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      Temporal trends of healthcare associated infections and antimicrobial use in 2011-2013, observed with annual point prevalence surveys in Ferrara University Hospital, Italy

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          Summary

          Introduction.

          Healthcare associated infections (HAIs) and misuse of antimicrobials (AMs) represent a growing public health problem. The Point Prevalence Surveys (PPSs) find available information to be used for specific targeted interventions and evaluate their effects. The objective of this study was to estimate the prevalence of HAIs and AM use, to describe types of infections, causative pathogens and to compare data collected through three PPSs in Ferrara University Hospital (FUH), repeated in 3 different years (2011-2013). The population-based sample consists of all patients admitted to every acute care and rehabilitation Department in a single day.

          Methods.

          ECDC Protocol and Form for PPS of HAI and AM use, Version 4.2, July 2011. Risk factor analysis was performed using logistic regression.

          Results.

          1,239 patients were observed. Overall, HAI prevalence was 9.6%; prevalence was higher in Intensive Care Units; urinary tract infections were the most common HAIs in all 3 surveys; E.coli was the most common pathogen; AM use prevalence was 51.1%; AMs most frequently administered were fluoroquinolones, combinations of penicillins and third-generation cephalosporins. According to the regression model, urinary catheter (OR: 2.5) and invasive respiratory device (OR: 2.3) are significantly associated risk factors for HAIs (p < 0.05).

          Conclusions.

          PPSs are a sensitive and effective method of analysis. Yearly repetition is a useful way to maintain focus on the topic of HAIs and AM use, highlighting how changes in practices impact on the outcome of care and providing useful information to implement intervention programs targeted on specific issues.

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          Most cited references29

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          Applied Logistic Regression

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            The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.

            In a representative sample of US general hospitals, the authors found that the establishment of intensive infection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tract infection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for other characteristics of the hospitals and their patients. Essential components of effective programs included conducting organized surveillance and control activities and having a trained, effectual infection control physician, an infection control nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with these components reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs, however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s, leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effective programs, the overall infection rate increased by 18% from 1970 to 1976.
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              The preventable proportion of nosocomial infections: an overview of published reports.

              The proportion of nosocomial infections potentially preventable under routine working conditions remains unclear. We performed a systematic review to describe multi-modal intervention studies, as well as studies assessing exogenous cross-infection published during the last decade, in order to give a crude estimate of the proportion of potentially preventable nosocomial infections. The evaluation of 30 reports suggests that great potential exists to decrease nosocomial infection rates, from a minimum reduction effect of 10% to a maximum effect of 70%, depending on the setting, study design, baseline infection rates and type of infection. The most important reduction effect was identified for catheter-related bacteraemia, whereas a smaller, but still substantial potential for prevention seems to exist for other types of infections. Based on these estimates, we consider at least 20% of all nosocomial infections as probably preventable, and hope that this overview will stimulate further research on feasible and cost-effective prevention of nosocomial infections for daily practice.
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                Author and article information

                Journal
                J Prev Med Hyg
                J Prev Med Hyg
                Pacini
                Journal of Preventive Medicine and Hygiene
                Pacini Editore SRL
                1121-2233
                2421-4248
                September 2016
                : 57
                : 3
                : E135-E141
                Affiliations
                [1 ] Department of Hospital Hygiene & Healthcare Associated Infection Risk Management, Hospital Health Medical Management, Ferrara University Hospital, Ferrara, Italy;
                [2 ] Department of Hospital Hygiene & Healthcare Associated Infection Risk Management, Ferrara University Hospital, Ferrara, Italy;
                [3 ] Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy;
                [4 ] Postgraduate School of Hygiene and Preventive Medicine, Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, Ferrara, Italy;
                [5 ] Planning and Control Management, Ferrara University Hospital, Ferrara, Italy
                Author notes
                Correspondence: Giovanni Gabutti, Section of Public Health Medicine, Department of Medical Sciences, University of Ferrara, via Fossato di Mortara 64/b, 44121 Ferrara, Italy - Tel. +39 0532 455568 - Fax +39 0532 205066 - E-mail: giovanni.gabutti@ 123456unife.it

                Authors' contributions

                PA, GG, AS, MCM was responsable for the research coordination and contributed to the protocol definition, data collection, data analysis, manuscript drafting and critical revision of the manuscript. BB, AV, AF contributed to the data collection, data analysis and critical revision of the manuscript. All authors read and approved the final manuscript.

                Article
                Pacini
                5139608
                44ac9213-d367-43ef-b2bd-a0ede55104b2
                © Copyright by Pacini Editore SRL, Pisa, Italy

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License, which permits for noncommercial use, distribution, and reproduction in any digital medium, provided the original work is properly cited and is not altered in any way. For details, please refer to http://creativecommons.org/licenses/by-nc-nd/3.0/

                History
                : 29 May 2016
                : 21 July 2016
                Categories
                Original Article

                healthcare-associated infections,antimicrobial use,point prevalence surveys

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