Time for awareness: healthcare-associated infections and

antimicrobial use in long-term care facilities – Hungary, 2013

Rita Szabó1,2 (szabo.rita@oek.antsz.hu), K. Böröcz2

1European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

2National Center for Epidemiology, Department of Hospital Epidemiology, Budapest, Hungary

Project Review Module

28 August 2013, Stockhom

2007 2008 2009 2010 2011

16%

16,2%

16,4%

16,6%

16,7%

Pro

po

rtio

n (

%)

of

pe

op

le

Year

Number of people over 65 years

BACKGROUND

2000 2008 2009 2010

39,847

49,894 51,353 51,736

Nu

mb

er

of

resi

de

nts

Year

Number of residents in LTCFs

BACKGROUND (2)Resident factors

• Poor functional and immune status

• Co-morbidities / chronic diseases

• Non-specific clinical symptoms

• Medical device use

Facility factors• Collective living

• Lack of certified nurses

• Physicians visit infrequent

• Low priority to preventive and control measures

• No basic diagnostic background

• No isolation possibility

OBJECTIVES

Primary objective:

Improving the „safety” of residents in LTCFs by measuring the prevalence of healthcare-associated infections (HAI) and antimicrobial (AB) use

Secondary objective:

Identifying needs for intervention, training andinfection control (IC) resources

METHODS

• Point-prevalence survey between April and May 2013

• Criteria to eligibility

Eligible LTCFs: each LTCF who accept to participation

Eligible residents: each resident present at 8 AM in the LTCF on the PPS day (present since 24h)

• Data collection tools

Institutional questionnaire: on infection control practices in each voluntary participating LTCF

Resident questionnaire: each resident with sign/symptoms of HAI and/or receiving AB therapy

RESULTS

• Participating LTCFs: 91 (22 %)

• Eligible residents: 11,823

• Number of HAIs: 250

• Prevalence of HAI: 2.1 % (95% CI : 0.2 – 2.9)

• Number of ABs: 159

• Prevalence of AB use: 1.3 % (95% CI : 0.3 – 1.9)

Healthcare-associated infections

91

75

52

1812

2 1Pro

po

rtio

n (

%)

of

HA

Is

Type of healthcare associated infections

Proportion of surveyed types of healthcare-associated infections (n=250) in 91 LTCFs with 11,823 eligible residents, Hungary, April-May

2013

Antimicrobial use by type of HAIs

UTI RTI SST GI EEN OTHER UF BSI

40 38

13

3 2 2 1 0

Pro

po

rtio

n(%

)o

f an

tim

icro

bia

ls

Type of healthcare-associated infections

Proportion of surveyed antimicrobials by types of healthcare-associated infections (n=159) in 91 LTCFs with 11,823 eligible

residents, Hungary, April-May 2013

Antimicrobial use by ATC classes

Tetracyclines (J01A)

Amphenicols (J01B)

Beta-lactam antibacterials,

penicillins (J01C)

Other beta-lactam antibacterials (J01D)

Sulfonamides and trimethoprim (J01E)

Macrolides, lincosamides and

streptogramins (J01F)

Aminoglycoside antimicrobials (J01G)

Quinolone antibacterials (J01M)

Combinations of antimicrobials (J01R)

Other antimicrobials

(J01X)

Agents against amoebiasis and other

protozoal diseases (P01A) Antifungals for

systemic use (D01B)

Number of surveyed classes of antimicrobials (n=250) in 91 LTCFs 91 LTCFs

with 11,823 eligible residents, Hungary, April-May 2013

Microbiological sampling

Type of infection Number of

residents with

AB

Microbiological

sampling before AB

prescription (%)

Name of isolated

pathogens

Urinary tract 52 2 Enterobacter cloacae /

Escherichia coli

Respiratory tract 74 - -

Skin and soft tissues 91 - -

Gastrointestinal 18 3 Clostridium difficile

Eye, ear, nose and

mouth

12 - -

Bloodstream 0 - -

Unexplained fever 2 - -

Other 1 1 Staphylococcus aureus

Isolated pathogens (n=6) before antimicrobial prescription in 91 LTCFs 91

LTCFs with 11,823 eligible residents, Hungary, April-May 2013

CONCLUSION

Surveillance of HAI and AB use

and

Support infection control

IMPROVING THE SAFETY OF RESIDENTS

Thank you for your attention!