Point prevalence studies on HCAI and AB usage. Lithuanian experience. Rolanda Valinteliene, Institute of Hygiene,

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1 Point prevalence studies on HCAI and AB usage. Lithuanian experience Rolanda Valinteliene, Institute of Hygiene,

2 Main issues Methodology Protocol Data collection

3 PPS history in LT First PPS (survey) 1996 Repetitive PPS pilot (part of the pilot surveillance program) Every second year (april) Voluntary Repetitive PPS national (part of the national scheme) since 2009 Every year (may) Mandatory

4 Background of the first PPS, 1996 Mandatory registration system not operational recorded incidence <0,1% reports from <5 % of hospitals HAI neglected and hidden PPS methodology tested during Lithuanian Danish program, 1994

5 First PPS, 1996 Aim To determine the prevalence of HAI and antibiotic use Methodology Protocol adopted from first UK study (1994) with simple HAI criteria One study team for all hospitals Random sampling of hospitals (14) Bedside data collection

6 First PPS, 1996 Results HAI prevalence 5,8% Peculiarities : Specific HAI structure Low prevalence of risk factors Low microbiology usage Long hospital stay

7 Pilot PPS, Aims To promote HAI surveillance in hospitals and prove the usefulness of PPS To monitor the prevalence of HAI and antibiotic use To determine main HAI risk areas (age, department, hospital type, diagnostics) Methodology Voluntary participation Acute hospitals Patient based protocol (bedside or med. chart review) Data collection by hospital staff (education) Feedback of results Confidentiality

8 Pilot PPS, Results Good participation hospitals, > patients Initiated surveillance in hospitals Big variations between hospitals demand of education Necessity of stratification Patient based protocol useful for Stratification of hospitals Denominator collection Case finding

9 10 HAI prevalence in hospitals, HAI prevalence, % LOCAL REGIONAL UNIVERS. 3, ,2 2, Ligoninės

10 Prevalence of risk factors, % of patients University Regional Local 5 0 1,4 1,6 0,4 Surgery Urinary cath. Ventilation

11 Microbiological diagnostics (% of HAI tested) Microbiologicaly tested, % of HAI University Regional Local

12 Antibiotic prescribing in different hospitals, PPS 2007 University Regional AB 69,2% AB+ 30,8%. prophylax. 39,8% treatment 59,8% AB 63,3% AB+ 36,7% prophylax. 21,4% treatment 78,2% Local prophylax; 17,8% AB 51,7% AB+ 48,3% treatment; 81,9%

13 Pilot PPS, Results Good participation hospitals, > patients (per survey) Initiated surveillance in hospitals Big variations between hospitals necessity of stratification demand of education Substantial differences from other studies HAI prevalence (incl. structure, diagnostics) Prevalence of risk factors Hospital stay, patient age, risk factors Patient based protocol useful for Denominator collection Case finding

14 National PPS, since 2009 Aim To monitor the prevalence of HAI and antibiotic use To promote HAI surveillance in hospitals To determine main HAI risk areas (age, department, hospital type, diagnostics) Methodology Patient based protocol (bedside or chart review) Mandatory participation Feedback of results Confidentiality Education of hospital staff Simple data maangment software (EpiData) Acute and long term care hospitals

15 HAI prevalence in different departments (pilot PPS) Long term Obstetrics/gynecol Hematology Medical Pediatrics ICU Trauma/orthopedics Surgery

16 (Duomenų registracijos forma) 1. LIGONINĖ 2. SKYRIUS 3. LOVŲ SKAIČIUS SKYRIUJE 4. TYRIMO DATA FORMĄ PILDĖ (vardas, pavardė, pareigos) 6. PACIENTO NUMERIS (įrašyti tiriamo paciento eilės numerį skyriuje - 1, 2, 3 ir t. t.) 7. PAGULDYMO DATA mėnuo, diena 8. AMŽIUS metai 9. BENDRI EJI DUOMENYS LYTIS V vyras, M moteris 10. ŠLAP. PŪSLĖS KATETERIS N ne, T taip Data collection form 11. KRAUJAGYSLINIS KATET. N ne, T taip RIZIKOS VEIKSNIAI 12. DIRBT. PL. VENTILIACIJA N ne, T taip 13. ĮVAIRŪS DRENAI N ne, T taip 14. OPERACIJA/GIMDYMAS N ne, T taip 15. OPERACIJOS KODAS (ŽR.KODUS)* 16. INFEKCIJA N ne, T taip 17. INFEKCIJOS KODAS (ŽR.KODUS)* 18. ĮGYTA (įrašyti atitinkamas reikšmes): 0 visuomen. 1 kt. lig. 2 šioje lig. INFEKCIJA 19. MIKROBIOLOGINIS TYRIMAS N ne, T taip 20. MIKROORGANIZMAS I (ŽR KODUS)* 21. MIKROORGANIZMAS II 22. MIKROORGANIZMAS III 23. ANTRINĖ BAKTEREMIJA 24. ANTIBAKTERINIS VAISTAS N ne, T taip 25. PAVADINIMAS (ŽR KODUS)* 26. PIRKTI (įrašyti atitinkamas reikšmes): L ligoninės, P paciento 27. TIKSLAS (įrašyti atitinkams reikšmes): G gydymui, P profilaktikai 28. ANTIBAKTERINIAI VAISTAI 29. PASTABOS SKYRIMO BŪDAS (įrašyti atitinkamas reikšmes): 1 per os 2 į raumenis 3 į veną 4 žvakutės 5 vietiškai

17 Data entry form (EpiData)

18

19 Conclusion (in relation to Euro PPS) Patient based protocol - priority: Case finding Stratify according to risk factors, hospital stay etc. Random sampling of hospitals Big differences between hospitals Education of hospital staff HAI criteria,?euro PPS english language, data entry

20 Dr. Rolanda Valinteliene, Institute of Hygiene, Thank you!

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