hospital B | Total | p Value | OR (95% CI) |
---|---|---|---|---|---|
Form of HAI n (morbidity %) | |||||
Pneumonia (PN) | 60 (0.7) | 52 (1.4) | 112 (0.9) | <0.001 | 1.918 (1.321–2.787) |
Urinary tract infection (UTI) | 21 (0.2) | 87 (2.3) | 108 (0.9) | <0.001 | 8.988 (5.686–14.792) |
Surgical site infection (SSI) | 77 (0.9) | 19 (0.5) | 96 (0.8) | <0.05 | 1.402 (0.788–2.494) |
Bloodstream infection (BSI) | 34 (0.4) | 23 (0.6) | 57 (0.5) | 0.132 | 1.497 (0.881–2.546) |
Total | 192(2.3) | 181 (4.8) | 373 (3.1) | <0.001 | 2.142 (1.741–2.634) |
HAIs Associated with the Use of Invasive Devices | Hospital A | Hospital B | Total |
---|---|---|---|
Ventilator-associated pneumonia (VAP) | |||
VAP | 35 | 9 | 44 |
VAP incidence density per 1000 MV pds | 60.3 | 23.7 | 45.9 |
Catheter-associated urinary tract infection (CA-UTI) | |||
CA-UTI | 21 | 82 | 105 |
CA-UTI incidence density per 1000 UC pds | 1.0 | 4.5 | 2.7 |
Central venous catheter-Bloodstream infection (CVC-BSI) | |||
CVC-BSI | 7 | 11 | 18 |
CVC-BSI incidence density per 1000 CVCpds | 1.3 | 2.8 | 1.9 |
Pathogen Type | Clinical Forms of HAIs | ||||||||
---|---|---|---|---|---|---|---|---|---|
BSI | PN | UTI | SSI | Total | |||||
Hospital A | Hospital B | Hospital A | Hospital B | Hospital A | Hospital B | Hospital A | Hospital B | ||
n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | n (%) | |
Gram-positive cocci n (%) | 14 (41.2) | 14 (60.9) | 8 (13.3) | 4 (7.7) | 2 (9.5) | 16 (18.4) | 41(53.2) | 5 (26.3) | 104 (28.0) |
Staphylococcus aureus | 5 (14.7) | 7 (30.5) | 6 (10.0) | 1 (1.9) | 1 (4.8) | 0 (0.0) | 20 (26.0) | 3 (15.8) | 43 (11.5) |
Staphylococcus epidermidis | 4 (11.8) | 6 (26.1) | 0 (0.0) | 1 (1.9) | 0 (0.0) | 1 (1.1) | 12 (15.6) | 2 (10.5) | 26 (7.0) |
Other Gram-positive | 5 (14.7) | 1 (4.3) | 2 (3.3) | 2 (3.8) | 1 (4.8) | 15 (17.2) | 9 (11.7) | 0 (0.0) | 35 (9.4) |
Enterobacteriaceae n (%) | 12 (35.3) | 6 (26,1) | 15 (25.0) | 6 (11,5) | 11 (52.4) | 44 (50.6) | 14 (18,2) | 10 (52.7) | 118 (31.6) |
Klebsiella pneumoniae | 3 (8.8) | 2 (8.7) | 6 (10.0) | 2 (3.8) | 4 (19.0) | 18 (20.7) | 5 (6.5) | 5 (26.3) | 45 (12.0) |
Escherichia coli | 3 (8.8) | 1 (4.3) | 3 (5.0) | 2 (3.8) | 6 (28.6) | 23 (26.4) | 2 (2.6) | 2 (10.5) | 42 (11.3) |
Enterobacter cloacae | 5 (14.7) | 1 (4.3) | 3 (5.0) | 1 (1.9) | 1 (4.8) | 2 (2.3) | 5(6.5) | 0 (0.0) | 18 (4.8) |
Other Enterobacteriaceae | 1 (2.9) | 2 (8.7) | 3 (5.0) | 1 (1.9) | 0 (0.0) | 1 (1.1) | 2 (2.6) | 3 (15.8) | 13 (3.5) |
Non-fermenting Gram-negative bacteria n (%) | 6 (17.6) | 2 (8.7) | 13 (21.7) | 1 (1.9) | 4 (19.0) | 5 (5.7) | 17 (22.1) | 0 (0,0) | 48 (12.9) |
Pseudomonas aeruginosa | 1 (2.9) | 1 (4.3) | 0 (0.0) | 0 (0.0) | 3 (14.3) | 3 (3.4) | 7 (9.1) | 0 (0.0) | 15 (4.0) |
Acinetobacter baumannii | 5 (14.7) | 1 (4.3) | 13 (21.7) | 1 (1.9) | 1 (4.8) | 2 (2.3) | 10 (13.0) | 0 (0.0) | 33 (8.8) |
Other n (%) | 2 (5.9) | 0 (0.0) | 1 (1.7) | 0 (0.0) | 4 (19.0) | 3 (3.4) | 0 (0.0) | 0 (0.0) | 10 (2.7) |
Candida spp. | 2 (5.9) | 0 (0.0) | 1 (1.7) | 0 (0.0) | 4 (19.0) | 3 (3.4) | 0 (0.0) | 0 (0.0) | 10 (2.7) |
No microbiological confirmation n (%) | 0 (0.0) | 1 (4.3) | 23 (38.3) | 41 (78.9) | 0 (0.0) | 19 (21.8) | 5 (6.5) | 4 (21.0) | 93 (24.9) |
NO TEST | 0 (0.0) | 1 (4.3) | 17 (28.3) | 41 (78.9) | 0 (0.0) | 18 (20.7) | 4 (5.2) | 4 (21.0) | 85 (22.8) |
NO GROWTH * | 0 (0.0) | 0 (0.0) | 6 (10.0) | 0 (0.0) | 0 (0.0) | 1 (1.1) | 1 (1.3) | 0 (0.0) | 8 (2.1) |
Total n (%) | 34 (100) | 23 (100) | 60 (100) | 52 (100) | 21 (100) | 87 (100) | 77 (100) | 19 (100) | 373 (100) |
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Rafa, E.; Kołpa, M.; Wałaszek, M.Z.; Domański, A.; Wałaszek, M.J.; Różańska, A.; Wójkowska-Mach, J. Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units. Int. J. Environ. Res. Public Health 2022, 19, 7544. https://doi.org/10.3390/ijerph19127544
Rafa E, Kołpa M, Wałaszek MZ, Domański A, Wałaszek MJ, Różańska A, Wójkowska-Mach J. Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units. International Journal of Environmental Research and Public Health. 2022; 19(12):7544. https://doi.org/10.3390/ijerph19127544
Chicago/Turabian StyleRafa, Elżbieta, Małgorzata Kołpa, Marta Zofia Wałaszek, Adam Domański, Michał Jan Wałaszek, Anna Różańska, and Jadwiga Wójkowska-Mach. 2022. "Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units" International Journal of Environmental Research and Public Health 19, no. 12: 7544. https://doi.org/10.3390/ijerph19127544