Epidemiological approach to nosocomial infection surveillance data: the Japanese Nosocomial Infection Surveillance System

Surveillance of nosocomial infection is the foundation of infection control. Nosocomial infection surveillance data ought to be summarized, reported, and fed back to health care personnel for corrective action. Using the Japanese Nosocomial Infection Surveillance (JANIS) data, we determined the incidence of nosocomial infections in intensive care units (ICUs) of Japanese hospitals and assessed the impact of nosocomial infections on mortality and length of stay. We also elucidated individual and environmental factors associated with nosocomial infections, examined the benchmarking of infection rates and developed a practical tool for comparing infection rates with case-mix adjustment. The studies carried out to date using the JANIS data have provided valuable information on the epidemiology of nosocomial infections in Japanese ICUs, and this information will contribute to the development of evidence-based infection control programs for Japanese ICUs. We conclude that current surveillance systems provide an inadequate feedback of nosocomial infection surveillance data and, based on our results, suggest a methodology for assessing nosocomial infection surveillance data that will allow infection control professionals to maintain their surveillance systems in good working order. This article is based upon the research that was given encouragement award at the 77th annual meeting of the Japanese Society for Hygiene held in Osaka, Japan on 25–28 March 2007.     

TOPSIS法与密切值法对湖南省某医院医院感染监测的综合评价

目的采用TOPSIS法与密切值法对湖南省某医院2006-2010年医院感染监测管理质量进行综合评价,探索医院感染监测管理的适宜综合评价方法。方法资料来源于2006-2010年湖南省某医院的医院感染监测管理数据。以年度为评价对象,评价指标包括医院感染率、漏报率、环境卫生监测情况指标合格率等9个指标,应用TOPSIS法和密切值法对医院感染监测管理质量进行综合评价。结果 2006-2010年医院感染率和漏报率的平均增长速度分别为-12.4%和-11.6%;医院环境卫生监测合格率逐年增加。TOPSIS法、密切值法评价分析结果显示,在该院2006-2010年度医院感染监测情况中,监测管理质量最好年份为2009年,最差的年份为2006年;TOPSIS法与密切值法的排序结果分析完全一致。结论该医院2006-2010年医院感染感染率和漏报率均低于国家规定的控制标准。医院监测管理质量最好年份为2009年,TOPSIS法、密切值法均可作为评价医院感染监测管理质量的常规方法。     

医院感染病例监测网络信息系统的研发与应用

目的 采用计算机网络系统直接收集、统计及反馈医院感染病例监测（HIS）资料，提高报告的及时性和准确性，实现医院感染实时监控。方法 利用大型数据库SQL server 2000和先进的面向对象的软件开发工具Delphi7．0，开发一套功能强大的医院感染病例监测系统，并将该系统嵌入院内的HIS中。结果 该系统可在医院范围内将医院感染管理科及各临床科室的终端通过HIS连接在一起，实现了全院范围内的医院感染病例网络报告、实时监控及监测数据共享。结论 该系统提高了医院感染病例资料上报、统计及反馈的及时性和准确性，减轻了临床医生的工作负担，提高了医院感染管理专职人员的工作效率和工作质量，具备一定的推广应用价值。     

综合重症监护病房患者医院感染目标性监测分析

目的探讨目标性监测在重症监护病房(ICU)的实施效果,为制定医院感染预防控制措施提供科学依据。方法对2008年1月-2009年12月入住ICU的患者进行目标性监测,用患者平均病情严重程度(ASIS)调整法调整医院感染发病率,重点对3种导管留置患者的医院感染发生率进行研究分析。结果共监测1050例次,发生医院感染279例次(26.57%);与同期平均医院例次感染率(3.02%)相比,差异有统计学意义(P0.01);日医院例次感染率为34.36‰,经ASIS法调整后日医院例次感染率(8.42‰);2008、2009年日医院例次感染率分别为46.48‰、26.62‰,2009年较2008年下降19.86‰;动静脉插管、使用呼吸机、导尿管留置相关性导管例次感染率分别为(15.36‰、9.58‰)(、45.62‰、24.39‰)、(10.80‰、8.71‰),分别下降5.79‰、21.23‰、2.12‰;医院感染以呼吸机相关性下呼吸道感染为主。结论 ICU患者是医院感染的高危人群,医院感染以3种导管留置患者为主,目标性监测可针对侵入性诊疗操作患者实施全程管理,重点干预诊疗操作中的医疗行为;是减少医院感染的科学监测方法。     

Erläuterungen zu den Empfehlungen der Kommission für Krankenhaushygiene und Infektionsprävention zur Surveillance von postoperativen Wundinfektionen in Einrichtungen für das ambulante Operieren

Since the beginning of 2001, the German Protection Infection Act requires the ongoing surveillance of nosocomial infections in at least one hospital department with a high risk oft these infections, such as intensive care units or surgical departments. In addition, it also requires the surveillance of surgical site infections in surgical outpatient settings. However, surveillance consists not only in registering cases of nosocomial infection and calculating infection rates, it also means interpreting infection data carefully in order to be able to draw appropriate conclusions for reducing surgical site infections in the future. A comparison with already available reference data is necessary, although comparison with data from hospitals may turn out to be misleading due to the different types of operations, patient mixture, surgical conditions and the subsequent follow-up conditions. As the NNIS risk index is of no practical use in outpatient settings, calculation of the crude SSI rates is recommended, comparing them with hospital surveillance data of patients in risk group 0 of KISS (Krankenhaus-Infektions-Surveillance-System), at least for those operations which are performed not only in hospitals but also in an outpatient situation. In the long run, the establishment of a surveillance system for surgical site infections in outpatient settings will be necessary in order to generate reference data for outpatient surgery patients. This article describes the background of the recommendations of the commission for hospital hygiene at the Robert Koch-Institut for the surveillance of surgical site infections in an outpatient setting.     

基层医院医院感染病例的监测与分析

目的 医院感染的监测、控制和管理是医院管理的重要内容,是医疗质量好坏的重要保障,为了解住院患者医院感染状况,开展前瞻性医院感染监测提供本底数据,更好地提高医院感染的监测、控制和管理水平,对医院感染病例进行回顾性监测.方法 从2005年1月-2009年12月,出院病历62186份,发生1651例医院感染,感染率为2.66％.结果 回顾性监测感染病例表明,我们医院的医院感染率在正常范围,其中重症监护室的病例占感染高发科室的10.86％,下呼吸道感染病例占高发部位的32.4％.结论 回顾性监测是基础,可掌握全院感染的情况,了解医院感染率、科室和部位,针对相关因素,采取相应的措施,控制医院感染的发生.     

Impact of an infection control program on the prevalence of nosocomial infections at a tertiary care center in Switzerland .

OBJECTIVE: To study the impact of a multimodal infection control program on the rate of nosocomial infections at a 550-bed tertiary care center. METHODS: Before and after the implementation of an infection control program, the rate of nosocomial infection was recorded in time-interval prevalence studies. Hand hygiene compliance was studied before and after the intervention. As a surrogate marker of compliance, the amount of alcohol-based hand rub consumed before the intervention was compared with the amount consumed after the intervention. The intervention included additional staff for infection control, repeated instructions for hand hygiene, new guidelines for preoperative antibiotic prophylaxis, and isolation of patients infected or colonized with multidrug-resistant bacteria. RESULTS: The rate of nosocomial infection decreased from approximately 11.7% to 6.8% in 2 years. The rate of hand hygiene compliance increased by 20.0%; it was 59.0% before the intervention and increased to 79.0% afterward. These results correlate with data on the consumption of alcohol-based hand rub, but not with data on the use of antibiotics. CONCLUSION: Within 2 years, a multimodal infection control program intervention such as this one may reduce the rate of nosocomial infection at a tertiary care center by more than one-third and improve both the quality of care and patient outcomes. It may also generate considerable savings. Therefore, such programs should be promoted not only by hospital epidemiologists but also by hospital administrators.     

Active surveillance of nosocomial infections in heart surgery patients: implementation of the American National Nosocomial Infections Surveillance (NNIS) System in a large hospital in Rome

The authors present the implementation of the American NNIS System method for active surveillance in the heart surgery and its intensive care unit (ICU) of a large hospital in Rome (almost 1.000 beds). This surveillance was based on full time infection control professionals. Device-associated infection rates were calculated for adult ICU surveillance component. For surgical patient surveillance component we used the surgical site infection (SSI) risk index based on wound class, duration of operation and American Society of Anesthesiology score. The NNIS System method allowed us to understand the most relevant problems in heart surgery patients: in comparison with NNIS data, we found high rates of SSIs both in procedures on valves and in coronary artery bypass grafts. The central line-associated bloodstream infection rate was higher than the American median rate. Therefore, we decided to focus on surgical risk factors linked to SSIs and to revise recommendations for intravascular-device use. In conclusion, in our experience the NNIS System method proved to be a very useful and versatile tool for nosocomial infections active surveillance.     

重症监护病房医院感染目标性监测分析与控制对策

目的 了解重症监护病房(ICU)医院感染发病特点,针对性地采取控制措施.方法 采用目标性监测方法,对某院2009年1-12月5个ICU患者医院感染发病情况进行监测,并用患者平均病情严重程度调整感染发病率,同时对3种侵入性操作相关感染进行分析,提出具体的预防控制措施.结果 呼吸机,导尿管和血导管相关性感染发病率最高者分别为综合科ICU 7.5%、神经外科ICU 4.8%、内科3.8%、急诊科ICU 3.5%.结论 根据各ICU医院感染发生的特点针对性地进行干预以降低感染率.     

Data linkage between existing healthcare databases to support hospital epidemiology

Enhancing the use of existing datasets within acute hospitals will greatly facilitate hospital epidemiology, surveillance, the monitoring of a variety of processes, outcomes and risk factors, and the provision of alert systems. Multiple overlapping data systems exist within National Health Service (NHS) hospitals in the UK, and many duplicate data recordings take place because of the lack of linkage and interfaces. This results in hospital-collected data not being used efficiently. The objective was to create an inventory of all existing systems, including administrative, management, human resources, microbiology, patient care and other platforms, to describe the data architecture that could contribute valuable information for a hospital epidemiology unit. These datasets were investigated as to how they could be used to generate surveillance data, key performance indicators and risk information that could be shared at board, clinical programme group, specialty and ward level. An example of an output of this integrated data platform and its application in influenza resilience planning and responsiveness is described. The development of metrics for staff absence and staffing levels may also be used as key indicators for risk-monitoring for infection prevention. This work demonstrates the value of such a data inventory and linkage and the importance of more sophisticated uses of existing NHS data, and innovative collaborative approaches to support clinical care, quality improvement, surveillance, emergency planning and research.     

Quality management for preventing healthcare-acquired infections. The importance of surveillance

Healthcare acquired (nosocomial) infections are one of the most frequent complications of medical care. The management to prevent such nosocomial infections is a typical example of the use of the general principles of quality management in healthcare institutions: each institution should compare their own nosocomial infection rates for defined patient risk groups with reference data and identify problems concerning specific infection types or units/departments. This comparison should stimulate a careful analysis of the process of care and the options to improve the situation. Structured interventions, such as the introduction of bundles of infection control measures or checklists, are very helpful to increase compliance with infection control measures and to decrease nosocomial infection rates. However, often only interventions individually designed according to the specific needs in a particular unit/department are successful to improve infection rates. Therefore, the employment of experienced infection control personnel and surveillance strategies designed according to the specific needs of the institution are key elements of a good infection control management within healthcare institutions.     

Computerized system analyzes epidemiological data.

The computer is a valuable tool in helping to analyze epidemiological data that are collected through the infection surveillance system. The computerized system described has many significant advantages over the manual system of infection surveillance: quick assimilation, computation, and dissemination of the nosocomial infection summary report (within seven working days of the month's end); identification of infection problems and problem areas; and ability to retrieve data necessary for a complete establishment of a hypothesis regarding cause and effect implicated by an epidemiological investigation. Above all, timely and accurate infection data must be obtained in order for the reports to be beneficial in the decision-making process used by the infection control committee. Manual systems of month-to-month correlation of infection data are difficult and extremely time consuming for the surveillance person. Often the infection control committee cannot act intelligently and quickly because it is not knowledgeable of current trends occurring within the hospital. The computer has a number of limitations, and any computerized surveillance system should be approached with caution, especially during the developmental stages. The computer uses input data, follows instructions, and thus formulates output. If the computer is given either inadequate input data or inaccurately programmed instructions, the output will be erroneous. Therefore, a close working relationship should be established between the epidemiologist and the hospital's data processing department. The goals of the system must be clearly defined and understood by both areas. Once the system is established, the output is only as good as the data supplied by the epidemiologist. If this system is properly utilized, valuable information can be obtained that would have been difficult to obtain using a manual surveillance method.     

血液净化室医院感染的监测与规范化管理

目的 加强血液净化室医院感染的监测与管理,预防与控制医院感染的发生.方法 建立健全血液净化室医院感染管理规章制度与操作规范,强化医院感染预防控制意识,每月定期对血液净化室空气、物体表面、医务人员手、使用中的消毒剂、消毒物品、透析用水、透析液细菌总数及内毒素等指标进行监测分析.结果 5年共检测标本1799份,总合格率为95.4％;其中物体表面、使用中的消毒液、消毒物品、透析用水细菌、内毒素合格率均为100.0％,空气合格率为97.2％、医务人员手为93.8％、透析液细菌为94.2％、内毒素监测为94.5％,通过规范化管理,医院感染率始终控制在较低水平.结论 血液净化室定期进行监测,是预防和控制医院感染的重要措施之一,医院感染控制必须通过有效措施,以科学监测为依据,以感染管理为手段.     

应用办公自动化系统提高医院感染管理质量

应用办公自动化（OA）系统,可在OA公告栏发布感控信息,设置医院感染督查结果反馈流程,设置消毒剂准入审批流程,设置院感处专属文件柜上传感控资料以及医院感染管理法规及知识在线考试。借助OA系统可使院感督查结果反馈流程在15天内完成,医院感染漏报率也从8.5%降低至2.58%,提高了医院感染管理工作效率和质量。     

Surveillance of nosocomial infections in a neurologic intensive care unit.

OBJECTIVE: To assess data on the epidemiology of nosocomial infection (NI) among neurologic intensive care patients. DESIGN: Prospective periodic surveillance study. SETTING: An 8-bed neurologic intensive care unit (ICU). PATIENTS: All those admitted for more than 24 hours during five 3-month periods between January 1999 and March 2003. METHODS: Standardized surveillance within the German infection surveillance system. RESULTS: Three hundred thirty-eight patients with a total of 2,867 patient-days and a mean length of stay of 8.5 days were enrolled during the 15-month study period. A total of 71 NIs were identified among 52 patients. Urinary tract infections (UTIs) were the most frequent NI (36.6%), followed by pneumonia (29.6%) and bloodstream infections (BSIs) (15.5%). The overall incidence and incidence density of NIs were 21.0 per 100 patients and 24.8 per 1,000 patient-days, respectively. Incidence densities were 9.8 UTIs per 1,000 urinary catheter-days (CI95, 6.4-14.4), 5.6 BSIs per 1,000 central venous catheter-days (CI9s, 2.8-10.0), and 12.8 cases of pneumonia per 1,000 ventilation-days (Cl95, 8.0-19.7). Device-associated UTI and pneumonia rates were in the upper range of national and international reference data for medical ICUs, despite the intensive infection control and prevention program in operation in the hospital. CONCLUSION: Neurologic intensive care patients have relatively high rates of device-associated nosocomial pneumonia and UTI. For a valid comparison of surveillance data and implementation of targeted prevention strategies, we would strongly recommend provision of national benchmarks for the neurologic ICU setting.     

医院感染及其存在的问题

本文综述了医院感染的研究概况，包括NI的定义、NI监控进展、方法学研究和存在的问题等。     

鼠伤寒沙门菌生物学分型方法在流行病学调查和监测中的应用

为探索用简便有效的手段对鼠伤寒沙门菌感染进行调查监测，采用英国学者Ｄｕｇｕｉｄ的鼠伤寒沙门菌生物学分型方法，应用于医院天津监测、病例追踪、食物中毒调查。结果：从医院感染患儿分离菌株的主要生物型与医院环境污染、医务人员携带菌株的生物型分布相似；截瘫患者尿中菌株与从其家庭环境和妻子手上分离菌株生物型别一致；从食物中毒者和乘彩中分离菌株的生物型别与鸭子携带菌株主要生物型别一致。结论：患儿医院感染是由于病     

导管室医院感染的监测与管理

目的预防和控制导管室医院感染,降低术后感染率,提高导管室的医疗管理质量。方法每月定期对导管室空气、物体表面、医护人员手、使用中消毒液进行细菌学监测。结果3年共监测标本253份,总合格率为99.6%;空气合格率98.6%,物体表面合格率100.0%,医护人员手合格率100.0%,使用中消毒液合格率100.0%。结论对导管室定期进行监测,是预防和控制医院感染的重要措施之一。     

Nosocomial surveillance--compass for infection control

The authors, after defining basic concepts, make the case that nosocomial surveillance is an indispensable tool without which up-to-date infection control is impossible. They provide an overview of the nosocomial surveillance practices in many countries in Europe and overseas, comparing their methods, results and protocols, keeping in mind cost effectiveness and quality assurance considerations. The authors' view is that in Hungary two kinds of nosocomial surveillance programs should be established: 1. There should be reliable surveys to follow up the incidence of nosocomial infections. Without such data any national infection control strategy is at best uncertain. Obtaining this information is mostly in the interest of the government. Procedures should be coordinated from a central office, financial backing for the surveys should be provided, and the personal and institutional infrastructure should be built up in a consensual manner, with much care and technical expertise, relying on domestic and foreign experience. 2. Each institution should decide, based on their current goals, which selective nosocomial surveillance method is most appropriate for a given occasion. This decision should be voluntary and government regulation of these activities would be counterproductive.