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Tomasz Ozorowski, M.D . University of Medical Sciences, Poznan , Poland

Networks of hospitals: building a common strategy for HAI prevention and control and antimicrobial policy. Tomasz Ozorowski, M.D . University of Medical Sciences, Poznan , Poland National Programme Of Antibiotic Protection.

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Tomasz Ozorowski, M.D . University of Medical Sciences, Poznan , Poland

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  1. Networks of hospitals: building a common strategy for HAI prevention and control and antimicrobial policy Tomasz Ozorowski, M.D. University of Medical Sciences, Poznan, Poland National Programme Of AntibioticProtection

  2. National Programme Of AntibioticProtectionfor morerationalantibioticusagein Polandsupported by Ministry of Health Medicine Veterinary Agriculture PrimaryCare Secondarycare Guidelines for ABS ICU branch pilot hospitals • Network of hospitals • Implementing ABS • Collecting data • Exchangingexperience

  3. National Programme of Antibiotic ProtectionPilot hospitals Initial requirements: Acute hospital > 400 beds with ICU Support from hospital administration Antimicrobial team Ability to conduct PPS • 31 acute hospitals • Mean number of beds = 573 • Mean numbres of beds in ICU = 8 • Mean time of hospital stay = 5.3 days • Mean time of ICU stay = 10 days

  4. Pilot hospitals: 3-stage cooperation • 1. Collection of entrance data (2008-10) • retrospectivelly: antibiotic consumption, bloodstream infection • prospectivelly: PPS study • 2. Implementation of ABS programme • cooperationwithantimicrobial team • workshops for administration and physicansatthehospital and • department level 3. Observe and analyze the results Practical conclusions Less scientific Examples for other hospitals Probably not possible to Correction of the programme find relation with mortality rate and change in resistance

  5. Pilot hospitalsantibioticconsumption, one-year period,ATC class J01, DDD/100 BD HOSPITAL ICU The results were compared with ARPAC and CARE-ICU European studies: (1) MacKenie F., Monnet D., Gould I.: Relationship between the number of different antibiotics used and the total use of antibiotics in european hospitals, J Antimicrob Chemother 2006;58:657-60. (2) Hanberger H., Arman D., Gill H., et al.: Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control, Intensive Care Med 2009; 35:91-100 (35 ICU)

  6. Top 10 ten antibioticsinPolishhospitalsnumber of DDD (>1 mln)

  7. Top 10 antibioticsinPolish ICUnumber of DDD

  8. Pilot hospitals – incidence of HA bloodstreaminfectiondiagnosedinhospitals/1000 admissionsone-year period, 525266 pts, 906 infections • The results were compared with the following studies: • Finland :4 hospitals Lyytikäinen Clin Infect Dis 2002; 35:e14-19 • Estonia: 3 hospitals , Mitt: J Hosp Infect 2009;71:365-70 • Belgium : 117 hospitals, RonveauxEur J Clin Microbiol Infect Dis 1998;17:695-700. • USA: 49 hospitals, WisplinghhoffClin Infect Dis 2004;39:309-17.

  9. Pilot hospitals: etiology of HA bloodstream infection

  10. Incidence and etiology of HA bloodstream infection acquired in ICU 27 ICU, 4641 pts, 39125BD , 294 infection 16% HELICS=2,3% (1) ECDC: Annual epidemiological report on communicable diseases in Europe, 2010.

  11. Point Prevalence Survey Results of pilot study in 31 Polish hospitals

  12. PPS –data collection • Risk factor for HAI • HAI • Community acquired infections • Antibiotic use as surgical prophylaxis • Antibiotic use for other reason than infection and surgical prophylaxis Exclusion: day centre, and day-case patients, no psychiatric departments 1 day = one unit Two education sessions about conducting PPS for hospital teams

  13. PPS – main results, 9288 patients

  14. PPS results536 HAI in 9288 patients (5.8%) • Etiology identified in 60% of HAI : 1. E.coli, 2 A.baumanii, 3. S.aureus (33% MRSA), no VRE , no CRE , only 2 cases of C.difficile

  15. PPS results prevalence of risk factors for HAIprevalence of the use of central venous catheter Theresultswerecomparedwiththefollowingstudies: Slovenia: 19 acute care hospitals,6695 pts; Klavs J Hosp Infect 2003;54:149-57 Greece : 14 hospitals academic /regional, 3925 pts; Gikas J Hosp Infect 2002;50:269-75 Italy: 21 acute care hospitals ; Pellizerr Infection 2008;36:112-9 USA: 6 academic centers,2459 pts; ClimoICHE 2003;24:942-5

  16. PPS results prevalence of risk factors for HAI% of ICU patients- day of the study The results were compared with the following studies: UK: 4 country study; Smyth J Hosp Infect 2008;69:230-48 Slovenia: 19 acute care hospitals,6695 pts, Klavs J Hosp Infect 2003;54:149-57 Nosocomial infections in Belgium part I: national prevalence study. KCE reports 92C. ,2008 Greece : 14 hospitals academic/regional, 3925 pts, Gikas J Hosp Infect 2002;50:269-75 Italy: 21 acute care hospitals Pellizerr Infection 2008;36:112-9

  17. PPS-resultsantibiotic prescribed: no infection and surgical prophylaxis: 7,7% pts PPS as a useful tool for antibiotic overuse identification → analysis and proposes→ feedback to physicians

  18. Pilot hospital: main conclusion from the results • Antibiotic consumption similar to other countries but high domination of iv amoxicllin with clavulanate, even in ICU • Acinetobacterbaumanii: very frequent Gram negative as a cause of HAI, probably as a result of loworganizationlevel and insufficienteducation of cleaning services • Significantly higher incidence of bloodstream infection in polishICU than in HELICS study • Prevalence of HAI (5.8%) approximates the average from 7 main European studies (6.8%) but significantly lower prevalence of the main risk factor for HAI, probably as a result of different organization of healthcare system

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