Reduction of nosocomial infections Petra Gastmeier Hanover Medical University German National Center

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Reduction of nosocomial infections Petra
GastmeierHanover Medical University German
National Center Reference for Surveillance of
Nosocomial Infections
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Wenzel/Edmond NEJM 2006 355 278-83
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Pittet D
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Hand hygiene
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Hugonett et al. 2007 3576-81
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Hugonett et al. 2007 3576-81
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Quality management
4. Evaluation
3. Intervention
Patient
1. Surveillance
2. Analysis
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KISS componentswww.nrz-hygiene.de12/2006
ICU-KISS
145 hospitals
MRSA-KISS
18 dept.
425 ICUs
416 dept.
OP-KISS
ONKO-KISS
140 units
NEO-KISS
AMBU-KISS
136 NICUs
DEVICE-KISS
112 facilities
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Distribution of CVC associated bloodstream
infection rates / 1000 CVC days
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Reduction of CVC associated bloodstream infection
rates in KISS

• 84 ICUs were included
• participating in KISS for at least 24 months

Zuschneid et al. ICHE 2003 24501-05
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Reduction of ICU infection rates in KISS ?
Inclusion criteria 150 ICUs with having had at
least 3 years of ongoing participation
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Pooled CVC-BSI rates according to the year of
participation (150 ICUs)
CVC-BSI cases/1000 CVC days
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RR 0.80 (CI95 0.72-0.90)
Gastmeier et al. J Hosp Infect 2006 64 16-22
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Reduction of BSI in NEO-KISS?
Inclusion criteria 48 NICUs with having had at
least 3 years of ongoing participation
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Pooled BSI rates according to the year of
participation
RR 0.73 (CI95 0.66-0.80)
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n 3,856 patients from 48 NICUs
Schwab F et al. J Hosp Infect 2007
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Results of multiple logistic regression analysis
for primary bloodstream infection
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Pittet D
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Questionnaire to 182 KISS ICUs
Use of sterile barrier precautions during CVC
insertion ?
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Vonberg et al. Der Anästhesist 2005
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There is room for improvement in many hospitals.
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Intervention studies to reduce the incidence of
CVC-BSIs
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Intervention studies in individual ICUs
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• 5 Interventions were introduced
• Educational programme
• Introduction of a catheter insertion card
• Daily check of indication for CVC use
• Check list for controlling of prevention
  measures
• Authorization of staff to interrupt insertion
  when a violance of guidelines was observed

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Intervention ICU CVC associated BSI rate 1.
Quarter 1998 11.3/1,000 CVC days 4. Quarter
2002 0/1,000 CVC days Control ICU 1.
Quarter 1998 5.7/1,000 CVC days 4. Quarter
2002 1.6/1,000 CVC days Estimation 43
CVC-BSI cases avioded, 8 deaths and 1,945,922
attributable costs per year
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Prevention Epicenter Programme

• 12 ICUs from 6 university hospitals
• Written standards self learning modul with pre-
  and post-test, educational lectures
• Reduction of infection rates from 11.2 to 8.9 per
  1000 CVC days (RR 0.79 0.67-0.93)

Warren et al. ICHE 2006 27 662-69
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• Voluntary intervention study for reducing CVC
  associated BSI rates in ICUs
• Intervention by hospital staff
• 32 hospitals from Pennsylvania
• Duration of intervention 4 years (4/2001-3/2005)

Muto C et al., MMWR, Oct. 14, 2005, Vol. 54, No.
40
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-66
Muto et al. MMWR 2005
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• Study in 103 ICUs in Michigan over 3 years
• Intervention Hand disinfection, full
  barrier-precautions, skin disinfection with
  Chlorhexidine, no femoralis catheters, strict
  indication
• Reduction of CVC-BSI rate from 7.7 to 1.4 per
  1000 CVC days (66 Reduction on average)

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Pittet D
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Ho et al. JAC 2006 58 281-86
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Randomized controlled trial in an oncology ward
Study group 300 patients/19 with BSI Control
group 301 patients/34 with BSI RR 0.56 (CI95
0.33-0.96)
Ruschulte et al., Euroanaesthesia Congress Madrid
June 2006
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High risk groups, special problems
Pittet D