Point prevalence surveys on healthcare acquired infections in medical and surgical wards of a teaching hospital in Rome.

BACKGROUND Healthcare acquired infections (HAI) are an important cause of morbidity and mortality in hospitals worldwide. Aim of the study was to analyze nine years surveillance activity, carried out by point prevalence surveys from 2007 to 2015, in a 450-bed teaching hospital in Rome. METHODS Point prevalence surveys were carried out every year in the medical and surgical wards following the same methodology. In accordance with definitions used by the Centers for Disease Control, all infections occurred more than 48 hours after hospital admission were considered HAI, and included in the study. Baseline characteristics, clinical features, isolated pathogens (only for the period 2011-2015) and antimicrobial resistance were recorded. RESULTS During the nine years point prevalence surveys a total 2,840 patients were enrolled. Overall 136 (4.79%) patients developed 180 (6.34%) HAI. The most frequent HAI were respiratory tract infections (RTI), which accounted for 35.0% of all HAI, followed by surgical site infections (SSI) 22.2%, urinary tract infections (UTI) 19.4%, bloodstream infections (BSI) 17.2%, and others 6.1%. HAI related to major invasive risk procedures were also evaluated. SSI/patients undergoing surgery 3.99%, UTI/ patients with urinary catheter 4.17% and BSI/patients with CVC 9.42%. Over one-half of all patients surveyed (1,532, 53.9%) were receiving antibiotics at the time of our study. Among them 892 (58.2%) for treatment, 641 (41.8%) for prophylaxis. In the latter group, 109 (17.0%) underwent extra-short term, 89 (13.9%) short term and 443 (69.1%) a long term prophylaxis. During the period 2011-2015 out of 110 HAI episodes 71 (64.5%) were confirmed microbiologically. In total 106 pathogens were isolates, Gram-negative bacteria (63.2%) were isolated more frequently than Gram-positive bacteria (28.3%). CONCLUSIONS The overall HAI prevalence in our hospital was consistent with those reported in other studies in Italy. The study underlined the role of Gram-negative bacteria in HAI and the need for antimicrobial stewardship. It also provided useful baseline data for rational priorities in allocation of resources, for further infection control activities.

[1]  H. Rüden,et al.  Repeated prevalence investigations on nosocomial infections for continuous surveillance. , 2000, The Journal of hospital infection.

[2]  S. Romagnoli,et al.  Hospital-acquired infections in Italy: a region wide prevalence study. , 2004, The Journal of hospital infection.

[3]  G. Ducel,et al.  An international survey of the prevalence of hospital-acquired infection. , 1988, The Journal of hospital infection.

[4]  G. Privitera,et al.  Prevalence of nosocomial infections in Italy: result from the Lombardy survey in 2000. , 2003, The Journal of hospital infection.

[5]  Zhiyuan Yao,et al.  Annual surveys for point-prevalence of healthcare-associated infection in a tertiary hospital in Beijing, China, 2012-2014 , 2016, BMC Infectious Diseases.

[6]  R G Newcombe,et al.  Four country healthcare associated infection prevalence survey 2006: overview of the results. , 2008, The Journal of hospital infection.

[7]  H. Sax,et al.  Assessing the Burden of Healthcare-Associated Infections through Prevalence Studies: What Is the Best Method?1 , 2014, Infection Control & Hospital Epidemiology.

[8]  Carol A. Keohane,et al.  Health care-associated infections: a meta-analysis of costs and financial impact on the US health care system. , 2013, JAMA internal medicine.

[9]  H. Goossens,et al.  The European Centre for Disease Prevention and Control (ECDC) pilot point prevalence survey of healthcare-associated infections and antimicrobial use. , 2012, Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin.

[10]  J. Wille,et al.  Prevalence of nosocomial infections in The Netherlands, 2007-2008: results of the first four national studies. , 2010, The Journal of hospital infection.

[11]  B. Yangco,et al.  CDC definitions for nosocomial infections. , 1989, American journal of infection control.

[12]  D. Xie,et al.  Annual point-prevalence of healthcare-associated infection surveys in a university hospital in China, 2007-2011. , 2013, Journal of infection and public health.

[13]  G. B. Orsi,et al.  Laboratory confirmed bloodstream infection aetiology in an intensive care unit: eight years study. , 2012, Annali di igiene : medicina preventiva e di comunita.

[14]  M. Stazi,et al.  National prevalence survey of hospital-acquired infections in Italy, 1983. , 1986, The Journal of hospital infection.

[15]  M. Raponi,et al.  Surveillance and Infection Control in an Intensive Care Unit , 2005, Infection Control & Hospital Epidemiology.

[16]  S. Solomon,et al.  Costs Attributable to Healthcare-Acquired Infection in Hospitalized Adults and a Comparison of Economic Methods , 2010, Medical care.

[17]  G. Ippolito,et al.  Prevalence of nosocomial infections in 15 Italian hospitals: first point prevalance study for the INF-NOS project. , 2003, Infection.

[18]  A. Gikas,et al.  Prevalence study of hospital-acquired infections in 14 Greek hospitals: planning from the local to the national surveillance level. , 2002, The Journal of hospital infection.

[19]  F. Ansaldi,et al.  Surveillance of hospital-acquired infections in Liguria, Italy: results from a regional prevalence study in adult and paediatric acute-care hospitals. , 2009, The Journal of hospital infection.

[20]  R. Lynfield,et al.  Multistate point-prevalence survey of health care-associated infections. , 2014, The New England journal of medicine.