PatientInnensicherheit und nosokomiale Infektionen Oskar Janata Hygieneteam des DSP Wien Seite 1
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Monatliche Sterblichkeitsrate an der Geburtenstation von Ignaz Semmelweis 1841 bis 1849. Seite 3
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Postulate der Aufenthalt im Spital ist (potentiell) gefährlich...... Nosokomiale Infektionen Epidemiologie - sind häufig & in allen Bereichen Patient - verursachen Morbidität, Mortalität Mikrobiologie - verursachen Resistenzdruck Spitalträger - verursachen LOS & Kosten wir wissen (theoretisch) was man dagegen tun kann Seite 6
Nosokomiale Infekte kommen überall vor betreffen jedes Organ haben Konsequenzen
Nosocomial Bloodstream Infection in Critically III Patients Excess Length of Stay, Extra Costs, and Attributable Mortality Didier Pittet, MD, JAMA. 1994 Parameter Gesamt Sterblichkeit Infekt bedingt Sterblichkeit Patient mit Bakteriämie Patient ohne Bakteriämie Signifikanz 50 % 15 % p <.01 35 % LOS an SICU 15 Tage 7 Tage p <.01 LOS im Spital 40 Tage 26 Tage p <.01 LOS im Spital Überlebende Extrakosten pro Überlebenden 54 Tage 30 Tage p <.01 40.000 $ Seite 9
Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention William R. Jarvis in Infection Control and Hospital Epidemiology 1996 Seite 10
Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention William R. Jarvis in Infection Control and Hospital Epidemiology 1996 Seite 11
es ist zu schön um wahr zu sein...
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Selected Aspects of the Socioeconomic Impact of Nosocomial Infections: Morbidity, Mortality, Cost, and Prevention William R. Jarvis in Infection Control and Hospital Epidemiology 1996 Seite 14
wer NICHTS weiß muss ALLES glauben Seite 15
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Absence of Excess Mortality in Critically Ill Patients With Nosocomial Escherichia coli Bacteremia Stijn Blot et al in Infection Control and Hospital Epidemiology 2003 Seite 17
Hospital mortality and rates of inadequate Ibrahim, E. H. et al. Chest 2000;118:146-155
2003 CMI, 9, 412 418 to our knowledge, this is the first study to find no differences in mortality rates between critically ill patients with a bloodstream infection who received inappropriate PatientInnensicherheit empirical und nosokomiale antimicrobial Infektionen treatment and those who were given appropriate treatment Seite 20
Stirbt man AN oder MIT der Infektion? Seite 21
Incidence of bacteremia at the time of ICU admission and its impact on outcome Prashant Nasa in Indian Journal of Anaesthesia, 2011 Seite 22
Mortality Attributable to Nosocomial Infection: A Cohort of Patients With and Without Nosocomial Infection Author(s): P.F. Peray in Infection Control and Hospital Epidemiology 2007 Seite 23
McCabe and Johnson score non fatal fatal within 5 years fatal within 6 months The Charlson comorbidity index predicts the 10 y mortality 1 each: Myocardial infarct, congestive heart failure, peripheral vascular disease, dementia, cerebrovascular disease, chronic lung disease, connective tissue disease, ulcer, chronic liver disease. 2 each: Hemiplegia, moderate or severe kidney disease, diabetes, diabetes with complication, tumor, leukemia, lymphoma. 3 each: Moderate or severe liver disease. 6 each: Malignant tumor, metastasis, AIDS. Seite 24
Prevalence of Nosocomial Infections in Swiss Children s Hospitals K. Mühlemann in Infection Control and Hospital Epidemiology 2004
Predicted and actual ICU mortality for the three organism types Note the change in predicted mortality for the group with yeast infections between the time of admission until the day prior to the infection Seite 27
Mortality Attributable to Nosocomial Infection: A Cohort of Patients With and Without Nosocomial Infection Seite 28
NI Infektionen verantwortlich für Mortalität? Aber: LOS & Kosten
The Attributable Mortality and Costs of Primary Nosocomial Bloodstream Infections in the Intensive Care Unit BRUNO DIGIOVINE in AM J RESPIR CRIT CARE MED 1999 After matching for severity of illness, we could not detect an association between primary nosocomial bloodstream infections and increased ICU mortality Seite 30
Attributable Cost and Length of Stay for Patients With Central Venous Catheter Associated Bloodstream Infection in Mexico City Intensive Care Units Francisco Higuera in Infection Control and Hospital Epidemiology 2007 Seite 31
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HAIs unquestionably have substantial effects on morbidity and mortality However, quantifying the exact economic burden attributable to HAIs still remains a challenging issue
weniger Infektionen = weniger Antibiotika = weniger resistente Erreger? Seite 34
Verbrauch an Glykopeptiden und VR-Enterococcus faecium DSP 2003-2013 (35, 36, 46)
Verbrauch an Glykopeptiden und VR-Enterococcus faecium DSP 2003-2013??
Resumee der Aufenthalt im Spital ist gefährlich!... Nosokomiale Infektionen Epidemiologie - sind häufig & in allen Bereichen Patient - verursachen Morbidität & Mortalität (?) Mikrobiologie - verursachen Resistenzdruck (?) Spitalträger - verursachen LOS & Kosten (?) Wissenschaft - verursachen schlechte Publikationen wir wissen was man dagegen tun kann Seite 37
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Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland Corina Ebnöther in Infection Control and Hospital Epidemiology, 2008 Seite 39
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Impact of an Infection Control Program on the Prevalence of Nosocomial Infections at a Tertiary Care Center in Switzerland Corina Ebnöther in Infection Control and Hospital Epidemiology, 2008 Seite 41
The Effect of Handwashing with Water or non-antibacterial Soap on Bacterial Contamination of Hands Maxine Burton in Int J Environ Res Public Health. 2011 Seite 42
wer NICHTS weiß muss ALLES glauben Seite 1
Danke für Aufmerksamkeit! Seite 44
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Attributable Cost and Length of Stay for Patients With Central Venous Catheter Associated Bloodstream Infection in Mexico City Intensive Care Units Francisco Higuera in Infection Control and Hospital Epidemiology 2007 40% had laboratory-confirmed BSI! In our study, we were unable to find statistically significant differences in mortality between case and control patients Seite 47
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