onco-kiss nosocomial infection surveillance during neutropenia petra gastmeier, md charité –...
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ONCO-KISS nosocomial infection surveillance during
neutropenia
Petra Gastmeier, MD
Charité – University Medicine Berlin, Germanyand German National Reference Center for Surveillance of Nosocomial Infections
2
KISS componentswww.nrz-hygiene.de
ICU-KISS
OP-KISS
DEVICE-KISS
AMBU-KISS
MRSA-KISS
NEO-KISS
CDAD-KISS
ONKO-KISS
Objectives of ONKO-KISSObjectives of ONKO-KISS
• Establishment of a database with nosocomial infections of patients with bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT) in Germany
• Providing reference data for internal quality management
• Reduction of nosocomial infections
Nosocomial infections in BMT Nosocomial infections in BMT patients in Freiburgpatients in Freiburg
Nosocomial infections
Total NI during neutropenic
period
Total 239 171 (71.5 %)
Primary BSI 85 70
Pneumonia 77 60
UTI 11 8
Surveillance over a 5 year period with 351 patients
Dettenkofer et al. Bone Marrow Transplant 2003; 31:795-801
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Method ONKO-KISS
Infections Standardization Stratification•Pneumonia•Primary blood stream infection
Neutropenia days
• allogen• autolog
Dettenkofer, Bone Marrow Ttransplant 2003; 31: 795-01
Which data are recorded ?Which data are recorded ?
Neutropenic daysNosocomial BSINosocomial pneumonia
• BSI: according to CDC criteria• Pneumonia: modified CDC criteria
(Carlisle et al., 1993)
Which definitions are used?Which definitions are used?
Laboratory confirmed BSI (CDC)Laboratory confirmed BSI (CDC)At least one of the following criteria:
• Recognized pathogen isolated from blood culture that was not related to an infection at another site and/or
• One of the following criteria: Fever (>38°C), shivering or hypotension and one of the following:
– Isolation of a common skin contaminant from 2 separate blood cultures that was unrelated to an infection at another site
– Isolation of a common skin contaminant from 1 blood cultures for patients with an an intravascular device for whom a physician initiated appropriate antimicrobial therapy
– Positive antigen blood test and the pathogen is unrelated to an infection at another site
Nosocomial pneumonia Nosocomial pneumonia ONKO-KISS (Carlisle et al., 1993)ONKO-KISS (Carlisle et al., 1993)
• At least one of the following criteria:
• Fever (>38°C) and new or worsening infiltrates from chest radiography or a thoracic CT and/or
• At least 2 of the following production of sputum
coughdyspnearhonchi or rales polymorphonuclear leucocytes on a sputum gram stainpleural rub
Which rates are calculated ?Which rates are calculated ?
number of BSI casesBSI rate = ----------------------------------
number of neutropenic days
number of pneumonia cases
Pneumonia rate = ---------------------------------------
number of neutropenic days
Standardization according to the number of neutropenia
daysTrans-plantation
Depart-ments
Patients 25th Percentile
Median 75th Percentile
autolog 25 2 225 8.0 8.9 10.4
allogen 19 3 096 15.7 18.3 20.2
ONKO-KISS data 12/2007
Stratification according to the type of transplantation
Trans-plantation
Depart-ments
Patients Neutropenia days
Sepsis/1000
neutropenia days
Pneumonia/1000
neutropenia days
autolog 25 2 225 20 382(Ø 9,2 days)
16,4 5,5
allogen 19 3 096 58 170(Ø 18,8 days)
9,2 5,8
ONKO-KISS data 12/2007
CVC associated BSI rates in various KISS components
Patientengruppe wards CVC days CVC days associated BSI rates /1000 CVC days
Interdisciplinary ICUs 143 889 013 1.6
Surgical ICUs 80 654 023 2.0
Medical ICUs 61 300 106 1.9
Neurosurgical ICUs 11 87 695 1.4
Pediadric ICUs 7 24 116 4.2
Newborns 1000-< 1500g 37 13 945 8.1
Newborns < 1000g 36 27 823 13.1
BMT patients 17 22 032 14.0
Non-ICU patients 70 5 171 3.9
Gastmeier P et al. Dt. Ärztebl 2005; 102: A2098-2101
Reduction of BSI rates by surveillance and intervention over a 36 months
period
Chaberny et al. submitted
0
5
10
15
20
25
30
1.period 2.period
BSI/1000 neutropenic days
Intervention
OR= 0.58 (CI95 0.34-0.99)
268 patients, 87 BSI
autolog allogen autolog allogen
Centers 5 6 25 19
patients 21 166 2 225 3 096
Neutropenia days
241 3 740 20 382 58 170
Ø number of neutropenia days
11,5 22,5 9.2 18.8
ONKO-KISS surveillance among children with BMT/PBSCT
ONKO-KISS 6/2007
Children Adults
ONKO-KISS surveillance among children
Primary BSI per 1000 neutropenia days
ONKO-KISS analysis 6/2007
Acute myeloic
leucaemiaAML
Acute lymphatic leucaemia
ALL
BMT/PBSCTautolog
BMT/PBSCTallogen
Centers 6 6 25 19
patients 614 186 2 225 3 096
Neutropenia days
10 529 2 288 20 382 58 170
Ø number of neutropenia days
17.1 12.3 9.2 18.8
ONKO-KISS surveillance among patient with acute
leucaemia
ONKO-KISS 12/2007
ONKO-KISS surveillance among patient with acute leucaemia
Primary BSI per 1000 neutropenia days
ONKO-KISS analysis 6/2007
Summary• Surveillance of nosocomial infections ist also feasible in the group of hematology/oncology patients
• BSI and pneumonia are the most interesting outcomes in this patient group.
• A standardization according to the number of neutropenia days seems to be useful.
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HAND-KISS
Annual amount of alcoholic hand rub (ml)
____________________________
Annual number of patient days
for each unit/ward of the hospital:
0
20
40
60
80
100
120
140
ICUs
non-ICUs
Median amount of alcoholic hand rub used (ml) per patient day 2007 (68 hospitals)
Group Number of ICUs
25th percentile
Median 75th percentile
Internal medicine
23 34 57 71
Surgery 22 58 101 113
Pediatrics 8 40 69 98
Neonatology 14 67 116 178
interdisciplinary
57 44 59 91
Distribution of the amount of alcoholic hand rub used (ml) per patient day 2007 (ICUs only)
Total 136 43 59 95