2/10/2017
Les programmes nationaux de
Surveillance en Belgique – nsih.be
Boudewijn Catry
Louisa Ben Abdelhafidh
Katrien Latour
Barbara Legiest
Marie-Laurence Lambert
Els Duysburgh
Theofilos Papadopoulos
Karl Mertens
Thaddé Mahmourian
Annie Uwineza
Syvlanus Fonguh
Béatrice Jans
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium
T +32 2 642 51 11 | F +32 2 642 54 10 | email: [email protected] | http://www.iph.fgov.be
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
Conclusions
1
2/10/2017
Point prevalence survey: PPS (photo)
Surveillance continue (film)
&
Point Prevalence Survey: HAI - ABU
Pourcentage de patients avec une HAI: 7.0%
20%
15%
10%
Mean prevalence: 7% [0%-23%]
5%
0%
11
13
15
20
38
59
58
34
27
63
49
30
50
2
62
14
51
61
40
37
7
48
55
41
16
18
17
46
33
24
57
21
12
36
56
19
39
43
60
5
53
22
42
4
29
45
23
28
32
44
52
35
6
54
8
47
3
1
26
31
9
25
10
% patients w ith H A I
25%
Hospital number
Goossens, M WIV-ISP
2
2/10/2017
http://www.ecdc.europa.eu/en/publications/Publications/healthcareassociated-infections-antimicrobial-use-PPS.pdf
Point Prevalence Survey: HAI - ABU
N pts (a)
Prevalence%
(95%CI) (b)
N HAI (c)
Relative
% HAI (d)
Pneumonia & other LRTI
392
2.0% (1.8-2.2)
394
25.7%
Surgical site infections (e)
290
1.5% (1.3-1.6)
290
18.9%
Urinary tract infections
263
1.3% (1.2-1.5)
264
17.2%
Bloodstream infections (BSI)(f)
216
1.1% (0.9-1.2)
217
14.2%
Gastro-intestinal system
infections
118
0.6% (0.5-0.7)
119
7.8%
Skin and soft tissue infections
59
0.3% (0.2-0.4)
59
3.9%
Bone and joint infections
38
0.2% (0.1-0.3)
39
2.5%
Eye, Ear, Nose or Mouth infection
47
0.2% (0.2-0.3)
47
3.1%
Systemic infections(f)
40
0.2% (0.1-0.3)
40
2.6%
Zarb et al., 2012 Eurosurveillance
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2/10/2017
Point Prevalence Survey: HAI - ABU
On antimicrobials: 36.6%
Mean antimicrobials for those on antimicrobials: 1.5
Indication for Antimicrobial N=5543
1%
13%
HI :acute
4%
4%
3%
44%
15%
8%
hospital-acquired
:community-acquired
CI
LI :acquired in NH
M :medical prophylaxis
U :unknown reason
S1:single dose
S2:one day
Surg
S3:> 1 day
23%
Goossens, M WIV-ISP
Belgium 2011 PPS continued
http://www.ecdc.europa.eu/en/publications/Publications/healthcareassociated-infections-antimicrobial-use-PPS.pdf
4
2/10/2017
Belgium 2011 PPS continued
MRSA 0.368*11%= 4.048%
Candida spp
= 6%
http://www.ecdc.europa.eu/en/publications/Publications/healthcare-associatedinfections-antimicrobial-use-PPS.pdf
Mission
To provide standardized definitions and tools for the containment
of health care associated infections in hospitals and nursing
homes, and to establish national reference data on incidence of
nosocomial infections and antimicrobial resistance.
5
2/10/2017
Nosocomial infection (1/3)
An active infection was defined as “healthcareassociated” (associated to acute care hospital
stay only for the purpose of this protocol) when:
The onset of the signs and symptoms had started
on Day 3 of the current admission or later
(where Day 1 is the day of admission)
OR
The signs and symptoms were present at
admission or became apparent before Day 3, but
the patient had been discharged from another
hospital less than two days before admission
Zarb et al., 2013 Eurosurveillance
Nosocomial infection (2/3)
OR
The signs and symptoms of an active surgical site
infection were present at admission or started
before Day 3, and the surgical site infection
occurred within 30 days of a surgical
intervention (or in the case of surgery involving
an implant, a deep or organ/space surgical site
infection that developed within a year of the
intervention),
Zarb et al., 2013 Eurosurveillance
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2/10/2017
Nosocomial infection (3/3)
OR
The signs and symptoms of a Clostridium difficile
infection were present at admission or started
before Day 3, with the patient having been
discharged from an acute care hospital less
than 28 days before the current admission.
Zarb et al., 2013 Eurosurveillance
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
Conclusions
7
2/10/2017
Cadre légal (annexes)
Le financement de l’infirmier en hygiène hospitalière est porté à
53 105,00 euros (°2007 indexé) par équivalent temps plein.
Cette majoration est conforme au positionnement de l’infirmier
au niveau du cadre intermédiaire. Cette mesure s’applique aux
hôpitaux aigus, spécialisés (Sp), gériatriques (G) et
psychiatriques.
Par ailleurs, pour les hôpitaux généraux et pour les hôpitaux
spécialisés (Sp) et gériatriques (G) comptant au moins 150 lits,
un encadrement minimal est prévu pour l’équipe d’hygiène
hospitalière. Ces institutions doivent employer au moins 1
infirmier en hygiène hospitalière ETP et au moins 0.5 médecin
en hygiène hospitalière ETP.
Le budget prévu pour les frais de fonctionnement – 10 % du
budget affecté aux salaires de l’infirmier en hygiène hospitalière
et du médecin en hygiène hospitalière – est maintenu.
Arrêt royal 2015
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2/10/2017
Arrêt Royal 2015
9
2/10/2017
Burden = ‘Frais des extras
soins’
PLOS Medicine, 2016
We estimated that 2,609,911 new cases of HAI occur every year in the European Union
and European Economic Area (EU/EEA). The cumulative burden of the six HAIs was estimated
at 501 DALYs per 100,000 general population each year in EU/EEA. HAP and HA
primary BSI were associated with the highest burden and represented more than 60% of
the total burden, with 169 and 145 DALYs per 100,000 total population, respectively. HA
UTI, SSI, HA CDI, and HA primary BSI ranked as the third to sixth syndromes in terms of
burden of disease. HAP and HA primary BSI were associated with the highest burden
because of their high severity. The cumulative burden of the six HAIs was higher than the
total burden of all other 32 communicable diseases included in the BCoDE 2009±2013
study. The main limitations of the study are the variability in the parameter estimates, in particular
the disease models' case fatalities, and the use of the Rhame and Sudderth formula
for estimating incident number of cases from prevalence data.
PLOS Medicine | DOI:10.1371/journal.pmed.1002150 October 18, 2016
10
2/10/2017
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
Conclusions
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
Conclusions
11
2/10/2017
Data Collection & Analysis: WIV
• Objectives
• Improve HH compliance & basic requirements in
institutions
• Target : 100%
• Methods
• Measurement of compliance
• Software
• continuous measurements possible
• reports immediately available
Mobile version
•
Internet connection
•
Connect via WiFi
•
Designed for Internet explorer 11
browser (Safari ok)
12
2/10/2017
Report
• https://nsihweb.wiv-isp.be: secured website
• Password: www.nsih.be/contact – include NSIHcode !
• simple
• for all measurement periods
• hospital report
• Online available
• national report
• available after national campaigns
• allows comparison of hospital data with national
Table1 : Hand hygiene compliance in Belgian hospitals over different campaigns (before and after campaign)
Campaigns (Year)
Compliance before
Compliance after
1st campaign (2005)
49.6%
68.6%
2nd campaign (2006-2007)
53.2%
69.5%
3rd campaign (2008-2009)
58.0%
69.1%
4th campaign (2010-2011)
62.3%
72.9%
5th
64.1%
75.8%
campaign (2013)
Fonguh, S
WIV-ISP 2013
13
2/10/2017
Fonguh, S
WIV-ISP 2013
Fonguh, S
WIV-ISP 2013
14
2/10/2017
Fongugh Sylvanus, 2013 www.nsih.be
Fongugh Sylvanus, 2013 www.nsih.be
15
2/10/2017
Fongugh Sylvanus, 2013 www.nsih.be
Point Prevalence Survey: HAI - ABU
N pts (a)
Prevalence%
(95%CI) (b)
N HAI (c)
Relative
% HAI (d)
Pneumonia & other LRTI
392
2.0% (1.8-2.2)
394
25.7%
Surgical site infections (e)
290
1.5% (1.3-1.6)
290
18.9%
Urinary tract infections
263
1.3% (1.2-1.5)
264
17.2%
Bloodstream infections (BSI)(f)
216
1.1% (0.9-1.2)
217
14.2%
Gastro-intestinal system infections
118
0.6% (0.5-0.7)
119
7.8%
Skin and soft tissue infections
59
0.3% (0.2-0.4)
59
3.9%
Bone and joint infections
38
0.2% (0.1-0.3)
39
2.5%
Eye, Ear, Nose or Mouth infection
47
0.2% (0.2-0.3)
47
3.1%
Systemic infections(f)
40
0.2% (0.1-0.3)
40
2.6%
Zarb et al., 2012 Eurosurveillance
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2/10/2017
Taux d'observance de l'hygiène des mains selon les 5 indications
5 Indications
Nombre d'opportunités
observées (n)
Hygiène des mains
Alcool + savon (n)
Taux d'observance
(%)
Avant contact patient
258
121
47
Après contact patient
323
210
65
Avant acte propre/invasif
96
54
56
Après contact liquide
biologique + muqueuse
22
17
77
Après contact matériel et
environnement du patient
128
62
48
Fonguh, S
WIV-ISP 2013
Exigences de base…
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2/10/2017
Figure 16: Pourcentage de personnes portant une bague, par
catégorie professionnelle. Avant et Après campagne 2013 (N
hôpitaux=83) .
Fonguh, S WIV-ISP 2014
Figure 18: Pourcentage de personnes portant une montre par catégorie
professionnelle. Avant et Après campagne 2013 (N hôpitaux=83) .
Fonguh, S WIV-ISP 2014
18
2/10/2017
Figure 20: Pourcentage de personnes portant un bracelet par catégorie
professionnelle. Avant et Après campagne 2013 (N hôpitaux=83) .
Fonguh, S WIV-ISP 2014
Figure 28: Pourcentage de personnes avec vernis à ongles par
catégorie professionnelle. Avant et Après campagne 2013 (N
hôpitaux=83) .
Fonguh, S WIV-ISP 2014
19
2/10/2017
Figure 30: Pourcentage de personnes avec des
ongles artificiels par catégorie professionnelle. Avant
et Après campagne 2013 (N hôpitaux=83).
Fonguh, S WIV-ISP 2014
Fonguh, S
WIV-ISP 2016
20
2/10/2017
Compliance in ICU
Objectifs de la présentation
•
•
•
•
•
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
–
–
–
–
ISO & USI
SEP
Clostridium difficile
ABUH
• Conclusions
21
2/10/2017
National surveillances of Surgical Site Infections
(SSI) and Nosocomial Infections (NI) in Intensive
Care Units (ICU)
Ir. Karl Mertens
National Programme on Healthcare-associated Infections
Scientific Institute of Public Health, Brussels (BE)
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium
T +32 2 642 51 11 | F +32 2 642 50 01 | email: [email protected] | www.wiv-isp.be
22
2/10/2017
Background: Importance
Surgical Site Infections
Nosocomial Infections in the ICU
Impact: readmission, re-intervention
Impact: extra length of stay,
morbidity, mortality
SSI: 3rd most frequent type of infection (14.6%)
ICU: bed index with highest prevalence (25.3%)
National Prevalence Study of Nosocomial Infections (KCE, 2007)
•
•
•
clear association with healthcare
related procedures
Varies according to surgical
intervention & procedures,
intervention duration, wound
contamination, patient severity
high rates of surgical interventions
taking place
•
•
Severe pathology of patient
population, vulnerable to NI
High exposure to medical
(invasive) acts
1/3rd of nosocomial infections can be prevented by means of an intensive
program of infection prevention and surveillance
SENIC study: Am J Epidemiol 1985; 121(2):182-205
SSI & ICU surveillance: tools
•
•
•
•
•
•
2 protocols
• follow closely ECDC (HAI-Net) protocols
• describe background, inclusion of surgical interventions (SSI) / patients
(ICU), case definitions, details on surveillance data to be collected,
participation options
Paper forms for manual data entry
NSIHwin software for local follow-up: data input, data import, validation,
analysis, export
Individual feedback reports for the hospital
Annually: national reports with aggregated indicators + submission of data to
ECDC – The European Electronic Surveillance System (TESSy).
http://www.nsih.be (SSI / ICU / NSIHwin webpages) : protocols, forms,
national annual reports, software & manual
23
2/10/2017
SSI surveillance in a glance
•
•
•
•
•
Participation period: 3 months
Choose >=1 group of interventions to follow from the list of NHSN (US)
intervention codes and its associated ICD-9-CM procedures
Recommended list of interventions (ECDC, optional)
Follow-up of SSI post-intervention, default 30d, 365d in case of foreign
bodies or materials
Optional:
•
•
•
•
post-discharge follow-up
intrinsic risk variables
microbial ecology
antimicrobial resistance
SSI surveillance: recommended interventions
Code
NHSN
Description
CBGB
Pontage coronaire avec incision
du thorax ainsi que
périphérique (B=Both)
Interventions à thorax ouvert en vue de
revascularisation directe du myocarde, y compris le
prélèvement du greffon veineux
CBGC
Pontage coronaire avec incision
du thorax seule (C=Chest only)
Comme ci-dessus, mais sans incision
complémentaire
CHOL
Cholécystectomie
Cholécystectomie avec ou sans geste sur la voie
biliaire principale
COLO
Chirurgie du colon
Incision, résection ou anastomose du colon;
comprenant également les anastomoses entre
l’intestin grêle et le colon
CSEC
Césarienne
HPRO
Prothèse de hanche
Prothèse articulaire de hanche
KPRO
Prothèse du genou
Prothèse articulaire de genou
LAM
Laminectomie
Exploration ou décompression des racines nerveuses
spinales par excision des structures vertébrales;
excision ou destruction de disque intervertébral
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Data input & analysis using NSIHwin software
•
•
•
•
•
•
Local software, MS Access
based, developed by IPH
Freely available
Used for 3 surveillances +
Hand hygiene campaigns
Manual data input,
Analysis using predefined
reports
Export to IPH (WIV-ISP)
Data import using NSIHwin software
•
•
•
•
In combination with NSIHwin
data entry & analysis
Objective: use surveillance
data that is already available
in electronic format
XLS format
Detailed manual available
from http://www.nsih.be
(NSIHwin webpage)
25
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Surveillance data: Indicators for Infection
Incidence
•
•
•
•
Objective: standardize Nosocomial Infection rates to make them
comparable across hospitals, countries
Construction of denominator
Progressive standardization according to the detail of the collected
denominator data:
• patients
• patientdays
• patientdays under fixed follow-up | invasive device days
• Stratified for intrinsic (case-mix) risk factors (SSI) or hospital types |
expected number of infections based on intrinsic risk factor data (ICU)
In its most refined case, differences in adjusted infection rates are due to
• Sampling variability
• Differences in sensitivity / specificity
• Differences in quality of care, infection prevention, structure & process
parameters.
SSI surveillance: Indicators for SSI
occurrence
# SSIs within 30d*
# interventions
•
Cumulative Incidence =
•
Cumulative Incidence within the hospital =
•
Incidence Density =
•
If available: stratification for NHSN risk index
categories
# SSIs in hospital within 30d*
# interventions
# SSIs in hospital within 30d*
# post-operative hospital days
* 1 year for HPRO or KPRO
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2/10/2017
ICU surveillance: Indicators for
infection occurrence
Nosocomial Pneumonia, Bloodstream, Urinary
Tract Infections:
# Infections
• Cumulative incidence =
# Patients
# Infections
# Patientdays
•
Incidence density =
•
Device-adjusted incidence density =
•
If available: Patients and patientdays,
Infection Incidence, device-adjusted
Infections incidence, mortality rates stratified
for risk factor levels
•
If available: Standardized Infection rate: #
Observed infections / # Expected Infections
# device-associated Infections
# device days
Individual feedback reports
•
•
•
Created and send back after
reception of surveillance data
Restricted to participating
hospitals, contact persons for the
particular surveillance within the
hospital
Versions: participation period,
year, cumulative | single, multiple
units (ICU)
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2/10/2017
Individual feedback reports
Tables showing for particular
participation period, for each
indicator:
• hospital’s mean
• the mean and relevant percentiles
of the national distribution
• ranking of the hospital mean within
the national distribution
Individual feedback reports
For most relevant indicators :
•
•
Benchmarks graphs showing
graphically the national distribution
+ position of the hospital’s mean
Evolution graphs showing the long
term evolution of the hospital’s
mean + relevant percentiles of the
national distribution
28
2/10/2017
SSI Surveillance: results 2002-2003
Cumulative incidence of SSI:
SSI Surveillance: results 2002-2003
Completeness of post-operative follow-up
29
2/10/2017
http://www.ecdc.europa.eu/en/publications/Publications/SSI-in-europe-2010-2011.pdf
30
2/10/2017
Coronary artery bypass graft
(CABG)
Key points
• 41 725 CABG operations were reported for 2010–
2011.
• The cumulative incidence of SSI was 3.5% [intercountry range: 2.8%–7.1%] in 2010–2011.
• The incidence density of SSI was 1.9 [intercountry range: 0.6–5.6] in-hospital SSI per 1 000
post-operative patient-days in 2010–2011.
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ICU Surveillance: Incidence 1997-2009
Nosocomial Pneumonia / 1000 patient
days:
Nosocomial intubation–associated
Pneumonia / 1000 intubation days
Mertens, et al., J Hosp Infect 2013
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2/10/2017
ICU Surveillance: Incidence 1997-2009
Nosocomial Bloodstream
Infections / 1000 patient days
Nosocomial catheter–associated
Bloodstream Infections / 1000 catheter
days
Mertens, et al., J Hosp Infect 2013
Objectifs de la présentation
•
•
•
•
•
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
–
–
–
–
ISO & USI
SEP
Clostridium difficile
ABUH
• Conclusions
33
2/10/2017
Naïma Hammami & Marie-Laurence Lambert
Belgian national surveillance of
bloodstream infections in the hospital (SEP)
Rue Juliette Wytsmanstraat 14 | 1050 Brussels | Belgium
T +32 2 642 51 11 | F +32 2 642 50 01 | email: [email protected] | www.wiv-isp.be
Relevance Public Health
Severity of infection 1:
•
•
•
High mortality
Increase length of stay
Increased health care cost
Incidence hospital acquired bloodstream infections
(HA-BSI): 5.9/1000 admissions and 8,2/10.000
patientdays2
Impact of preventive measures 3:
•
•
Origin: association invasive devices
↓ 10-70% of infection rates
1. Vrijens 2010 & Vrijens 2012
2. Belgian
national surveillance of nosocomial Septicemia, data 2013
77
3. Harbarth 2003, Pronovost 2006 – 2010, Umsheid 2011
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2/10/2017
OBJECTIVES
•
Monitoring trends :
incidence hospital-acquired bloodstream infections
(HA-BSI), focus preventable infections
•
•
Local and national level
Causal micro-organisms - resistance profile
•
•
Local and national level
Hammami, et al., WIV-SIP 2014
78
METHODS: Study design
Surveillance (start 1992, protocol review 2013)
Study population:
•
Belgian hospitals (KB/AR 2007):
•
•
Acute, chronic (if > 150 beds),
Hospitalised patients with HA-BSI episode:
•
Excl: non HA-BSI episodes (ambulatory patients,
community,etc), non hospital-Sp
Study (participation) period:
•
•
79
minimum 1 quarter / year
compulsory participation 2015 (new KB/AR June 2014)
Hammami, et al., WIV-SIP 2014
35
2/10/2017
OUTCOME INDICATORS
HOSPITAL
Indicator
Numerator
Denominator
Incidence HA-BSI
N HA-BSI ≥ 2 d
hospital
Admissions & pat.days hospital
Incidence ICU-BSI
N HA-BSI ≥ 2 d
ICU
Admissions & pat.days in ICU
(Admissions & pat.days ≥ 2 d in
ICU)
Incidence MO specific
BSI (e.g. MRSA HA-BSI)
→VIP2 (Flemish QI)
N HA-BSI ≥ 2 d
hospital, with
specific MO
Admissions & pat.days hospital
Incidence CVC
associated HA-BSI
→Federal QI
N CLABSI ≥ 2 d
hospital
Admissions & pat.days hospital
(Total patients with CVC)
(Total CVC days)
HA-BSI: hospital acquired bloodstream infections
ICU-BSI: ICU acquired bloodstream infections
MO: microorganism, CVC: central venous catheter, CLABSI: central line associated
80
bloodstream
infections
RESULTS: national report 2000-13
Descriptive:
•
Increasing participation:
•
•
Origin Top3:
•
•
ICU (22%), geriatrics (15%), internal medicine (12%)
µ-organism Top3:
•
81
central vascular catheter (27%), urinary (21%), pulmonary (11%),
Location Top3:
•
•
109 hospitalsites (>90%);
E. coli (22%), coag-neg. staphylococci (13%), Staph. aureus
(11%)
Hammami, et al., WIV-SIP 2014
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2/10/2017
METHODS: Data flow since 2013
Data entry :
By hospitals in Web-based application (Sharepoint)
(https://nsihweb.wiv-isp.be/SEP/ )
Bv. 2101 nsih code Nombre de septicémies par mois
•
•
Data transfer:
Hospital → SQL database
•
Feedback:
Hospital ( https://nsihweb.wiv-isp.be/SEP/ ):
•
•
individual FB, real time (scripts in SAS)
National:
•
•
•
annual (closure database end of March Y+1)
available on website
Hammami, et al., WIV-SIP 2014
82
RESULTS: national report 2000-13(2)
Overall incidence HA-BSI stable over years
•
2,5
Bias; changing participation
Incidence per µ-organism
SEP verworven in ziekenhuis /10.000 pd
2,0
2,0
Staphylococus aureus
1,5
Esherichia coli
1,2
Klebsiella pneumoniae
1,0
1,0
1,1
Pseudomonas aeruginosa
0,6
0,5
Enterococcus faecalis
0,5
0,4
0,4
0,3
0,0
2000
83
2001
2002
2003
2004
2005
2006 2007
Jaar
2008
2009
2010
2011
2012
2013
Hammami, et al., WIV-SIP 2014
37
2/10/2017
Hammami, et al., WIV-SIP 2014
Bloodstream infections
hospital wide
Duysburgh E & Lambert, MLL, WIV-ISP 2016
38
2/10/2017
Micro-organisms
Bloodstream infections
Duysburgh E & Lambert, MLL, WIV-ISP 2016
Bloodstream infections
Figure 10: Variation hospital associated bloodstream infections between hospitals, Belgium 2015
HA-BSI, hospital associated bloodstream infection; SD, standard deviation – The funnel plots gives a visual
identification of outliers; above or below 2SD (95%) and 3 SD (99.7%).
Duysburgh E & Lambert, MLL, WIV-ISP 2016
39
2/10/2017
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
•
•
•
•
ISO & USI
SEP
Clostridium difficile
ABUH
Conclusions
Evolution C. difficile
The peak in incidence around 2008 diminished and stabilised in 2010-2011
at an elevated level. Since then it is again showing a slight increase.
In 2013, the total incidence was reported as 1.65 cases / 1000
admissions in hospitals. In the same year, the mean incidence of
hospital-acquired cases (onset of symptoms > 2 days after admission in
the declaring hospital) was 1.29 / 10 000 hospitals days, more than the
preceding three years (data taken from hospitals participating in one
complete year [two semesters] of surveillance. The proportion of cases
which are community-associated has not substantially increased in
recent years, as described in other countries.
Neely, et al., WIV-SIP 2014
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Table 1: Epidemiological surveillance of Clostridium difficile infection (CDI): episodes of CDI in
hospitalized patients in Belgian hospitals 2008-2015
Year
2008
2009
2010
2011
2012
2013
2014
2015
2 989
2 949
2 466
2 516
2 507
2 711
2 444
2 975
65%
62%
62%
63%
61%
60%
59%
60%
Episodes
Total episodes reported
Episodes with hospital-associated
(HA) CDI* (%)
For episodes other than HA-CDI –
Suspected origin of infection
Community
56%
57%
59%
60%
63%
62%
63%
67%
Declaring hospital**
18%
17%
17%
18%
16%
15%
17%
15%
Other hospital
16%
14%
12%
10%
10%
10%
8%
9%
Unknown/missing
10%
12%
11%
12%
12%
12%
11%
9%
Yes
16%
12%
12%
11%
13%
13%
12%
15%
No
68%
70%
69%
72%
67%
68%
72%
70%
Unknown
16%
18%
19%
16%
20%
18%
16%
16%
Recurrent episodes*** (%)
*Defined as onset of diarrhoea 2 days or more after admission in the declaring hospital (onset date
minus admission date >=2)
**Declaring hospital : episodes with onset less than 2 days after admission subjectively thought to
have their origin in the declaring hospital (e.g. readmissions within 4 weeks after discharge)
***Defined as the proportion of episodes which are recurrent, and not the incidence of recurrences in
patients presenting with a new episode of CDI
Valencia et al., 2016
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Table 1: Top 5 CDI ribotypes isolated within the national
surveillance programme, by the number of hospitals in which
they are isolated. Belgium, 2009-2015
Year
N hospitals sending
strains for typing
(100%)
2009
104
2010
103
2011
84
2012
111
2013
103
2014
112
2015
97
35
33
11
11
34
33
26
25
32
38
20
24
45
41
35
32
42
38
39
35
6
5
38
37
25
24
29
28
28
27
13
13
42
38
28
25
41
37
27
24
18
16
46
47
41
42
35
36
30
31
N hospitals with...
BR014 (UCL16)
%
BR078 (UCL 3)
%
BR020 (UCL16a,16a+)
%
BR002 (UCL32,32+)
%
BR0106 (UCL048d)
%
21
22
Valencia et al., 2016
Mean incidence of hospital- associated Clostridium difficile infections per 10 000
hospital days in acute hospitals, by province. Belgium,2015
Mean incidence: sum of episodes / sum of hospital-days for all acute hospitals providing data
(one or two semesters) in 2015. Categories based on quartiles of the incidence distribution.
Valencia et al., 2016
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Figure 1 : Mean annual incidence of infection with Clostridium difficile (CDI) – total cases and
hospital associated cases /1000 admissions, in acute care$ Belgian hospitals, 2008-2015
Episodes CDI/1000 admissions
2,50
2,00
1,50
Hospital associated episodes
1,00
Total episodes
0,50
0,00
2008 2009 2010 2011 2012 2013 2014 2015
Year
* Only acute hospitals providing data for the whole year are included.
$
Acute hospitals: defined on the basis of mean length of stay <14 days
Valencia et al., 2016
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Table 1 : Hospital stays with an intestinal infection due to Clostridium difficile (code ICD-9_CM
008.45*), Belgium 1999-2010
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
CDI as primary diagnostic code (no.)
415
467
423
501
723
907
959
1007
1040
1116
1148
920
866
26%
23%
23%
25%
23%
22%
23%
22%
23%
25%
24%
24%
% of the total
25%
CDI as secondary diagnostic code (no.)
Total
1270
1356
1404
1698
2155
3086
3456
3383
3646
3633
3514
2947
2715
1685
1823
1827
2199
2878
3993
4415
4390
4686
4749
4662
3867
3581
*ICD9-CM International classification of diseases, CDI: Clostridium difficile infection
Neely et al., 2014 – WIV-ISP
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C. difficile USA
RESULTS:
The population-based rate of CDI in older Americans was 282.9/100,000 person-years (95%
confidence interval (CI)) 226.3 to 339.5) for individuals with depression and
197.1/100,000 person-years for those without depression (95% CI 168.0 to 226.1). The
odds of CDI were 36% greater in persons with major depression (95% CI 1.06 to 1.74), 35%
greater in individuals with depressive disorders (95% CI 1.05 to 1.73), 54% greater in those
who were widowed (95% CI 1.21 to 1.95), and 25% lower in adults who did not live alone
(95% CI 0.62 to 0.92). Self-reports of feeling sad or having emotional, nervous or psychiatric
problems at baseline were also associated with the later development of CDI. Use of certain
antidepressant medications during hospitalization was associated with altered risk of CDI.
CONCLUSIONS:
Adults with depression and who take specific anti-depressants seem to be more likely to develop
CDI. Older adults who are widowed or who live alone are also at greater risk of CDI.
Rogers, M.A.M., Greene, M.T., Young, V.B., Saint, S., Langa, K.M., Kao, J.Y., Aronoff, D.M., 2013. Depression, antidepressant medications, and risk of Clostridium
difficile infection. BMC Med. 11, 121. http://dx.doi.org/10.1186/1741-7015-11-121.
Conclusions
Antibiotic agents are ‘invasive’, also if given orally
45
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Objectifs de la présentation
•
•
•
•
•
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
–
–
–
–
ISO & USI
SEP
Clostridium difficile
ABUH
• Conclusions
Specialities to be reported (WHO, ESAC, pubMED)
ATC classification:
A07A Antibiotics for gastro-intestinal use
J01, P01AB Antibiotics
J02, D01BA Antimycotics for systemic use
J04A Tuberculostatics
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ATC
Class
J01C
Beta-lactam antibacterials, penicillins
J01D
Other beta-lactam antibacterials
J01M
Quinolone antibacterials
J01X
Other antibacterials
J02A
Antimycotics for systemic use
J01F
Macrolides, lincosamides and streptogramins
J01G
Aminoglycoside antibacterials
J04A
Drugs for treatment of tuberculosis
J01E
Sulfonamides and trimethoprim
A07A
Intestinal anti-infectives
P01A
Agents against amoebiasis/protozoal diseases
J01A3
Tetracyclines
D01B
Antifungals for systemic use
J01B0
Amphenicols
FEEDBACK
Compare own use with national mean
47
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AUTOMATIC FEEDBACK
Local follow up
FEEDBACK
48
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Conclusions ABUH
-
Résultats: points faibles
-
dénominateur: journées d’hosp vs. admissions?
Stratification: unité, type d’hôpital, taille, région?
-
Evolution MRSA, MRE, C.diff, … complémentaire
Nécessite collecte mensuelle (rétrospective)
-
-
Plusieurs hôpitaux l’ont déjà fait!
Résultats: points forts
-
Suivi interne plus important que le ‘benchmarking’
Ingenbleek, A et al. WIV-ISP 2015
49
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Ingenbleek, A et al. WIV-ISP 2015
J01 - Non-paediatrics
15 most used products
DDD/1000 bed-days
40
30
20
10
C
ef
az
C
ol
ip
in
ro
P
flo
ip
er
xa
&
ci
n
en
zy
in
Fl
h
ib
uc
lo
xa
ci
M
lli
n
er
op
en
em
C
ef
tri
ax
on
M
ox
e
ifl
ox
ac
C
in
ef
ur
ox
im
C
lin
e
da
m
C
yc
la
rit
in
hr
om
M
yc
et
in
ro
ni
da
zo
le
A
m
ox
ic
illi
n
Te
m
oc
ill
C
in
ef
ta
zi
di
m
V
an
e
co
m
yc
in
0
2007
2008
2009
2010
2011
2012
2013
Note: National median consumption in acute care settings. J01CR02 excluded
Participation: 2007 n=55; 2008 n=96; 2009 n=98; 2010 n=97; 2011 n=97; 2012 n=93; 2013 n=83
Ingenbleek, A et al. WIV-ISP 2015
50
2/10/2017
Ingenbleek, A et al. WIV-ISP 2015
Stratified by ward: antibacterials
51
2/10/2017
Stratified by ward: antimycotics
ESAC
National level, all antimicrobials included
HOSPITALS
Year
Participants
Total DDD for the year
DDD/1000 Nights
2008
121
7315319.20
579.734
2009
124
7273099.57
583.651
2010
120
6940067.65
585.087
2011*
106
6561559.15
581.215
2011*: The data collection for the year 2011* is on-going.
52
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53
2/10/2017
Conclusions
Antibiotic agents are ‘invasive’, also if given orally
Denominator /1000 patient days is superior unit
for hospitals (not DDD/1000 inhabitants per
day).
35
1,75
30
1,5
25
1,25
20
1
15
0,75
10
0,5
5
0,25
0
0
1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Years
DDD per 1000 inhabitants and per day
DDD per 1000 inhabitants and per day
Ambulant care
J01
J02
Figure 2. Trends of antimicrobial (ATC group J01) and antimycotic (ATC group J02) drugs for systemic use in the ambulant care in
Belgium. Reporting years 1997-2015. (DDD: defined daily dose).
WIV-ISP, 2017 NSIH report Catry et al., in press
54
2/10/2017
Introduction des données par https://www.healthstat.be
1. Authentication par eID
Selectionnez: ‘LOG IN’:
138
https://www.healthstat.be
1. Authentication par eID
Selectionnez le certificat et introduisez votre code pin (e-ID):
139
139
55
2/10/2017
https://www.healthstat.be
2. Indiquez l’organisation/site/fusion – ensuite ‘Enregistrer’
140
140
Ingenbleek A, Vrancken K, WIV-ISP 2016
56
2/10/2017
Objectifs de la présentation
Introduction
Cadre légal
nsih.be
Campagne HDM
Surveillances
•
•
•
•
ISO & USI
SEP
Clostridium difficile
ABUH
Conclusions
57
2/10/2017
Conclusions (1)
Antibiotic agents are ‘invasive’, also if given orally
Hand hygiene alone is insufficient to control HAI
Monthly FQ consumption, expressed as DDD/1000 PD. Filled circles, pre-intervention period
values; open circles, intervention period values; diamonds, post-intervention period values.
Lafaurie M et al. J. Antimicrob. Chemother. 2012;67:10101015
© The Author 2012. Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:
[email protected]
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Monthly consumption of ABHR solution.
Lafaurie M et al. J. Antimicrob. Chemother. 2012;67:10101015
© The Author 2012. Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:
[email protected]
Change in monthly FQ-resistant P. aeruginosa rates, from 2002 to 2010.
Lafaurie M et al. J. Antimicrob. Chemother. 2012;67:10101015
© The Author 2012. Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:
[email protected]
59
2/10/2017
Change in monthly MRSA rates, from 2002 to 2010.
Lafaurie M et al. J. Antimicrob. Chemother. 2012;67:10101015
© The Author 2012. Published by Oxford University Press on behalf of the British Society for
Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail:
[email protected]
Conclusions (2)
Antibiotic agents are ‘invasive’, also if given orally
Hand hygiene alone is insufficient to control HAI
Denominator /1000 patient days is superior unit for
hospitals (not DDD/1000 inhabitants per day).
Hotspots: ICU/HAE-ONC & livestock
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61
2/10/2017
Figuur 1Non-pediatric antimicrobial use in the community in Daily Defined Doses per 1000 inhabitant days.
Belgium 2007-2013
62
2/10/2017
Conclusions (3)
Antibiotic agents are ‘invasive’, also if given orally
Hand hygiene alone is insufficient to control HAI
Denominator /1000 patient days is superior unit for
hospitals (not DDD/1000 inhabitants per day).
Hotspots: ICU/HAE-ONC & livestock
Fast diagnostics (AB spectrum) and automatisation
(hand hygiene & GLIMS), and qualtiy validation
of National Ref Centers are needed.
The detailed information is out there…
Acknowledgements:
The NSIH team, ECDC, BAPCOC
The labs, NRCs & hospitals & nursing homes
[email protected]
Slides available on: www.nsih.be
63

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Intestinal spirochetosis: a case series and review of the