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Health care-associated infection epidemiology

This report explores the epidemiology of health care-associated infections (HCAIs), also known as nosocomial or hospital infections, including the determinants, prevalence, and impact on morbidity and mortality. It provides an overview of HCAI rates in high-income countries and highlights the most frequent types of infections and associated pathogens.

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Health care-associated infection epidemiology

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  1. Health care-associated infection epidemiology

  2. Health care-associated infection(also referred to as “nosocomial” or “hospital infection”) • Definition Health care-associated infection (HCAI) is an infection occurring in a patient during the process of care in a hospital or other health care facility, which was not present or incubating at the time of admission. • Most HCAIs become evident 48 hours or more following admission(typical incubation period) HCAIs can also appear after discharge.

  3. Frequently prevalent infections include : • central line-associated bloodstream infections • catheter-associated urinary tract infections • surgical site infections • ventilator-associated pneumonia

  4. Determinants • Risk factors determining nosocomial infections depends upon the: • environment in which care is delivered • the susceptibility and condition of the patient • and the lack of awareness of such prevailing infections among staff and health care providers.

  5. Environment Poor hygienic conditions and inadequate waste disposal from health care settings. • Susceptibility Immunosuppression in the patients, prolonged stay in intensive care unit, and prolonged use of antibiotics • Unawareness Improper use of injection techniques, poor knowledge of basic infection control measures, inappropriate use of invasive devices (catheters) and lack of control policies. In low income countries these risk factors are associated with poverty, lack of financial support, understaffed health care settings and inadequate supply of equipments

  6. Introduction • Health care-associated infections (HCAI) are one of the most common adverse events in care delivery and a major public health problem with an impact on morbidity, mortality and quality of life • These infections occur worldwide both in developed and developing countries. • With increasing in HCAIs, there is an increase in prolonged hospital stay, long term disability, increased antimicrobial resistance, increase in socio-economic disturbance, and increased mortality rate.

  7. Nosocomial infections epidemiology in the Worldwide

  8. WHO • Nosocomial infections accounts for 7% in developed and 10% in developing countries • According to WHO estimates, approximately 15% of all hospitalized patients suffer from these infections • death from HAI occurs in about 10% of affected patients

  9. Report on the Burden of Endemic Health Care-Associated Infection Worldwide -World Health Organization 2011 Data included in this report are the results of systematic reviews of the literature on endemic HCAI from 1995 to 2010 in high- and low/middle-income countries Nosocomial infections epidemiology based on:

  10. HCAIs in high-income countries

  11. Prevalence of health care-associated infection in high-income countries • In national and multicenter studies identified, the prevalenceof hospitalized patients who acquired at least one HCAI ranged from 3.5% to 12% . • HCAIpooled prevalence in mixed patient populations in high-income countries is7.6%.(95% CI 6.9-8.5) • More than 4 million patients affected by HCAI every year in Europe; 1.7 million affected patients in USA

  12. Prevalenceof health care-associated infection in high-incomecountries, 1995-2010

  13. HCAIs in high-risk adult patients in high-income countries • According to a recent European multicenter study, the proportion of infected patients in the ICU can be as high as 51%; most of these are health care-associated. • In high-income countries, approximately 30% of ICU patients are affected by at least one episode of HCAI with substantial associated morbidity and mortality. • Based on large studies from USA and Europe included in our review, HCAI incidence density ranged from 13.0 to 20.3 episodes per 1000 patient-days

  14. Incidence of overall health care-associated infection and device-associated infection in high-risk adult patients in high-income countries, 1995-2010

  15. Most frequent type of infections in high-income countries • In the USA and Europe, UTIwas the most frequent type of infection hospital-wide (36% and 27%, respectively). • In the USA, this was followedbySSI(20%), bloodstream infection (BSI), and pneumonia (both 11%). • In Europe, the second most frequent type was lower respiratory tract infection (24%), followed bySSI(17%), and BSI(10.5%).

  16. Use of invasive devices and HCAI in high-income countries • High frequency of infection is associated with the use of invasive devices, in particular central lines, urinary catheters, and ventilators. • In a report from the USA NNIS system, 83%of episodes of hospital-acquired pneumoniawere associated with mechanical ventilation, 97%of UTIsoccurred in catheterized patients, and 87%of primary BSIin patients with a central line.

  17. Most frequent pathogens causing HCAI in high-income countries • In this review E. coli (20.1%) and S. aureus (17.8%) were the most frequent single pathogens causing HCAI in mixed patient populations, thus reflecting the fact that UTI and SSI are the most common types of infection encountered. • Other key pathogens were: • Pseudomonas spp. (11.5%), • enterobacteriaceae (10.6%); • Candida spp. (6.7%); • enterococci (6.5%); • Acinetobacter spp. (5.8%); • and coagulase-negative staphylococci (5.3%).

  18. Burden of HCAIs in high-income countries • In studies mainly conducted in high-income countries, crude mortality rates associated with HCAI vary from 12% to 80%,depending on the patient population • In Europe, HCAIs cause 16 million extra-days of hospital stay and 37 000 attributable deaths (and contribute to an additional 110 000).Associated costs: approximately € 7 billion annually. • In the United States of America (USA), it was estimated that around 1.7 million patients are affected by HAI each year, representing a prevalence of 4.5% and accounting for 99 000 deaths. • According to the US Centers for Disease Control and Prevention, the overall , annual, direct medical costs of HAI to hospitals in the USA ranges from US$ 35.7 to US$ 45 billion

  19. HCAIs inlow- and middle-income countries

  20. Prevalence of health care-associated infection in low- and middle-income countries • Hospital-wideprevalenceof HCAI varied from 5.7% to 19.1%with apooled prevalence of 10.1per 100 patients(95% CI 8.4-12.2) • Of note, it was calculated that the pooled HCAI prevalence was significantly higher in high- than in low-quality studies (15.5% vs 8.5%, respectively). • SSI is the most frequent HCAI hospital-wide in low- and middle-income countries with a pooled incidence of 11.8 per 100 patients undergoing surgical procedures.

  21. Prevalence of health care-associated infection in low- and middle-income countries, 1995-2010

  22. HCAIs in high-risk adult patients in low- and middle-income countries • In low- and middle-income countries, incidence of ICU-acquired infection is at least 2–3 fold higher than in high-income countries • Theproportionof patients with ICU-acquired infection was as high as 35.2% (95% CI 24.2-48.0) (pooled cumulative incidence). The incidence of HCAI ranged from 4.4% up to 88.9%. • HCAI incidence density in settings with limited resources significantly varied between 4.1 and 91.7 episodes per 1000 patient-days , and pooled cumulative incidence was42.7 episodes per 1000 patient-days (95% CI 34.8-50.5) days). • Data reported in several studies from Argentina and Turkey indicated that infection density in ICU patients can be higher than 50 per 1000 patient-days.

  23. Most frequent type of infections in low- and middle-income countries • Themost frequent type of infection in these mixed patient populations was SSI(29.1%), followedbyUTI(23.9%), BSI(19.1%), HAP(14.8%), and otherinfections (13.1%) • SSIappears to be also the most frequent HCAI hospital-wide in low- and middle-income countries and more than 10% of operated patients usually develop SSI. • Reported SSI cumulative incidence ranged from 0.4 to 30.9 per 100 patients undergoing surgical procedures and from 1.2 to 23.6 per 100 surgical procedures.

  24. Use of invasive devices and HCAI in low- and middle-income countries • In studies in neonatal and pediatric ICUs retrieved through this review and as reported also by Zaidi and colleagues, VAP and CR-BSI densities were particularly high, ranging from 10.9 to 143 episodes per 1000 ventilator-days and from 2.1 to 60.0 episodes per 1000 catheter-days, respectively. • Pooled cumulative incidence densities of CR-BSI, CR-UTI, and VAP among adult ICU patients in low- and middle-income countries were 12.2 per 1000 CL-days (95% CI 10.5-13.9),8.8 per 1000 urinary catheter-days (95% CI 7.3-10.4) and 23.9 per 1000 ventilatordays (95% CI 20.7-27.1) • device-associated infection densities up to 13 times higher than in the USA were reported in some studies

  25. Most frequent pathogens causing HCAI in in low- and middle-income countries • Gram-negativerods as the most common nosocomial isolates, both in mixed patient populations and in high-risk patients. • The most frequent single pathogens were S. aureus in mixed patient populations, and Acinetobacter spp. in high-risk patients. • S. aureus was the most frequent cause of both SSI and BSI • Surprisingly, gram-negative rods were isolated in a large proportion of SSIs.

  26. Burden of HCAIs in low- and middle-income countries • Among hospital-born babies, these infections are responsible for 4% to 56% of all causes of death in theneonatal period, with three quarters occurring in the South-East Asia Region and sub-Saharan Africa. • Increasedlength of stay associated with HCAI in developing countries: 5-29.5 days. • Economic impact of HCAI in Belo Horizonte, Brazil, in 1992: US$ 18 million. • In Mexican ICUs, overall average cost of a HCAI episode: US$ 12 155. • In ICUs in Argentina, overall extra-costs for CR-BSI and HAP: US$ 4 888 and US$ 2 255 per case, respectively

  27. وضعیت عفونت بیمارستانی در ایران

  28. در مورد وضعیت عفونت های بیمارستانی در کشور بررسی ها و مطالعات پراکنده ای در مراکز دانشگاهی و بیمارستان ها انجام شده است که به تعدادی از آنها اشاره می شود.

  29. در یک مطالعه در کرمان از 4617 مورد بررسی شده 376 کشت مثبت در بیماران مبتلا به عفونت بیمارستانی پیدا شد که میزان کشت مثبت 8.14% بود و 44 % آنها مربوط به کودکان بود. استافیلوکوک، اشرشیاکولی و پسودوموناس به ترتیب شایع ترین جرم ها بودند. • یک مطالعه توصیفی - تحلیلی ، آینده نگر و مقطعی در نیمه دوم سال 1381 به مدت 6 ماه بر روی تمام بیماران بستری شده زیر 15 سال در بیمارستان حضرت رسول اکرم (ص) در تهران با روش استانداردNNIS انجام گرفت میزان کلی عفونت بیمارستانی در این گروه 8.5% برآورد شد. • یک مطالعه در تهران به منظور بررسی میزان موارد عفونت های بیمارستانی در بخش های مراقبت ویژه کودکان و نوزادان مرکز طبی کودکان در سال 1381 انجام شد. میزان عفونت در بخشNICU این مرکز 12.2 % ودربخش PICU، 11.9 % برآورد گردید. • در یک مطالعه در مشهد در بیماران بیمارستان امام رضا (ع) که به صورت بررسی شیوع لحظه ای انجام شده میزان عفونت بیمارستانی 12.5 % در زمان بررسی برآورد شد. • مرور سایر مطالعات انجام شده در بیمارستان های کشور نشان می دهد میزان عفونت های بیمارستانی در ایران در حدود 15-10 درصد برآورد می شود

  30. گزارش وضعیت عفونت بیمارستانی در کشور بر اساس آمار و اطلاعات ثبت شده در سامانه کشوری

  31. روند بروز عفونت بیمارستانی در کشور 1396-1386

  32. سال 1396 • بروز عفونت بیمارستانی بر اساس تعداد بستری : 1.28% • بروز بر اساس بیمار - روز : 5.74 به ازاء 1000 بیمار- روز

  33. روند مرگ گزارش شده در مبتلایان به عفونت بیمارستانی1395-1386

  34. درصد عفونت های بیمارستانی به تفکیک نوع در سال 1395

  35. درصد عفونت های بیمارستانی به تفکیک نوع در گروههای سنی مختلف - سال 1395

  36. درصد عفونت های بیمارستانی به تفکیک نوع در سال 1396

  37. درصد عفونت های بیمارستانی Device Associated به تفکیک نوع- سال 1396

  38. درصد عفونت های بیمارستانی براساس تعداد بستری به تفکیک بخش-سال 1396 • بیشترین گزارش بروز مربوط به بیماران بستری در بخشهای ذیل بوده است • ICU داخلی: در 17.09% موارد بستری • پیوند: در 12.69% موارد بستری • ICU جنرال: در 11.19% موارد بستری • سوختگی: در 9.98% موارد بستری • کمترین گزارش بروز مربوط به بیماران بستری در بخشهای ذیل بوده است • چشم: در 0.19 % موارد بستری • ENT: در 0.25 % موارد بستری • قلب: در 0.45 % موارد بستری

  39. شایع ترین عوامل میکروبی گزارش شده در عفونتهای بیمارستانی سال 1396 • شایع ترین عوامل میکروبی در مجموع عفونتهای گزارش شده: • E.COLI13.98 % • آسینتوباکتر 9.78% • کلبسیلا 6.26%

  40. شایع ترین عوامل میکروبی گزارش شده به تفکیک نوع عفونت بیمارستانی-سال 1396

  41. مقاومت میکروبی گزارش شده در موارد عفونت بیمارستانی سال 1396

  42. از توجه شما سپاسگزارم

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