2006年英国全国性医院感染现况的调查研究

David

Journal of Hospital Infection
Article in Press, Corrected Proof

Web-based reporting of the results of the 2006 Four Country Prevalence Survey of Healthcare Associated Infections
2006年英国全国性医院感染调查研究：第一部 网络直报结果汇总
S. Harris, a, , M. Morgana and E. Daviesa

aWelsh Healthcare Associated Infection Programme (WHAIP), National Public Health Service, Cardiff, UK


Received 19 February 2008;  accepted 1 April 2008.  Available online 3 June 2008.

Summary
In order to feed back the results of the 2006 prevalence survey of healthcare-associated infections in a timely manner to all participating hospitals in England, Wales and Northern Ireland. A web-based reporting system was developed. The database accommodated 75 000 records from over 250 hospitals. The reporting system was hosted on the National Health Service intranet, accessible via secure login. Users were able to access their individual Trust data via a series of predefined reports and an export facility was included to facilitate additional analysis. The reporting system was made available to participating hospitals within 12 months of completion of the survey. From the results of a user satisfaction survey, end-users responded positively to receiving feedback in this format. It serves as a useful model for the feedback of results for future prevalence surveys.

Keywords: Intranet; World-wide web; Healthcare-associated infection; Survey; prevalence survey


Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the results
2006年英国全国性医院感染调查研究：第二部 结果统计回顾
E.T.M. Smytha, b, , , G. McIlvennya, J.E. Enstonec, A.M. Emmersonc, H. Humphreysd, e, F. Fitzpatricke, f, E. Daviesg, R.G. Newcombeh, R.C. Spencerc and on behalf of the Hospital Infection Society Prevalence Survey Steering Group

aNorthern Ireland Healthcare Associated Infection Surveillance Centre, Belfast, UK

bInfection Prevention and Control, The Belfast HSC Trust, Belfast, UK

cHospital Infection Society, London, UK

dDepartment of Clinical Microbiology, Royal College of Surgeons in Ireland, Dublin, Ireland

eDepartment of Microbiology, Beaumont Hospital, Dublin, Ireland

fHealth Protection Surveillance Centre, Dublin, Ireland

gNational Public Health Service, Cardiff, UK

hCentre for Health Sciences Research, Cardiff University, Cardiff, UK


Received 19 February 2008;  accepted 18 April 2008.  Available online 11 June 2008.

Summary
A survey of adult patients was conducted in February 2006 to May 2006 in acute hospitals across England, Wales, Northern Ireland and the Republic of Ireland to estimate the prevalence of healthcare-associated infections (HCAIs). A total of 75 694 patients were surveyed; 5743 of these had HCAIs, giving a prevalence of 7.59% (95% confidence interval: 7.40–7.78). HCAI prevalence in England was 8.19%, in Wales 6.35%, in Northern Ireland 5.43% and in the Republic of Ireland 4.89%. The most common HCAI system infections were gastrointestinal (20.6% of all HCAI), urinary tract (19.9%), surgical site (14.5%), pneumonia (14.1%), skin and soft tissue (10.4%) and primary bloodstream (7.0%). Prevalence of MRSA was 1.15% with MRSA being the causative organism in 15.8% of all system infections. Prevalence of Clostridium difficile was 1.21%. This was the largest HCAI prevalence survey ever performed in the four countries. The methodology and organisation used is a template for future HCAI surveillance initiatives, nationally, locally or at unit level. Information obtained from this survey will contribute to the prioritisation of resources and help to inform Departments of Health, hospitals and other relevant bodies in the continuing effort to reduce HCAI.

Keywords: Surveillance; Prevalence; Healthcare-associated infection; Meticillin-resistant Staphylococcus aureus (MRSA); Clostridium difficile

Four Country Healthcare Associated Infection Prevalence Survey 2006: risk factor analysis
2006年英国全国性医院感染调查研究：第三部 风险因素分析
H. Humphreysa, b, , , R.G. Newcombec, J. Enstoned, E.T.M. Smythe, f, G. McIlvennye, f, F. Fitzpatrickb, g, C. Fryh, R.C. Spencerd and on behalf of the Hospital Infection Society Steering Group

aDepartment of Clinical Microbiology, Royal College of Surgeons in Ireland, Ireland

bDepartment of Microbiology, Beaumont Hospital, Dublin, Ireland

cCentre for Health Sciences Research, Cardiff University, Cardiff, UK

dHospital Infection Society, London, UK

eHealthcare Associated Infection Surveillance Centre, The Royal Hospitals, Belfast, UK

fInfection Prevention and Control, The Belfast HSC Trust, Belfast, UK

gHealth Protection Surveillance Centre, Dublin, Ireland

hDepartment of Health (England), London, UK


Received 19 February 2008;  accepted 18 April 2008.  Available online 11 June 2008.

Summary
Point prevalence surveys are useful in detecting changes in the pattern of healthcare-associated infection (HCAI). In 2004 the Hospital Infection Society was asked to conduct a third national prevalence survey, which included England, Wales, Northern Ireland and the Republic of Ireland. A similar but not identical survey was carried out in Scotland. Data were collected on standardised forms using Centres for Disease Control and Prevention definitions. This report considers associations with a wide range of risk factors for all HCAI and for four main categories. The overall prevalence rate of HCAI was 7.6% and increased significantly with age. All risk factors considered were associated with highly significantly increased risk of HCAI, except recent peripheral IV catheter and other bladder instrumentation use. Primary bloodstream infection (PBSI) was associated with antibiotic, central intravenous catheter and parenteral nutrition use. Pneumonia was associated with antibiotic, central catheter, parenteral nutrition use, mechanical ventilation and current peripheral catheter use. Surgical site infection was associated with recent surgery, antibiotic and central catheter use, mechanical ventilation and parenteral nutrition. Urinary instrumentation and antibiotic use were associated with urinary tract infection. Patients under a critical care medicine consultant had the highest prevalence of HCAI (23.2%). This report highlights those areas requiring attention to prevent HCAI, i.e. device-related infections such as PBSI (e.g. central catheters) and pneumonia (e.g. mechanical ventilation) and should influence protocols for future prevalence surveys of HCAI, e.g. the recording of risk factors at the time of assessment only is sufficient.

Keywords: Healthcare-associated infection; Risk factors; Primary bloodstream infection; Pneumonia; Surgical site infection; Urinary tract infection; Specialty