Trends, risk factors and outcomes of healthcare-associated infections within the Italian network SPIN-UTI.

BACKGROUND Implementing infection control measures in light of healthcare-associated infection (HAI) surveillance data can prevent HAIs. Surveillance has been associated with a reduction of HAI in intensive care unit (ICU) patients, though the reasons for this improvement remain unclear. AIM To evaluate changes in healthcare-associated infection (HAI) rates during three surveys of the Italian Nosocomial Infections Surveillance in Intensive Care Units (ICUs) network (SPIN-UTI) six-year project and to explore sources of variation of indicators of HAI in the 65 participating ICUs. METHODS The SPIN-UTI network adopted the European protocols for patient-based HAI surveillance. Cumulative incidence, incidence density, infection rates adjusted for device-days, and device utilization ratios were calculated for each survey and compared. To identify risk factors multiple logistic regression analyses were performed. Crude excess mortality was computed as the difference between the crude overall case-fatality rate of patients with and without HAI. FINDINGS The risk of ICU-acquired infections increased in the third survey compared with previous (relative risk: 1.215; 95% confidence interval: 1.059-1.394). Among risk factors, the number of hospitalized patients requiring ICU admission and the Simplified Acute Physiology Score II increased from 73.7% to 78.1% and from 37.9% to 40.8% respectively. Although mortality rates remained unchanged, HAIs trebled the risk of death. Acinetobacter baumannii was the most frequently reported micro-organism in the third survey (16.9%), whereas in the previous surveys it ranked third (7.6%) and second (14.3%). CONCLUSIONS The study highlighted the increased risk of HAI, at least partially explained by the greater severity and number of hospitalized patients requiring ICU admission. Furthermore, the management of intubation procedures and of ventilated patients was identified as a potential target for infection control interventions to decrease the growing risk of HAI in ICUs.

[1]  P. Gastmeier,et al.  Reproducibility of the Surveillance Effect to Decrease Nosocomial Infection Rates , 2009, Infection Control & Hospital Epidemiology.

[2]  K. Mertens,et al.  Clinical outcomes of health-care-associated infections and antimicrobial resistance in patients admitted to European intensive-care units: a cohort study. , 2011, The Lancet. Infectious diseases.

[3]  H. Rüden,et al.  Trends in Ventilator-Associated Pneumonia Rates Within the German Nosocomial Infection Surveillance System (KISS) , 2007, Infection Control & Hospital Epidemiology.

[4]  H. Rüden,et al.  Reducing Central Venous Catheter–Associated Primary Bloodstream Infections in Intensive Care Units Is Possible: Data From The German Nosocomial Infection Surveillance System , 2003, Infection Control & Hospital Epidemiology.

[5]  Stephan Harbarth,et al.  Use of benchmarking and public reporting for infection control in four high-income countries. , 2011, The Lancet. Infectious diseases.

[6]  R. Haley,et al.  The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. , 1985, American journal of epidemiology.

[7]  Diederick E Grobbee,et al.  Reduced risk of surgical site infections through surveillance in a network. , 2006, International journal for quality in health care : journal of the International Society for Quality in Health Care.

[8]  A Agodi,et al.  Validation of intensive care unit-acquired infection surveillance in the Italian SPIN-UTI network. , 2010, The Journal of hospital infection.

[9]  A Agodi,et al.  Building a benchmark through active surveillance of intensive care unit-acquired infections: the Italian network SPIN-UTI. , 2010, The Journal of hospital infection.

[10]  Fred Goldstein,et al.  A continuous quality-improvement program reduces nosocomial infection rates in the ICU , 2004, Intensive Care Medicine.

[11]  Margaret A Dudeck,et al.  National Healthcare Safety Network (NHSN) report, data summary for 2012, Device-associated module. , 2013, American journal of infection control.

[12]  H. Rüden,et al.  [Surveillance of nosocomial infections in intensive care units. Current data and interpretations]. , 2003, Wiener klinische Wochenschrift.

[13]  G. Valenti,et al.  Containment of an Outbreak of KPC-3-Producing Klebsiella pneumoniae in Italy , 2011, Journal of Clinical Microbiology.

[14]  B. Grandbastien,et al.  Impact of a six-year control programme on surgical site infections in France: results of the INCISO surveillance. , 2007, The Journal of hospital infection.

[15]  M. Schumacher,et al.  Implementing strategic bundles for infection prevention and management , 2012, Infection.

[16]  R. Evans.  European Centre for Disease Prevention and Control. , 2014, Nursing standard (Royal College of Nursing (Great Britain) : 1987).

[17]  P. Gastmeier,et al.  Nosocomial infections and multidrug-resistant organisms in Germany: epidemiological data from KISS (the Hospital Infection Surveillance System). , 2011, Deutsches Arzteblatt international.

[18]  H. Rüden,et al.  Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. , 2006, The Journal of hospital infection.