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P17.17 Outcome of Sepsis in Japanese Intensive Care Units: the Japanese Nosocomial Infection Surveillance System
Poster Presentations
S87
device days and 11 BSI’s per 1000 patient days. Numbers of events and types or organism are shown in the table. Events Organisms % Gram(+) % Gram(–) % Fungi Virus cocci bacilli All pneumonias 61 CVC related 22 BSI’s 60
87 23 64
33.5 47.6 42.5
59.5 43.3 43.5
6 9.1 14
1 0 0
Conclusion: We found HELICS time consuming but robust and are using it to inform practice with the aim of reducing the incidence of infection. P17.17 Outcome of Sepsis in Japanese Intensive Care Units: the Japanese Nosocomial Infection Surveillance System M. Suka1 *, K. Yoshida1 , J. Takezawa2 . 1 St. Marianna University School of Medicine, Japan, 2 Nagoya University Graduate School of Medicine, Japan Background: The Japanese Ministry of Health, Labour, and Welfare established the Japanese Nosocomial Infection Surveillance (JANIS) System in July 2000 when participating multidisciplinary hospitals with 200 beds routinely started to report their surveillance data for a national database. Objective: To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS). Methods: Using the JANIS data between June 2002 and June 2004, 21895 eligible patients aged 16 years, hospitalized in 28 participating units for 24 hours, were followed until ICU discharge. A diagnosis of sepsis was defined as the presence of infection along with at least one of the following: body temperature 38ºC or 36ºC; heart rate 90 bpm; respiratory rate 20 bpm or PaCO2 32 mmHg; white blood cell count 12,000/mm3 or 4000/mm3 . Incidence curves from ICU admission were computed using KaplanMeier method and compared using log rank test. Standardized mortality ratio (SMR) was calculated based on the mortality in patients without nosocomial infection (NI). Mean LOS for survivors was assessed by two-way ANOVA (adjusting for APACHE II). Results: Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. The comparison of incidence curves from ICU admission showed that men, high APACHE II, ventilator use, central venous catheter use, and urgent operation were significantly associated with high incidence of sepsis, while no significant difference was found in age and urinary catheter use. SMR was 1.18 (95%CI:0.82–1.21) in NI patients without sepsis and 2.43 (95%CI:1.88–3.09) in those with sepsis. Mean LOS for survivors was 14.7 days (95%CI:14.3– 15.0) in NI patients without sepsis and 18.5 days (95%CI:17.7– 19.3) in those with sepsis compared to 5.1 days (95%CI:5.0–5.2) in non-NI patients. Conclusion: The JANIS data suggest high-risk subgroups for developing sepsis during the ICU stay. Sepsis increases mortality and LOS in patients with NI. P17.18 Severe Consequences of Nosocomial Infections in Nursing Homes. A Study from Six Norwegian Nursing Homes A.M. Koch1 *, P. Elstrom2 , H.M. Eriksen2 , P. Aavitsland2 , S. Harthug1 . 1 Haukeland University Hospital, Norway, 2 The Norwegian Institute of Public Health, Norway Background: The aim of his study was to obtain data about incidence of nosocomial infections in nursing homes in Norway and possible consequences of such infections.
Patients and Methods: Incidence of infections was studied prospectively in six nursing homes in Bergen and Oslo during the period 1 October 2004 to 31 March 2005. Data was registered for totally 142000 resident-days. In a nested casecontrol study, two residents without infections were chosen as controls for each resident with an observed infection. Both cases and controls had a follow-up for 30 days and possible changes in physical condition, admittance in hospital and death were analysed. Analyses were performed by cross tabulation of relevant variables, and significant variables were entered into a logistic regression analysis. Results: Incidence of infection was 5.2 per 1000 residentdays. Urinary tract and lower respiratory tract infections were the most common infections. After 30 days follow-up 11% of residents with infections was found to have a reduced physical condition, compared to 5% of the controls (RR 2.3). 13% of residents with infections were admitted to hospital during 30 days follow-up, versus 1.4% of the controls (RR 9.2). 16% of those with infections died in the nursing homes during the same period versus 2.4% of controls (RR 6.6). Most serious consequences were found for patients with lower respiratory tract infections. Conclusions: Incidence of infections in nursing homes in Norway is at the same level as shown in other published studies. Nosocomial infections have severe consequences: reduced physical function, admittance to hospital and death. P17.19 An Organizational Culture Change Led by Nurses in the Field of Surgical Site Infections O. Eluk *, H. Admi, G. Hayms, G. Rabino, N. Unger, M. Kranzler, N. Elkalai, L. Hen, T. Mashiah. Rambam – Health Care Campus, Israel Background: Surgical Site Infections (SSI) are the second most common nosocomial infections, with great influence on patients and clinical and organizational indicators. Formerly, continuous surveillance was done in selected departments but, in 2003, we established a hospital-wide process of managing SSI in all our surgical departments. Aim: Changing organizational attitudes and behaviors by conducting cross-hospital change processes, led by nurses, for SSI prevention and control. Results: 1. New clinical guidelines were developed and implemented regarding the usage of prophylactic antibiotics, professional behavior in the operating room, and pre/postoperative patient management. 2. Development of a new SSI surveillance system, including an ongoing daily SSI assessment tool, based on the National Nosocomial Infection Surveillance System (NNIS) criteria. 3. Adherence to the prophylaxis guidelines was achieved in 83% of surgical interventions. 4. After a year of follow-up, in which data was collected using the SSI surveillance tool, we found that our SSI rate was higher than that reported by NNIS in most of the surgery groups. Conclusion: The success of this mission is due to the joint efforts of the Infection Control Division, nursing and medical representatives of the surgical departments, and hospital management; as well as the solid vision of the project leaders and the ability to accept the clinical experience and feedback from all members, novices and experts alike. The Nursing Division took responsibility for leading the process of surveillance; their thoroughness and diligence was a leading factor in the data collection. This study demonstrates an organizational change process that brought about a turnaround in organizational culture in the area of SSI control. Our next challenge is to continue the surveillance process to reduce and prevent infections. We have invited all other hospitals in Israel to join us and learn from our model, hoping to develop a national data base.
S87
device days and 11 BSI’s per 1000 patient days. Numbers of events and types or organism are shown in the table. Events Organisms % Gram(+) % Gram(–) % Fungi Virus cocci bacilli All pneumonias 61 CVC related 22 BSI’s 60
87 23 64
33.5 47.6 42.5
59.5 43.3 43.5
6 9.1 14
1 0 0
Conclusion: We found HELICS time consuming but robust and are using it to inform practice with the aim of reducing the incidence of infection. P17.17 Outcome of Sepsis in Japanese Intensive Care Units: the Japanese Nosocomial Infection Surveillance System M. Suka1 *, K. Yoshida1 , J. Takezawa2 . 1 St. Marianna University School of Medicine, Japan, 2 Nagoya University Graduate School of Medicine, Japan Background: The Japanese Ministry of Health, Labour, and Welfare established the Japanese Nosocomial Infection Surveillance (JANIS) System in July 2000 when participating multidisciplinary hospitals with 200 beds routinely started to report their surveillance data for a national database. Objective: To determine the incidence of sepsis in Japanese intensive care units (ICUs) and to evaluate the impact of sepsis on mortality and length of stay (LOS). Methods: Using the JANIS data between June 2002 and June 2004, 21895 eligible patients aged 16 years, hospitalized in 28 participating units for 24 hours, were followed until ICU discharge. A diagnosis of sepsis was defined as the presence of infection along with at least one of the following: body temperature 38ºC or 36ºC; heart rate 90 bpm; respiratory rate 20 bpm or PaCO2 32 mmHg; white blood cell count 12,000/mm3 or 4000/mm3 . Incidence curves from ICU admission were computed using KaplanMeier method and compared using log rank test. Standardized mortality ratio (SMR) was calculated based on the mortality in patients without nosocomial infection (NI). Mean LOS for survivors was assessed by two-way ANOVA (adjusting for APACHE II). Results: Sepsis was diagnosed in 450 patients (2.1%), with 228 meeting the definition on ICU admission and 222 during the ICU stay. The overall incidence of sepsis was 1.02/100 admissions or 2.00/1000 patient-days. The comparison of incidence curves from ICU admission showed that men, high APACHE II, ventilator use, central venous catheter use, and urgent operation were significantly associated with high incidence of sepsis, while no significant difference was found in age and urinary catheter use. SMR was 1.18 (95%CI:0.82–1.21) in NI patients without sepsis and 2.43 (95%CI:1.88–3.09) in those with sepsis. Mean LOS for survivors was 14.7 days (95%CI:14.3– 15.0) in NI patients without sepsis and 18.5 days (95%CI:17.7– 19.3) in those with sepsis compared to 5.1 days (95%CI:5.0–5.2) in non-NI patients. Conclusion: The JANIS data suggest high-risk subgroups for developing sepsis during the ICU stay. Sepsis increases mortality and LOS in patients with NI. P17.18 Severe Consequences of Nosocomial Infections in Nursing Homes. A Study from Six Norwegian Nursing Homes A.M. Koch1 *, P. Elstrom2 , H.M. Eriksen2 , P. Aavitsland2 , S. Harthug1 . 1 Haukeland University Hospital, Norway, 2 The Norwegian Institute of Public Health, Norway Background: The aim of his study was to obtain data about incidence of nosocomial infections in nursing homes in Norway and possible consequences of such infections.
Patients and Methods: Incidence of infections was studied prospectively in six nursing homes in Bergen and Oslo during the period 1 October 2004 to 31 March 2005. Data was registered for totally 142000 resident-days. In a nested casecontrol study, two residents without infections were chosen as controls for each resident with an observed infection. Both cases and controls had a follow-up for 30 days and possible changes in physical condition, admittance in hospital and death were analysed. Analyses were performed by cross tabulation of relevant variables, and significant variables were entered into a logistic regression analysis. Results: Incidence of infection was 5.2 per 1000 residentdays. Urinary tract and lower respiratory tract infections were the most common infections. After 30 days follow-up 11% of residents with infections was found to have a reduced physical condition, compared to 5% of the controls (RR 2.3). 13% of residents with infections were admitted to hospital during 30 days follow-up, versus 1.4% of the controls (RR 9.2). 16% of those with infections died in the nursing homes during the same period versus 2.4% of controls (RR 6.6). Most serious consequences were found for patients with lower respiratory tract infections. Conclusions: Incidence of infections in nursing homes in Norway is at the same level as shown in other published studies. Nosocomial infections have severe consequences: reduced physical function, admittance to hospital and death. P17.19 An Organizational Culture Change Led by Nurses in the Field of Surgical Site Infections O. Eluk *, H. Admi, G. Hayms, G. Rabino, N. Unger, M. Kranzler, N. Elkalai, L. Hen, T. Mashiah. Rambam – Health Care Campus, Israel Background: Surgical Site Infections (SSI) are the second most common nosocomial infections, with great influence on patients and clinical and organizational indicators. Formerly, continuous surveillance was done in selected departments but, in 2003, we established a hospital-wide process of managing SSI in all our surgical departments. Aim: Changing organizational attitudes and behaviors by conducting cross-hospital change processes, led by nurses, for SSI prevention and control. Results: 1. New clinical guidelines were developed and implemented regarding the usage of prophylactic antibiotics, professional behavior in the operating room, and pre/postoperative patient management. 2. Development of a new SSI surveillance system, including an ongoing daily SSI assessment tool, based on the National Nosocomial Infection Surveillance System (NNIS) criteria. 3. Adherence to the prophylaxis guidelines was achieved in 83% of surgical interventions. 4. After a year of follow-up, in which data was collected using the SSI surveillance tool, we found that our SSI rate was higher than that reported by NNIS in most of the surgery groups. Conclusion: The success of this mission is due to the joint efforts of the Infection Control Division, nursing and medical representatives of the surgical departments, and hospital management; as well as the solid vision of the project leaders and the ability to accept the clinical experience and feedback from all members, novices and experts alike. The Nursing Division took responsibility for leading the process of surveillance; their thoroughness and diligence was a leading factor in the data collection. This study demonstrates an organizational change process that brought about a turnaround in organizational culture in the area of SSI control. Our next challenge is to continue the surveillance process to reduce and prevent infections. We have invited all other hospitals in Israel to join us and learn from our model, hoping to develop a national data base.