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P12.09 Use of Devices for Urinary Drainage in Hospitals and Nursing Homes in Denmark, 1982-2006
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Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
P12.08 Developing Model Infection Control Policies for Scotland C. Kilpatrick *, B. Cullen, M. Henry. Health Protection Scotland (HPS), UK Background: Following a mandate from the Scottish Executive Health Department and reports that standards in care settings in Scotland required improvement, The Infection Control Team at Health Protection Scotland developed model infection control policies to support infection prevention and control programs. Objectives: • To evaluate the approaches that could be utilised to develop national model policies. • To provide model policies on standard precautions in the first instance, in a format suitable for use by care settings across Scotland. Methods: • A Steering Group of policy developers, users, and a member of the public among others, oversaw the work. A web based forum was used for consultation and to facilitate version control of documents as they were produced to a standard format. • A project management approach was used to facilitate progress and quality assurance. • A review of the methods for literature appraisal was conducted and a method applied. Autoalerts were used to ensure any new, relevant literature would be highlighted in a timely fashion for critique. Literature critiques as well as expert opinion informed policy development. Results: The Team produced nine model policies, and associated literature reviews, which were published on their web pages in 2006. The literature critiques were presented on a template developed to reflect the critique method applied. Conclusions: The quality assured process used to develop these policies proved essential in ensuring a high standard of work in line with international standards, that users would have confidence in, and would achieve greater consistency in practice. It has proven to be a resource intense exercise, however, duplication of policy development in Scotland has been prevented. The response to the policies has been very positive, thus highlighting the need for such resources. Updates and further developments in policies and methods of policy development continue. P12.09 Use of Devices for Urinary Drainage in Hospitals and Nursing Homes in Denmark, 1982–2006 C.S. Jensen *, E.T. Jensen. Statens Serum Institute, Denmark Background: The prevalence of nosocomial urinary tract infection (UTI) has decreased from 5.5% in 1979 to 2.1% in 1999 in Denmark. However, it increased to 2.9% in 2003. During 1999–2003, use of indwelling catheters among patients with nosocomial UTI increased from 21% to 44%, suggesting it has become suboptimal. Consumption of antibiotics for treatment of UTI in hospitals doubled from 1999 to 2004. Aim: To evaluate the extent of devices used for urinary drainage in Danish hospitals and nursing homes. Methods: For hospitals, use of indwelling and intermittent catheters was estimated from the amounts purchased in 2003. For nursing homes, use of indwelling and intermittent catheters, condom drainage and diapers were estimated by questionnaires in 2006. The results were compared to previous studies. Results: In 2003, Danish hospitals purchased approx. 200,000 indwelling and approx. 900,000 intermittent catheters. Between 1982 and 2003, use of indwelling catheters increased from 25 to 37 per 1,000 pat.-days and use of intermittent catheters from 25 to 166 per 1,000 pat.-days. In nursing homes, the percent residents using devices for urinary drainage increased from 58% in 1991 to 78% in 2006. This increase was strongly influenced by diapers (52% to 71%). For other devices only small changes
were observed (indwelling catheters: 4.9% to 5.6%; intermittent catheters: 0.1% to 0.5%; condom drainage: 0.8% to 3.5%). Discussion: Our study shows that the use of devices for urinary drainage has increased, both in hospitals and in nursing homes. The changes are consistent with present recommendations, i.e. intermittent catheters should be preferred to indwelling catheters, and diapers rather than catheters in nursing homes. The changes should also be interpreted in relation to the general ageing of the population. Further studies are needed to determine how and for how long the devices are used and to relate this to the prevalence of UTI in hospitals and nursing homes in Denmark. P12.10 Prevalence of Infections and ESBL Producine Bacteria Circulation in Italian LTCF S. Brusaferro1 *, L. Regattin1 , D. Turello1 , A. Grigis2 , A. Goglio2 . 1 Medical School, University of Udine, Italy, 2 Hospital of Bergamo, Italy Background: The number of Long Term Care Facilities (LTCFs) is rapidly growing in Italian National Health System (NHS) so that the attention to the risk to acquire an infection. Aims: The study assesses prevalence of hospital acquired infections (HAIs) in LTCFs of a North Italian province. A secondary objective evaluates in LTCF the circulation of extended spectrum b-lactamase (ESBL) producing bacteria specifically in urine of patients with permanent urinary catheter (PUC). Methods: We carried out a prevalence point study in 14 LTCFs in June 2005. All the patients were considered but the ones admitted less than 48 hours before the day of the study. Infections were categorized according to APIC definition. For ESBL prevalence estimation, a sample of urine was collected from all patients with PUC. Results: HAIs prevalence rate was 8% (120/1498), patients infected were 7% (105/1498). Most frequent infections resulted: low respiratory tract infections (30%), high respiratory tract infections (18.3%) and conjunctivitis (15%). At the multivariate analysis presence of devices O.R. 2.2 (95% CI: 1.3–3.7), presence of an antidecubitus device O.R. 4.3 (95% CI: 2.5– 7.4), psychophysic impairment O.R.2.7 (95% CI: 1.0–7.1) and chronic obstructive pulmonary disease O.R. 2.1 (95% CI: 1.3–3.2) remained significant factors for HAIs risk. Eighty patients had a PUC, in 39 (48.8%) we isolated ESBL producing bacteria but only 4 (5%) had an urinary tract infection. Isolated bacteria were most of all CTX-M producing Escherichia coli 35.9%(14/39) and TEM producing Proteus mirabilis 33.3%(13/39). Discussion: The point prevalence rate shows a homogeneous trend with other Italian studies. Risk factors emerging in multivariate analysis can be used to focus prevention measures on patients at higher risk of HAI. We found a high circulation of ESBL producing bacteria, but since similar data are lacking in Italian LTCFs we think that further studies are necessary to better describe the situation. P12.11 Policy Into Practice: an Internet Based Infection Control Manual for All G. Scott *, M. Shemko. UCLH NHS Foundation Trust, UK Background: There is a need for a centralised method of infection control policy development and dissemination. The solution proposed is an internet based infection control manual (ICM). The starting point is the UCLH ICM, which has been consistently developed by many contributors since 1984. Putting the ICM onto the internet allows for extremely fast policy updates. A shortened list of guidelines was published as an A3 “desktop” guide, which points to the full policies on the website. Antimicrobial guidelines are being published on the reverse side of the desktop guide.
Abstracts, 6th Int. Conf. of the Hospital Infection Society, 15–18 October 2006, Amsterdam, The Netherlands
P12.08 Developing Model Infection Control Policies for Scotland C. Kilpatrick *, B. Cullen, M. Henry. Health Protection Scotland (HPS), UK Background: Following a mandate from the Scottish Executive Health Department and reports that standards in care settings in Scotland required improvement, The Infection Control Team at Health Protection Scotland developed model infection control policies to support infection prevention and control programs. Objectives: • To evaluate the approaches that could be utilised to develop national model policies. • To provide model policies on standard precautions in the first instance, in a format suitable for use by care settings across Scotland. Methods: • A Steering Group of policy developers, users, and a member of the public among others, oversaw the work. A web based forum was used for consultation and to facilitate version control of documents as they were produced to a standard format. • A project management approach was used to facilitate progress and quality assurance. • A review of the methods for literature appraisal was conducted and a method applied. Autoalerts were used to ensure any new, relevant literature would be highlighted in a timely fashion for critique. Literature critiques as well as expert opinion informed policy development. Results: The Team produced nine model policies, and associated literature reviews, which were published on their web pages in 2006. The literature critiques were presented on a template developed to reflect the critique method applied. Conclusions: The quality assured process used to develop these policies proved essential in ensuring a high standard of work in line with international standards, that users would have confidence in, and would achieve greater consistency in practice. It has proven to be a resource intense exercise, however, duplication of policy development in Scotland has been prevented. The response to the policies has been very positive, thus highlighting the need for such resources. Updates and further developments in policies and methods of policy development continue. P12.09 Use of Devices for Urinary Drainage in Hospitals and Nursing Homes in Denmark, 1982–2006 C.S. Jensen *, E.T. Jensen. Statens Serum Institute, Denmark Background: The prevalence of nosocomial urinary tract infection (UTI) has decreased from 5.5% in 1979 to 2.1% in 1999 in Denmark. However, it increased to 2.9% in 2003. During 1999–2003, use of indwelling catheters among patients with nosocomial UTI increased from 21% to 44%, suggesting it has become suboptimal. Consumption of antibiotics for treatment of UTI in hospitals doubled from 1999 to 2004. Aim: To evaluate the extent of devices used for urinary drainage in Danish hospitals and nursing homes. Methods: For hospitals, use of indwelling and intermittent catheters was estimated from the amounts purchased in 2003. For nursing homes, use of indwelling and intermittent catheters, condom drainage and diapers were estimated by questionnaires in 2006. The results were compared to previous studies. Results: In 2003, Danish hospitals purchased approx. 200,000 indwelling and approx. 900,000 intermittent catheters. Between 1982 and 2003, use of indwelling catheters increased from 25 to 37 per 1,000 pat.-days and use of intermittent catheters from 25 to 166 per 1,000 pat.-days. In nursing homes, the percent residents using devices for urinary drainage increased from 58% in 1991 to 78% in 2006. This increase was strongly influenced by diapers (52% to 71%). For other devices only small changes
were observed (indwelling catheters: 4.9% to 5.6%; intermittent catheters: 0.1% to 0.5%; condom drainage: 0.8% to 3.5%). Discussion: Our study shows that the use of devices for urinary drainage has increased, both in hospitals and in nursing homes. The changes are consistent with present recommendations, i.e. intermittent catheters should be preferred to indwelling catheters, and diapers rather than catheters in nursing homes. The changes should also be interpreted in relation to the general ageing of the population. Further studies are needed to determine how and for how long the devices are used and to relate this to the prevalence of UTI in hospitals and nursing homes in Denmark. P12.10 Prevalence of Infections and ESBL Producine Bacteria Circulation in Italian LTCF S. Brusaferro1 *, L. Regattin1 , D. Turello1 , A. Grigis2 , A. Goglio2 . 1 Medical School, University of Udine, Italy, 2 Hospital of Bergamo, Italy Background: The number of Long Term Care Facilities (LTCFs) is rapidly growing in Italian National Health System (NHS) so that the attention to the risk to acquire an infection. Aims: The study assesses prevalence of hospital acquired infections (HAIs) in LTCFs of a North Italian province. A secondary objective evaluates in LTCF the circulation of extended spectrum b-lactamase (ESBL) producing bacteria specifically in urine of patients with permanent urinary catheter (PUC). Methods: We carried out a prevalence point study in 14 LTCFs in June 2005. All the patients were considered but the ones admitted less than 48 hours before the day of the study. Infections were categorized according to APIC definition. For ESBL prevalence estimation, a sample of urine was collected from all patients with PUC. Results: HAIs prevalence rate was 8% (120/1498), patients infected were 7% (105/1498). Most frequent infections resulted: low respiratory tract infections (30%), high respiratory tract infections (18.3%) and conjunctivitis (15%). At the multivariate analysis presence of devices O.R. 2.2 (95% CI: 1.3–3.7), presence of an antidecubitus device O.R. 4.3 (95% CI: 2.5– 7.4), psychophysic impairment O.R.2.7 (95% CI: 1.0–7.1) and chronic obstructive pulmonary disease O.R. 2.1 (95% CI: 1.3–3.2) remained significant factors for HAIs risk. Eighty patients had a PUC, in 39 (48.8%) we isolated ESBL producing bacteria but only 4 (5%) had an urinary tract infection. Isolated bacteria were most of all CTX-M producing Escherichia coli 35.9%(14/39) and TEM producing Proteus mirabilis 33.3%(13/39). Discussion: The point prevalence rate shows a homogeneous trend with other Italian studies. Risk factors emerging in multivariate analysis can be used to focus prevention measures on patients at higher risk of HAI. We found a high circulation of ESBL producing bacteria, but since similar data are lacking in Italian LTCFs we think that further studies are necessary to better describe the situation. P12.11 Policy Into Practice: an Internet Based Infection Control Manual for All G. Scott *, M. Shemko. UCLH NHS Foundation Trust, UK Background: There is a need for a centralised method of infection control policy development and dissemination. The solution proposed is an internet based infection control manual (ICM). The starting point is the UCLH ICM, which has been consistently developed by many contributors since 1984. Putting the ICM onto the internet allows for extremely fast policy updates. A shortened list of guidelines was published as an A3 “desktop” guide, which points to the full policies on the website. Antimicrobial guidelines are being published on the reverse side of the desktop guide.