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  • 1
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    Use of Central Venous Catheter and Peripheral Venous Catheter as Risk Factors for Nosocomial Bloodstream Infection in Very-Low-Birth-Weight Infants
    Cambridge University Press (CUP) ; 2010
    In:  Infection Control & Hospital Epidemiology Vol. 31, No. 4 ( 2010-04), p. 395-401
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 31, No. 4 ( 2010-04), p. 395-401
    Abstract: To describe the relationship between the use of central and peripheral venous catheters and the risk of nosocomial, primary, laboratory-confirmed bloodstream infection (BSI) for neonates with a birth weight less than 1,500 g (very-low-birth-weight [VLBW] infants). Methods. Cox proportional hazard regression analysis with time-dependent variable was used to determine the risk factors for the occurrence of BSI in a cohort of VLBW infants. We analyzed previously collected surveillance data from the German national nosocomial surveillance system for VLBW infants. All VLBW infants in 22 participating neonatal departments who had a complete daily record of patient information were included. Results. Of 2,126 VLBW infants, 261 (12.3%) developed a BSI. The incidence density for BSI was 3.3 per 1,000 patient-days. The multivariate analysis identified the following significant independent risk factors for BSI: lower birth weight (hazard ratio [HR], 1.1–2.2), vaginal delivery (HR, 1.5), central venous catheter use (HR, 6.2) or peripheral venous catheter use (HR, 6.0) within 2 days before developing BSI, and the individual departments (HR, 0.0–4.6). Conclusions. After adjusting for other risk factors, use of peripheral venous catheter and use of central venous catheter were significantly related to occurrence of BSI in VLBW infants.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/651303
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2010
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  • 2
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    How Many Nosocomial Infections Are Missed If Identification Is Restricted to Patients With Either Microbiology Reports or Antibiotic Administration?
    Cambridge University Press (CUP) ; 1999
    In:  Infection Control & Hospital Epidemiology Vol. 20, No. 02 ( 1999-02), p. 124-127
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 20, No. 02 ( 1999-02), p. 124-127
    Abstract: To investigate how many nosocomial infections would be missed if surveillance activities were restricted to patients having either microbiology reports or antibiotic administration. Design: Analysis of data from a large prevalence study on nosocomial infections (Nosocomial Infections in Germany— Surveillance and Prevention). Setting: A total of 14,966 patients were investigated in medical, surgical, obstetric-gynecologic, and intensive-care units of 72 German hospitals representatively selected according to size. Five hundred eighteen patients (3.5%) had at least one nosocomial infection. Microbiology reports were available for 56.6% of these patients on the prevalence day, and 86.3% received antibiotics. Results: Only 31 nosocomially infected patients (6%) would have been missed by using either microbiology reports or antibiotic treatment as an indicator. These indicators of nosocomial infections had a high diagnostic sensitivity for nosocomial pneumonia (98.8%), urinary tract infections (96.3%), and primary bloodstream infections (95.3%), but a lower sensitivity for wound infections (85.4%). Thus, 97.4% of all nosocomial infections were found with this method in intensive-care units and 96.1% in medicine units, but only 89.7% in surgical departments. In 9 (12.5%) of 72 hospitals, the overall sensitivity would have been & lt;80% using a combination of the two indicators. For this reason, the situation in one's own hospital should be checked before using this method. Conclusions: After checking the situation in one's own hospital, the “either-or” approach using the two indicators “microbiology report” and “antibiotic administration” can be recommended as a time-saving measure to diagnose pneumonia, urinary tract, and primary bloodstream infections. For wound infections, additional information obtained by changing dressings or participating in ward rounds is necessary to achieve satisfactory sensitivity in the surveillance of nosocomial infections. Of course, it is necessary that the surveillance staff discard all false positives to ensure a satisfactory specificity.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/501600
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1999
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  • 3
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    Identifying Outliers of Antibiotic Usage in Prevalence Studies on Nosocomial Infections
    Cambridge University Press (CUP) ; 2000
    In:  Infection Control & Hospital Epidemiology Vol. 21, No. 5 ( 2000-05), p. 324-328
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 21, No. 5 ( 2000-05), p. 324-328
    Abstract: To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (ρ) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator. Design: Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (ρ) and reference (ρ NIDHP [Nosokomiale Infektionen in Deutschland: Erfassung und Prävention]) correlation coefficients for “use of antibiotics/ presence of infections.” Setting: The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (ρ NIDEP ) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients ρ n for every prevalence investigation were determined. Results: In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient ρ NIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value ρ NIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use. Conclusion: The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient ρ for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/501764
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2000
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  • 4
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    Reducing Central Venous Catheter–Associated Primary Bloodstream Infections in Intensive Care Units Is Possible: Data From The German Nosocomial Infection Surveillance System
    Cambridge University Press (CUP) ; 2003
    In:  Infection Control & Hospital Epidemiology Vol. 24, No. 7 ( 2003-07), p. 501-505
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 24, No. 7 ( 2003-07), p. 501-505
    Abstract: The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)–associated primary bloodstream infections (BSIs) in ICUs since participation in KISS. Methods: Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test. Results: For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs. Conclusion: Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients ( Infect Control Hosp Epidemiol 2003;24:501-505).
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/502236
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2003
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  • 5
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    Methicillin-Resistant Staphylococcus aureus in German Intensive Care Units During 2000-2003: Data from Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units)
    Cambridge University Press (CUP) ; 2006
    In:  Infection Control & Hospital Epidemiology Vol. 27, No. 2 ( 2006-03), p. 146-154
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 27, No. 2 ( 2006-03), p. 146-154
    Abstract: The objective of this study was to analyze methicillin-resistant Staphylococcus aureus (MRSA) percentages (defined as the percentage of S. aureus isolates that are resistant to methicillin) and antimicrobial consumption in intensive care units (ICUs) participating in Project SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in Intensive Care Units), to look for temporal changes in MRSA percentages and antimicrobial consumption in individual ICUs as an indicator of the impact of an active surveillance system, and to investigate the differences between ICUs with increased MRSA percentages versus those with decreased percentages during a period of 3 years (2001-2003). Methods. This was a prospective, ICU-based and laboratory-based surveillance study involving 38 German ICUs during 2000-2003. Antimicrobial use was reported in terms of defined daily doses (DDDs) per 1,000 patient-days. Temporal changes in the MRSA percentage and antimicrobial use in individual ICUs were calculated by means of the Wilcoxon signed rank test. The incidence density of nosocomial MRSA infection was defined as the number of nosocomial MRSA infections per 1,000 patient-days. Results. From February 2000 through December 2003, a total of 38 ICUs reported data on 499,694 patient-days and 9,552 S. aureus isolates, including 2,249 MRSA isolates and 660,029 DDDs of antimicrobials. Cumulative MRSA percentages ranged from 0% to 64.4%, with a mean of 23.6%. The MRSA incidence density ranged from 0 to 38.2 isolates per 1,000 patient-days, with a mean of 2.77 isolates per 1,000 patient-days. There was a positive correlation between MRSA percentage and imipenem and ciprofloxacin use ( P 〈 .05). Overall, comparison of data from 2001 with data from 2003 showed that MRSA percentages increased in 18 ICUs (median increase, 13.2% [range, 1.6%-38.4%]) and decreased in 14 ICUs (median decrease, 12% [range, 1.0%-48.4%] ). Increased use of third-generation cephalosporins, glycopeptides, or aminoglycosides correlated significantly with an increase in the MRSA percentage ( P 〈 .05). The cumulative nosocomial MRSA infection incidence density for 141 ICUs that did not participate in SARI and, therefore, did not receive feedback increased from 0.26 to 0.35 infections per 1,000 patient-days during a 3-year period, whereas the rate in SARI ICUs decreased from 0.63 to 0.40 infections per 1,000 patient-days. Conclusion. The MRSA situation in German ICUs is still heterogeneous. Because MRSA percentages range from 0% to 64.4%, further studies are required to confirm findings that no change in the MRSA percentage and a decrease in the nosocomial MRSA infection incidence density in SARI ICUs reflect the impact of an active surveillance system.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/500619
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2006
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  • 6
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    How Outbreaks Can Contribute to Prevention of Nosocomial Infection: Analysis of 1,022 Outbreaks
    Cambridge University Press (CUP) ; 2005
    In:  Infection Control & Hospital Epidemiology Vol. 26, No. 4 ( 2005-04), p. 357-361
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 26, No. 4 ( 2005-04), p. 357-361
    Abstract: To describe the epidemiology of nosocomial outbreaks published in the scientific literature. Design: Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002. Methods: Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied. Results: Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period). Conclusion: Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/502552
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2005
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  • 7
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    Development of a Surveillance System for Methicillin-Resistant Staphylococcus aureus in German Hospitals
    Cambridge University Press (CUP) ; 2007
    In:  Infection Control & Hospital Epidemiology Vol. 28, No. 4 ( 2007-04), p. 446-452
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 28, No. 4 ( 2007-04), p. 446-452
    Abstract: To determine the appropriate method to calculate the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization (hereafter, MRSA rates) for interhospital comparisons, such that the large number of patients who are already MRSA positive on admission is taken into account. Design. A prospective, multicenter, hospital-based surveillance of MRSA-positive case patients from January through December 2004. Setting. Data from 31 hospitals participating in the German national nosocomial infections surveillance system (KISS) were recorded during routine surveillance by the infection control team at each hospital. Results. Data for 4,215 MRSA-positive case patients were evaluated. From this data, the following values were calculated. The median incidence density was 0.71 MRSA-positive case patients per 1,000 patient-days, and the median nosocomial incidence density was 0.27 patients with nosocomial MRSA infection or colonization per 1,000 patient-days (95% CI, 0.18-0.34). The median average daily MRSA burden was 1.13 MRSA patient-days per 100 patient-days (95% CI, 0.86-1.51), with the average daily MRSA burden defined as the total number of MRSA patient-days divided by the total number of patient-days times 100. The median MRSA-days–associated nosocomial MRSA infection and colonization rate, which describes the MRSA infection risk for other patients in hospitals housing large numbers of MRSA-positive patients and/or many patients who were MRSA positive on admission, was 23.1 cases of nosocomial MRSA infection and colonization per 1,000 MRSA patient-days (95% CI, 17.4-28.6). The values were also calculated for various MRSA screening levels. Conclusions. The MRSA-days–associated nosocomial MRSA rate allows investigators to assess the extent of MRSA colonization and infection at each hospital, taking into account cases that have been imported from other hospitals, as well as from the community. This information provides an appropriate incentive for hospitals to introduce further infection control measures.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/513444
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2007
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  • 8
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    Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems
    Cambridge University Press (CUP) ; 2007
    In:  Infection Control & Hospital Epidemiology Vol. 28, No. 4 ( 2007-04), p. 453-458
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 28, No. 4 ( 2007-04), p. 453-458
    Abstract: Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs). Objective. To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI. Methods. This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI. Results. During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction. Conclusion. The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/512630
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2007
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  • 9
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    Representativeness of the Surveillance Data in the Intensive Care Unit Component of the German Nosocomial Infections Surveillance System
    Cambridge University Press (CUP) ; 2010
    In:  Infection Control & Hospital Epidemiology Vol. 31, No. 9 ( 2010-09), p. 934-938
    Details
    In: Infection Control & Hospital Epidemiology, Cambridge University Press (CUP), Vol. 31, No. 9 ( 2010-09), p. 934-938
    Abstract: To assess the representativeness of the data in the Krankenhaus Infektions Surveillance System (KISS), which is a nosocomial infections surveillance system for intensive care units (ICUs) in Germany. Design. Prospective and retrospective surveillance study. Setting. Medical-surgical ICUs in Germany. Methods. A sample of medical-surgical ICUs from all over Germany, stratified according to hospital size, was randomly selected. Surveillance personnel from the hospitals were trained in surveillance of nosocomial infections, and they subsequently conducted a 2-month surveillance in their ICUs. Data were compared with KISS data for medical-surgical ICUs. Results. During the period from 2004 through 2005, a total of 50 medical-surgical ICUs agreed to participate in our study: 21,832 patient-days were surveyed, and 262 cases of nosocomial infection were registered, 176 of which were cases of device-associated nosocomial infection (100 cases of lower respiratory tract infection, 47 cases of urinary tract infection, and 29 cases of bloodstream infection). The overall incidence density of all types of nosocomial infections was estimated to be 10.65 cases per 1,000 patient-days. Device utilization rates in the study ICUs and in the KISS medical-surgical ICUs were similar. The pooled mean device-associated infection rates were higher in the study ICUs than in the KISS medical-surgical ICUs (10.2 vs 5.1 cases of pneumonia; 2.0 vs 1.2 cases of bloodstream infection; and 2.7 vs 1.2 cases of urinary tract infection), but the pooled mean device-associated infection rates in the study ICUs were comparable to those of the KISS ICUs during their first year of participation in KISS. The incidence density for nosocomial infections in the study ICUs varied according hospital size, with ICUs in larger hospitals having a higher incidence density than those in smaller hospitals. Conclusions. KISS ICUs started with nosocomial infection rates comparable to those found in our study ICUs. Over the years of participation, however, a decrease in nosocomial infections is seen. Thus, rates of nosocomial infection from KISS should be used as benchmarks, but estimations for Germany that are based on KISS data may underestimate the real burden of nosocomial infections.
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.1086/655462
    Language: English
    Publisher: Cambridge University Press (CUP)
    Publication Date: 2010
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  • 10
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    Importance of the Surveillance Method: National Prevalence Studies on Nosocomial Infections and the Limits of Comparison
    Cambridge University Press (CUP) ; 1998
    In:  Infection Control and Hospital Epidemiology Vol. 19, No. 9 ( 1998-09), p. 661-667
    Details
    In: Infection Control and Hospital Epidemiology, Cambridge University Press (CUP), Vol. 19, No. 9 ( 1998-09), p. 661-667
    Type of Medium: Online Resource
    ISSN: 0899-823X , 1559-6834
    URL: Article
    DOI: 10.2307/30141531
    Language: Unknown
    Publisher: Cambridge University Press (CUP)
    Publication Date: 1998
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