Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance

C Schröder; F Schwab; M Behnke; A-C Breier; F Maechler; B Piening; M Dettenkofer; C Geffers; P Gastmeier

doi:10.1016/j.ijmm.2015.08.034

Epidemiology of healthcare associated infections in Germany: Nearly 20 years of surveillance

Int J Med Microbiol. 2015 Oct;305(7):799-806. doi: 10.1016/j.ijmm.2015.08.034. Epub 2015 Aug 24.

Authors

C Schröder¹, F Schwab², M Behnke², A-C Breier², F Maechler², B Piening², M Dettenkofer³, C Geffers², P Gastmeier²

Affiliations

¹ Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany. Electronic address: christin.schroeder@charite.de.
² Institute for Hygiene and Environmental Medicine, National Reference Centre for the Surveillance of Nosocomial Infections, Charité - University Hospital, Hindenburgdamm 27, 12203 Berlin, Germany.
³ Institute for Environmental Medicine and Hospital Hygiene, University Medical Centre Freiburg, Germany.

PMID: 26358916
DOI: 10.1016/j.ijmm.2015.08.034

Abstract

Objective: To describe the epidemiology of healthcare-associated infections (HAI) in hospitals participating in the German national nosocomial infections surveillance system (KISS).

Method: The epidemiology of HAI was described for the surveillance components for intensive care units (ITS-KISS), non-ICUs (STATIONS-KISS), very low birth weight infants (NEO-KISS) and surgical site infections (OP-KISS) in the period from 2006 to 2013. In addition, risk factor analyses were performed for the most important infections of ICU-KISS, NEO-KISS and OP-KISS.

Results: Data from a total of 3,454,778 ICU patients from 913 ICUs, 618,816 non-ICU patients from 142 non-ICU wards, 53,676 VLBW from 241 neonatal intensive care units (NICU) and 1,005,064 surgical patients from operative departments from 550 hospitals were used for analysis. Compared with baseline data, a significant reduction of primary bloodstream infections (PBSI) and lower respiratory tract infections (LRTI) was observed in ICUs with the maximum effect in year 5 (or longer participation) (incidence rate ratio 0.60 (CI95 0.50-0.72) and 0.61 (CI95 0.52-0.71) respectively). A significant reduction of PBSI and LRTI was also observed in NEO-KISS when comparing the baseline situation with the 5th year of participation (hazard ratio 0.70 (CI95 0.64-0.76) and 0.43 (CI95 0.35-0.52)). The effect was smaller in operative departments after the introduction of OP-KISS (OR 0.80; CI95 0.64-1.02 in year 5 or later for all procedure types combined). Due to the large database, it has not only been possible to confirm well-known risk factors for HAI, but also to identify some new interesting risk factors like seasonal and volume effects.

Conclusions: Participating in a national surveillance system and using surveillance data for internal quality management leads to substantial reduction of HAI. In addition, a surveillance system can identify otherwise not recognized risk factors which should - if possible - be considered for infection control management and for risk adjustment in the benchmarking process.

Keywords: Epidemiology; Healthcare-associated infections; Nosocomial infections; Prevention; Surveillance.

MeSH terms

Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cross Infection / epidemiology*
Epidemiological Monitoring
Female
Germany / epidemiology
Hospital Departments
Humans
Infant
Infant, Newborn
Male
Middle Aged
Pneumonia / epidemiology
Risk Factors
Sepsis / epidemiology
Surgical Wound Infection / epidemiology
Young Adult