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Development of Outbreak Investigation Database for hospital Infections. Osaka University, Faculty of Medicine, JAPAN Kiyoko Makimoto, Ph.D., MPH. What are hospital infections?. Two types of infections you find in the hospital Hospital-acquired infections Community-acquired infections

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development of outbreak investigation database for hospital infections

Development of Outbreak Investigation Database for hospital Infections

Osaka University,

Faculty of Medicine, JAPAN

Kiyoko Makimoto, Ph.D., MPH

what are hospital infections
What are hospital infections?
  • Two types of infections you find in the hospital
    • Hospital-acquired infections
    • Community-acquired infections
  • How can we distinguish them?
    • By latency period
    • CDC definition for NIs: development of infections after 48 hours of admission
brief history of hospital infections
Brief history of hospital infections
  • First well documented hospital infections
    • In the middle of 1800 Lying-in Hospital in Vienna
    • Maternal mortality rates exceeded 10%, mainly due to puerperal fever (child-bed fever) endemic
  • Modern epidemiology of hospital infections
    • In 1950s, Staphylococcus aureus infection outbreaks in hospitals all over the world
  • Advances in 1970
  • Intensive research in the 1990s
what kinds of hospital infections exit
What kinds of hospital infections exit?
  • Device-related
    • Blood stream infections (BSI)
    • Urinary tract infections (UTI)
    • Ventilator-associated pneumonia (VAP)
  • Procedure-related
    • Surgical site infections (SSI)
  • Environmental contamination
    • Water, disinfectant, etc.
slide5

Devices and procedures as major sources of hospital infections

Changes in flora due to

antibiotic therapy :20-25%

Others:20%

Respirators

Cross-infections: 20-40%

Arterial/venous

catheters

Surgeries

Patients’ own flora: 40-60%

Urinary

catheters

why do we need to study hospital infections
Why do we need to study hospital infections?

Not all hospital infections are preventable, but they are associated with

  • Excess length of hospital stay
  • Excess cost
  • Excess mortality
  • Law suits
increases in the mean length of hospital stay due to hospital infections in the u s senic study
Increases in the mean length of hospital stay due to hospital infections in the U.S. , SENIC study
who are at risk for acquiring hospital infections
Who are at risk for acquiring hospital infections?
  • Patients in Intensive Care Units
    • ICU (medical, surgical, burn, Neonatal ICU、Pediatric ICU)
    • Surgery department
  • Immunocompromised patients
    • Cancer treatment, transplant, HIV infections
  • Other factors
    • Age, smoking, chronic diseases
distribution of hospital infections by infection sites and endemic outbreak status
Distribution of hospital infections by infection sites and endemic/outbreak status

Endemic

Outbreak

why do we need an outbreak investigation database
Why do we need an outbreak investigation database?
  • Literature search is considered essential for outbreak investigation
  • Difficulty in collecting relevant articles in hospitals with limited resources
  • Shortage of health care workers trained in epidemiology in Japan
  • Epidemiology of hospital infections is not taught in school
conducting medline search
Conducting Medline search
  • Medline search yielded >600 articles between 1970 and 2000
  • Only a small number of outbreak investigations reported all the information necessary to replicate the investigation
  • Recent investigations tend to focus on DNA typing to identify epidemic strains
what kinds of outbreaks have been reported
What kinds of outbreaks have been reported?
  • The largest number of people affected
    • Norwalk-like virus affected 635 employees (27% attack rate), 79 people affected in a single day
    • Am J Epidemiol. 1988 Jun;127(6):1261-71.
  • The longest duration
    • >= 10 years of unrecognized hospital transmission of legionnaires' disease among transplant patients (25 cases)
    • Infect-Control-Hosp-Epidemiol. 1998 Dec; 19(12): 898-904
continued
Continued
  • Unusual source of outbreak
    • Klebsiella pneumoniae producing ESBL transmitted by gel used for ultrasonography
    • 2 adults and 1 neonates were infected; 5 colonized
    • J-Clin-Microbiol. 1998 May; 36(5): 1357-60
  • Outbreak due to non-infectious origin
    • Hemolysis (discolored, pink serum visualized in spun serum sample) due to defect products (30 cases in 11 days)
    • Kidney-Int. 2000 Apr; 57(4): 1668-74
what kinds of fields do we need
Mode of transmission

Pathogens

Type of investigation

Place (NICU, ICU, surgery, etc.)

Country

Author

Hospital size

No. of patient affected

No. of deaths

Detail investigation process

Infection control and prevention strategies

What kinds of fields do we need?
usefulness of the database i
Usefulness of the Database I
  • A learning tool for epidemiologic and microbiologic investigations
    • Specific pathogens to look for in certain symptoms
    • Guide epidemiologic investigations
      • Identify study design in similar situations
      • Types of information to collect
epidemiologic skills required in complex investigations
Epidemiologic skills required in complex investigations
  • Case definition
    • Able to learn how to write a case definition to find cases
  • Selection of controls in case-control studies
    • Selection of controls is the most difficult part
usefulness of the database ii
Usefulness of the Database II
  • Provide infection prevention strategies by
    • pathogens
    • type of service
    • infectious diseases
    • mode of transmission, etc.
any impacts of the database on japanese culture
Any impacts of the database on Japanese culture?
  • Very few Japanese professionals report outbreak investigations
  • Reporting outbreaks to professional journals as professional and social obligation
  • Providing information in sufficient detail to help investigations
challenges
Challenges
  • Currently 220 records have been entered
  • Changes in hospital practices affecting the outbreak investigation
  • Funding is necessary to complete and keep updating outbreak database
changes in hospital practices
Changes in hospital practices
  • Factors related to patients
    • Shorter hospital stay
    • Increased patients’ acuity
    • Increases in intra- and inter-hospital transfer
  • Factors related to health care workers
    • High turnover of nurses
    • Floating shift
    • Employment of temporary staff