Development of Outbreak Investigation Database for hospital Infections - PowerPoint PPT Presentation

Loading...

PPT – Development of Outbreak Investigation Database for hospital Infections PowerPoint presentation | free to view - id: 203f02-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Development of Outbreak Investigation Database for hospital Infections

Description:

In the middle of 1800 Lying-in Hospital in Vienna. Maternal mortality rates exceeded 10%, mainly due to puerperal fever (child-bed fever) endemic ... – PowerPoint PPT presentation

Number of Views:77
Avg rating:3.0/5.0
Slides: 25
Provided by: kiyo9
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Development of Outbreak Investigation Database for hospital Infections


1
Development of Outbreak Investigation Database
for hospital Infections
  • Osaka University,
  • Faculty of Medicine, JAPAN
  • Kiyoko Makimoto, Ph.D., MPH

2
What are hospital infections?
  • Two types of infections you find in the hospital
  • Hospital-acquired infections
  • Community-acquired infections
  • How can we distinguish them?
  • By latency period
  • CDC definition for NIs development of infections
    after 48 hours of admission

3
Brief history of hospital infections
  • First well documented hospital infections
  • In the middle of 1800 Lying-in Hospital in Vienna
  • Maternal mortality rates exceeded 10, mainly due
    to puerperal fever (child-bed fever) endemic
  • Modern epidemiology of hospital infections
  • In 1950s, Staphylococcus aureus infection
    outbreaks in hospitals all over the world
  • Advances in 1970
  • Intensive research in the 1990s

4
What kinds of hospital infections exit?
  • Device-related
  • Blood stream infections (BSI)
  • Urinary tract infections (UTI)
  • Ventilator-associated pneumonia (VAP)
  • Procedure-related
  • Surgical site infections (SSI)
  • Environmental contamination
  • Water, disinfectant, etc.

5
Devices and procedures as major sources of
hospital infections
Changes in flora due to antibiotic therapy
20-25
Others 20
Respirators
Cross-infections 20-40
Arterial/venous catheters
Surgeries
Patients own flora 40-60
Urinary catheters
6
Why do we need to study hospital infections?
  • Not all hospital infections are preventable,
    but they are associated with
  • Excess length of hospital stay
  • Excess cost
  • Excess mortality
  • Law suits

7
Distribution of hospital infections by sites,
SENIC study
8
Increases in the mean length of hospital stay due
to hospital infections in the U.S. , SENIC study
9
Excess cost of hospitalization due to hospital
infections in the U.S., 1992
10
Who are at risk for acquiring hospital infections?
  • Patients in Intensive Care Units
  • ICU (medical, surgical, burn, Neonatal
    ICU?Pediatric ICU)
  • Surgery department
  • Immunocompromised patients
  • Cancer treatment, transplant, HIV infections
  • Other factors
  • Age, smoking, chronic diseases

11
Distribution of hospital infections by infection
sites and endemic/outbreak status
Endemic
Outbreak
12
Why do we need an outbreak investigation database?
  • Literature search is considered essential for
    outbreak investigation
  • Difficulty in collecting relevant articles in
    hospitals with limited resources
  • Shortage of health care workers trained in
    epidemiology in Japan
  • Epidemiology of hospital infections is not taught
    in school

13
Conducting Medline search
  • Medline search yielded gt600 articles between 1970
    and 2000
  • Only a small number of outbreak investigations
    reported all the information necessary to
    replicate the investigation
  • Recent investigations tend to focus on DNA typing
    to identify epidemic strains

14
What kinds of outbreaks have been reported?
  • The largest number of people affected
  • Norwalk-like virus affected 635 employees (27
    attack rate), 79 people affected in a single day
  • Am J Epidemiol. 1988 Jun127(6)1261-71.
  • The longest duration
  • gt 10 years of unrecognized hospital transmission
    of legionnaires' disease among transplant
    patients (25 cases)
  • Infect-Control-Hosp-Epidemiol. 1998 Dec
    19(12) 898-904

15
Continued
  • Unusual source of outbreak
  • Klebsiella pneumoniae producing ESBL transmitted
    by gel used for ultrasonography
  • 2 adults and 1 neonates were infected 5
    colonized
  • J-Clin-Microbiol. 1998 May 36(5) 1357-60
  • Outbreak due to non-infectious origin
  • Hemolysis (discolored, pink serum visualized in
    spun serum sample) due to defect products (30
    cases in 11 days)
  • Kidney-Int. 2000 Apr 57(4) 1668-74

16
What kinds of fields do we need?
  • Hospital size
  • No. of patient affected
  • No. of deaths
  • Detail investigation process
  • Infection control and prevention strategies
  • Mode of transmission
  • Pathogens
  • Type of investigation
  • Place (NICU, ICU, surgery, etc.)
  • Country
  • Author

17
Usefulness of the Database I
  • A learning tool for epidemiologic and
    microbiologic investigations
  • Specific pathogens to look for in certain
    symptoms
  • Guide epidemiologic investigations
  • Identify study design in similar situations
  • Types of information to collect

18
Epidemiologic skills required in complex
investigations
  • Case definition
  • Able to learn how to write a case definition to
    find cases
  • Selection of controls in case-control studies
  • Selection of controls is the most difficult part

19
Usefulness of the Database II
  • Provide infection prevention strategies by
  • pathogens
  • type of service
  • infectious diseases
  • mode of transmission, etc.

20
Searching by Pathogens Acinetobacter
baumannii
21
Any impacts of the database on Japanese culture?
  • Very few Japanese professionals report outbreak
    investigations
  • Reporting outbreaks to professional journals as
    professional and social obligation
  • Providing information in sufficient detail to
    help investigations

22
Challenges
  • Currently 220 records have been entered
  • Changes in hospital practices affecting the
    outbreak investigation
  • Funding is necessary to complete and keep
    updating outbreak database

23
Changes in hospital practices
  • Factors related to patients
  • Shorter hospital stay
  • Increased patients acuity
  • Increases in intra- and inter-hospital transfer
  • Factors related to health care workers
  • High turnover of nurses
  • Floating shift
  • Employment of temporary staff

24
Your comments are greatly appreciate it
  • URL for the outbreak investigation database
  • http//health-db.net/infection/index.asp
About PowerShow.com