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Clin Microbiol Infect. 2019 Apr;25(4):462-468. doi: 10.1016/j.cmi.2018.07.010. Epub 2018 Jul 21.

Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: a prospective interventional study.

Author information

1
Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany. Electronic address: stefan.hagel@med.uni-jena.de.
2
Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Anaesthesiology and Intensive Care Therapy, Jena University Hospital, Jena, Germany.
3
Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany.
4
Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine IV (Gastroenterology, Hepatology, and Infectious Diseases), Jena University Hospital, Jena, Germany.
5
Institute for Infectious Diseases and Infection Control, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, Jena University Hospital, Jena, Germany.
6
Institute for Medical Biometry and Statistics, Faculty of Medicine and Medical Centre-University of Freiburg, Freiburg, Germany; Freiburg Centre of Data Analysis and Modelling, University of Freiburg, Freiburg, Germany.
7
Institute of Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité Universitätsmedizin Berlin, Berlin, Germany.
8
Infection Control Programme, Geneva University Hospitals and Medical School and WHO Collaborating Centre, Geneva, Switzerland.
9
Centre for Clinical Studies Jena, Jena University Hospital, Jena, Germany.
10
Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.
11
Research Group Clinical Epidemiology, Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany; Institute of Medical Statistics, Computer and Data Sciences, Jena University Hospital, Jena, Germany; Centre for Sepsis Control and Care, Jena University Hospital, Jena, Germany.

Abstract

OBJECTIVES:

To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs).

METHODS:

Prospective, quasi-experimental study with two surveillance periods (September 2011 to August 2012; May 2013 to August 2014). Starting October 2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI).

RESULTS:

Overall, 62 154 patients were under surveillance, with 1568 HAIs identified in 1170 patients (4.3 per 100 admissions) in the first and 2336 HAIs identified in 1711 patients (4.9 per 100 admissions) in the second surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI 0.78-2.15) and intensive care units (ICUs) (aIRR 0.59, 95% CI 0.27-1.31). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98, 95% CI 0.97-1.00 per 1-week increment), in contrast to general wards (aIRR 1.01, 95% CI 1.00-1.02). A reduction in severe HAIs (aIRR 0.13, 95% CI 0.05-0.32) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56, 95% CI 0.31-0.99) were observed in the second period in the ICUs.

CONCLUSIONS:

There was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear.

KEYWORDS:

Healthcare-associated infections; Hospital-wide prevention; Incidence; Infection control programme; Sepsis

PMID:
30036671
DOI:
10.1016/j.cmi.2018.07.010
[Indexed for MEDLINE]
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