1. Networks of hospitals: building a common strategy for HAI prevention and control and antimicrobial policy
Tomasz Ozorowski, M.D.
University of Medical Sciences, Poznan, Poland
National Programme Of Antibiotic Protection

2. National Programme Of Antibiotic Protection for more rational antibiotic usage in Poland supported by Ministry of Health
Medicine
Veterinary
Agriculture
Primary Care
Secondary care
Guidelines for ABS
ICU branch
pilot hospitals
Network of hospitals
Implementing ABS
Collecting data
Exchanging experience

3. National Programme of Antibiotic Protection Pilot hospitals
Initial requirements:
Acute hospital > 400 beds with ICU
Support from hospital administration
Antimicrobial team
Ability to conduct PPS
31 acute hospitals
Mean number of beds = 573
Mean numbres of beds in ICU = 8
Mean time of hospital stay = 5.3 days
Mean time of ICU stay = 10 days

4. Pilot hospitals: 3-stage cooperation
1. Collection of entrance data ( )
retrospectivelly: antibiotic consumption, bloodstream infection
prospectivelly: PPS study
2. Implementation of ABS programme
cooperation with antimicrobial team
workshops for administration and physicans at the hospital and
department level
3. Observe and analyze the results
Practical conclusions Less scientific
Examples for other hospitals Probably not possible to
Correction of the programme find relation with
mortality rate and change
in resistance

5. Pilot hospitals antibiotic consumption, one-year period, ATC class J01, DDD/100 BD
ICU
The results were compared with ARPAC and CARE-ICU European studies:
(1) MacKenie F., Monnet D., Gould I.: Relationship between the number of different antibiotics used and the total use of antibiotics in european hospitals, J Antimicrob Chemother 2006;58:
(2) Hanberger H., Arman D., Gill H., et al.: Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control, Intensive Care Med 2009; 35: (35 ICU)

6. Top 10 ten antibiotics in Polish hospitals number of DDD (>1 mln)

7. Top 10 antibiotics in Polish ICU number of DDD

8. Pilot hospitals – incidence of HA bloodstream infection diagnosed in hospitals/1000 admissions one-year period, pts, 906 infections
The results were compared with the following studies:
Finland :4 hospitals Lyytikäinen Clin Infect Dis 2002; 35:e14-19
Estonia: 3 hospitals , Mitt: J Hosp Infect 2009;71:365-70
Belgium : 117 hospitals, Ronveaux Eur J Clin Microbiol Infect Dis 1998;17:
USA: 49 hospitals, Wisplinghhoff Clin Infect Dis 2004;39:

9. Pilot hospitals: etiology of HA bloodstream infection

10. Incidence and etiology of HA bloodstream infection acquired in ICU 27 ICU, pts, 39125BD , 294 infection
16%
HELICS=2,3%
(1) ECDC: Annual epidemiological report on communicable diseases in Europe, 2010.

11. Point Prevalence Survey
Results of pilot study in 31 Polish hospitals

12. PPS –data collection Risk factor for HAI HAI
Community acquired infections
Antibiotic use as surgical prophylaxis
Antibiotic use for other reason than infection and surgical prophylaxis
Exclusion: day centre, and day-case patients, no psychiatric departments
1 day = one unit
Two education sessions about conducting PPS for hospital teams

13. PPS – main results, 9288 patients

14. PPS results 536 HAI in 9288 patients (5.8%)
Etiology identified in 60% of HAI : 1. E.coli, 2 A.baumanii, 3. S.aureus (33% MRSA), no VRE , no CRE , only 2 cases of C.difficile

15. PPS results prevalence of risk factors for HAI prevalence of the use of central venous catheter
The results were compared with the following studies:
Slovenia: 19 acute care hospitals,6695 pts; Klavs J Hosp Infect 2003;54:149-57
Greece : 14 hospitals academic / regional, 3925 pts; Gikas J Hosp Infect 2002;50:269-75
Italy: 21 acute care hospitals ; Pellizerr Infection 2008;36:112-9
USA: 6 academic centers,2459 pts; Climo ICHE 2003;24:942-5

16. PPS results prevalence of risk factors for HAI % of ICU patients - day of the study
The results were compared with the following studies:
UK: 4 country study; Smyth J Hosp Infect 2008;69:230-48
Slovenia: 19 acute care hospitals,6695 pts, Klavs J Hosp Infect 2003;54:149-57
Nosocomial infections in Belgium part I: national prevalence study. KCE reports 92C. ,2008
Greece : 14 hospitals academic/regional, 3925 pts, Gikas J Hosp Infect 2002;50:269-75
Italy: 21 acute care hospitals Pellizerr Infection 2008;36:112-9

17. PPS-results antibiotic prescribed: no infection and surgical prophylaxis: 7,7% pts
Group of reasons
Specific reasons
Respiratory tract
Lung edema, pleuritis, unspecific X ray abnormalities
Urinary tract
Renal stones, catheter
Digestiv tract
Pancreatitis, liver cirrhosis, colon cancer
Neonates
CRP, mother risk factor for infection, results of superficial cultures
Skin and soft tissue
Chronic wound
CNS
Cerebral haemorrhage
Other
Fever, cancer, neutropenia, high CRP
PPS as a useful tool for antibiotic overuse identification
→ analysis and proposes→ feedback to physicians

18. Pilot hospital: main conclusion from the results
Antibiotic consumption similar to other countries but high domination of iv amoxicllin with clavulanate, even in ICU
Acinetobacter baumanii: very frequent Gram negative as a cause of HAI, probably as a result of low organization level and insufficient education of cleaning services
Significantly higher incidence of bloodstream infection in polish ICU than in HELICS study
Prevalence of HAI (5.8%) approximates the average from 7 main European studies (6.8%) but significantly lower prevalence of the main risk factor for HAI, probably as a result of different organization of health care system