Point prevalence studies on HCAI and AB usage. Lithuanian experience Rolanda Valinteliene, Institute of Hygiene, rolanda.valinteliene@hi.lt
Main issues Methodology Protocol Data collection
PPS history in LT First PPS (survey) 1996 Repetitive PPS pilot (part of the pilot surveillance program) 2003-2008 Every second year (april) Voluntary Repetitive PPS national (part of the national scheme) since 2009 Every year (may) Mandatory
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
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
First PPS, 1996 Results HAI prevalence 5,8% Peculiarities : Specific HAI structure Low prevalence of risk factors Low microbiology usage Long hospital stay
Pilot PPS, 2003-2008 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
Pilot PPS, 2003-2008 Results Good participation 30-40 hospitals, >10.000 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
10 HAI prevalence in hospitals, 2005 9 8 7 HAI prevalence, % 6 5 4 LOCAL REGIONAL UNIVERS. 3,5 3 2 2,2 2,4 1 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 Ligoninės
Prevalence of risk factors, 2007 35 30 % of patients 25 20 15 10 University Regional Local 5 0 1,4 1,6 0,4 Surgery Urinary cath. Ventilation
Microbiological diagnostics (% of HAI tested) Microbiologicaly tested, % of HAI 80 70 60 50 40 30 20 10 0 1996 2007 University Regional Local
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%
Pilot PPS, 2003-2008 Results Good participation 30-40 hospitals, >10.000 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
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
HAI prevalence in different departments (pilot PPS) Long term Obstetrics/gynecol Hematology Medical Pediatrics 2007 2005 ICU Trauma/orthopedics Surgery 0 5 10 15
(Duomenų registracijos forma) 1. LIGONINĖ 2. SKYRIUS 3. LOVŲ SKAIČIUS SKYRIUJE 4. TYRIMO DATA - - 5. 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
Data entry form (EpiData)
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
Dr. Rolanda Valinteliene, Institute of Hygiene, www.hi.lt, rolanda.valinteliene@hi.lt Thank you!