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To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs)” Hagel et al (2018).

Abstract:

Objectives: To evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs).

Methods: Prospective, quasi-experimental study with two surveillance periods (09/2011-08/2012; 05/2013-08/2014). Starting 10/2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI).

Results: Overall, 62,154 patients were under surveillance, with 1,568 HAIs identified in 1,170 patients (4.3 per 100 admissions) in the 1st and 2,336 HAIs identified in 1,711 patients (4.9 per 100 admissions) in the 2nd surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI: [0.78, 2.15]) and ICUs (aIRR 0.59 [0.27, 1.31]). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98 [0.97, 1.00] per 1-week increment), in contrast to general wards (aIRR 1.01 [1.00, 1.02]). A reduction in severe HAIs (aIRR 0.13 [0.05, 0.32]) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56 [0.31, 0.99]) were observed in the 2nd period in the ICUs.

Conclusions: There was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear.



Reference:

Hagel, S., Ludewig, K., Pletz, M.W., Frosinski, J., Moeser, A., Wolkewitz, M., Gastmeier, P., Harbarth, S., Brunkhorst, F.M., Kesselmeier, M. and Scherag, A. (2018) Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: A prospective interventional study. Clinical Microbiology and Infection. July 20th. [epub ahead of print].

DOI: https://doi.org/10.1016/j.cmi.2018.07.010