Titel: Full recording of nosocomial postoperative infections during a pre-intervention phase of a planned intervention study in a German Level A Traumacenter over a period of seven months
ID: 101/PRV
Art: Abstractautor
Session: Workshop 18
Out-Patient, in-Patient, no Patient: Bacteria, Infections and Intervention Strategies (FG PR, StAG HY)

Referent: Meike Strybos (Köln)

Abstract - Text

As part of the BMG-funded project "HygArzt" (ZMVI1-2516FSB111) nosocomial infection rates are to be minimized in the long term prevention through an evidence based intervention bundle by an infection control practicioner. To assess the initial situation, a surveillance system consisting of 97 outcome parameters which included all nosocomial infections was developed and introduced in three orthopedic/trauma surgery normal wards.

In the pre-intervention phase, 1503 patients who had undergone orthopedic/trauma surgery (1972 surgeries - partly consisting of several surgeries on the same patient) and were admitted to hospital were included. To identify and record nosocomial infections, clinical signs of infection according to KISS and CDC definitions were recorded in a checklist. For this, data from pre-existing conditions as well as current and previous infections found out from the hospital administration system, admission forms, discharge letters and nursing documentation, were aggregated with current patient data as well as with laboratory findings. In addition, three times a week the morning visit was attended to record not documented signs of infection.

A total of 52 nosocomial infections according to CDC definitions (infection rate by 2.6%, CI 95% 1.92%; 3.28%) 85 brought infections in 1972 surgeries were documented. Among the most common procedures were 233 lower leg procedures including metal removal, VAC changes and wound revisions, 167 knee arthroscopy, 115 cruciate ligament replacements. The nosocomial postoperative wound infections formed the majority with 39 cases (2.0% crude infection rate, CI 95% 1.40%; 2.60%). The number of surgeries in patients with postoperative wound infections was considered only up to the time the infection occurred. The pathogens found were predominantly S.aureus (MSSA) with 20 infections, followed by coagulase-negative Cocci mainly with S.epidermides (11 infections) and Enterobacteriaceae with P. aeroginosa, E. cloacae complex and C.koseri (8 infections). In addition to the wound infections, 4 catheter-associated urinary tract infections, 3 pneumonia, 3 C. difficile infections, 1 bronchitis and 1 thrombophlebitis could be detected nosocomially. So far, no infection rates have been calculated for these, as data on patient days are not yet available. Currently, a follow up of 30 days can take place in wound infections.

In the pre-intervention phase of the HygArzt study an overall nosocomial infection rate of 2,6% was determined. As main infection prevention target postoperative wound infections were identified, which should mainly be addressed by planned infection prevention measures bundle during the upcoming intervention period.