Impact of Education and Process Surveillance on Device-Associated Health Care-Associated Infection Rates in a Turkish ICU: Findings of the International Nosocomial Infection Control Consortium (INICC)

Abstract

Objective: The aim of this study was to analyze the impact of process and outcome surveillance on rates of device-associated health care-associated infections (DA-HAI) in an intensive care unit (ICU) in Turkey over a four-year period. Material and Methods: An open label, prospective cohort, active DA-HAI surveillance study was conducted on 685 patients admitted to the ICU of a university hospital in Turkey from January 2004 to December 2007, implementing the methodology developed by the International Nosocomial Infection Control Consortium. DA-HAI rates were recorded according to Centers for Disease Control and Prevention (CDC), National Healthcare Safety Network (NHSN) definitions. We analyzed the rates of DA-HAI, mechanical ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CAUTI), as well as microorganism profile, extra length of stay, and hand hygiene compliance. Pooled DA-HAI rates were calculated and compared by year. Results: The DA-HAI rate per 100 patients declined as follows: for 2004, the DA-HAI rate was 58.4%; for 2005, it was 38.9%; for 2006, it was 34.8%; and for 2007, it was 10.9%. The DA-HAI rate per 1,000 bed-days also declined: for 2004, it was 42.8, and for 2007 it was 10.7. The rates decreased from 25.8 to 13.4 for VAP; from 29.9 to 25.0 for CLA-BSI; and from 9.2 to 6.2 for CAUTI cases per 1,000 device-days during the study period. Conclusion: Process and outcome surveillance of DA-HAI significantly reduced DA-HAI. Turkish Başlık: Bir Türk Yoğun Bakım Ünitesinde Eğitim ve Sürveyansın Alet İlişkili Hastane Enfeksiyon Hızları Üzerine Etkisi: Uluslar Arası Nozokomiyal Enfeksiyon Kontrol Konsorsiyum Verileri Anahtar Kelimeler: Hastane enfeksiyonları, ventilatör ilişkili pnömoni, santral kateter ilişkili kan dolaşımı enfeksiyonu, kateter ilişkili idrar yolu enfeksiyonu, sürveyans, el hijyeni, yoğun bakım ünitesi Amaç: Bu çalışmanın amacı, Türkiye'deki bir yoğun bakım ünitesinin dört yıllık eğitim ve sürveyansının alet ilişkili hastane enfeksiyon hızları üzerine etkisinin değerlendirilmesidir. Gereç ve Yöntem: Çalışma prospektif kohort, açık-etiketli, aktif, alet ilişkili hastane enfeksiyon takibi ile, Türkiye'deki bir üniversite hastanesinin yoğun bakım ünitesinde Ocak 2004 ve Aralık 2007 tarihleri arasında kabul edilen 685 hastada uluslar arası nozokomiyal enfeksiyon kontrol konsorsiyumunun geliştirdiği yöntemlerin uygulandığı bir çalışmadır. Alet ilişkili hastane enfeksiyon hızları “Amerikan Hastalık Kontrol ve Önleme Merkezleri (CDC)” ve “Ulusal Sağlık Hizmeti Güvenlik Çalışma Ağı (NHSN)” tanımlarına göre kayıt edildi. Alet ilişkili enfeksiyon hızları, ventilatör ilişkili pnömoni hızları, santral kateter ilişkili kan dolaşımı enfeksiyon hızları, kateter ilişkili idrar yolu enfeksiyon hızları, mikroorganizma profilleri, ekstra hastane kalış günleri ve el hijyeni uyumları analiz edildi. Alet ilişkili enfeksiyon hızları hesaplandı ve yıllara göre karşılaştırıldı. Bulgular: Yüz hasta başına düşen alet ilişkili hastane enfeksiyon hızları 2004 için %58.4, 2005 için %38.9, 2006 için %34.8 ve 2007 için %10.9 olarak izlenmiştir. Buna ek olarak 1000 hastane günü başına düşen alet ilişkili hastane enfeksiyon hızları da 2004 için 42.8, 2007 için 10.7'dir. Ventilatör ilişkili pnömoni hızları 25.8'den 13.4'e, santral kateter ilişkili kan kültürü enfeksiyon hızları 29.9'dan 25.0'a, kateter ilişkili idrar yolu enfeksiyon hızları ise 9.2'den 6.2'ye gerilemiştir. Sonuç: Alet ilişkili hastane enfeksiyonlarının sürveyansı, bu enfeksiyonları belirgin şekilde azaltmıştır.

Keywords

• Health care-associated infection, ventilator-associated pneumonia, central line-associated bloodstream infection, catheter-associated urinary tract infection, outcome and process surveillance, hand hygiene, intensive care unit

Impact of Education and Process Surveillance on Device-Associated Health Care-Associated Infection Rates in a Turkish ICU: Findings of the International Nosocomial Infection Control Consortium (INICC)

Öz

Kaynakça

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