|Opis:||Hospital-acquired infections (HAI) are infections occurring in hospital environment. They are associated with medical care and high complications rates. Monitoring their frequency can be used as a quality indicator for hospitals. Repeated cross-sectional HAI surveys can be applied to monitor the changes in the frequency of HAI. Every 5 years the implementation of a cross-sectional HAI survey is coordinated by the European Centre for Disease Prevention and Control (ECDC).
In 2011, the second Slovenian National Cross-Sectional point prevalence survey (SNPRBO II) was conducted as part of a European Point Prevalence HAI study. The University Medical Centre Maribor was taking part in this study, where a high-qualified clinician for the management and control of HAI carried out a parallel validation of data, collected by interviewers in line with a standardized methodology for the collection of data as recommended by ECDC. The accuracy of the recorded data for all HAI patients and for every fifth patient without HAI were checked by qualified clinician.
Next to surveillance of micro-organisms spreading in the hospital environment and recognizing outbreaks, characterization of microorganisms (typing) causing HAI also plays a crucial role. At the University Medical Centre Maribor (UKC Maribor), methicillin resistant Staphylococcus aureus (MRSA) typing was used because the surveillance of MRSA is a mandatory quality indicator in Slovene hospitals. Clostridium difficile (CD) was chosen for typing because it is a quality indicator in numerous countries and is currently one of the most important health care associated infections. Spa typing was used for MRSA and ribotyping was used for CD.
The objectives of the thesis were the following: to develop a modified, work-intensive method of HAI recognition ("modified ECDC method") in order to validate the applied "usual ECDC method" for recognizing HAI in a cross-sectional HAI survey; to evaluate the HAI prevalence by using the "usual" and the "modified ECDC method" developed in the doctoral thesis; to assess the sensitivity and specificity of the "usual ECDC method" for identifying HAI compared to the "modified ECDC method" and assess the need to replace the "normal ECDC method" with our "modified ECDC method". We described the characteristics of patients involved in the survey, invasive procedures, HAI, exposure to commonly known risk factors for hospital infections, isolated microorganisms, and the resistance of certain microorganisms to selected antibiotics or groups of antibiotics, as well as the use of antibiotics. MRSA and CD were monitored over a period of at least one year and the importance of molecular typing for the recognition and control of HAI was evaluated.
The point prevalence study (PPS) included 991 patients, i.e. every patient that was hospitalized at the UKC Maribor on the day of survey. In addition to general data, HAI risk factors, treatment with antimicrobials, and hospital-acquired infections were also recorded. Using both methods, 52 patients with at least one HAI on the day of study were identified or still receiving treatment for HAI on the day of the study. HAIs prevalence was 5.2% (with a 95% CI 3.9%–6.8%). The prevalence of HAIs in ICUs was the highest (25.0%), followed by patients in surgical wards (6.2%), obstetrics/gynecology (4.4%), and departments of internal medicine (3.1%).
By using univariate and multivariate analyses, independent risk factors for HAI were defined: implant surgery in the last year, a urinary catheter, patients undergone surgery in the last 30 days and intubation.
66 HAIs were identified in total. The most common were lower respiratory tract infections (25%), surgical wound infections, and urinary tract infections. 9% of HAIs were already present at hospital admission, 91% were acquired during the current hospital stay and the majority was acquired in the period from day 4 to 7 following admittance. Except of one, all HAIs were acquired at|