Evaluation of the efficiency of hospital antibiotic policy applied Dr Jan Biziel University Hospital No 2 in Bydgoszcz in 2009-2013.

UNLABELLED: The Hospital Infection Control Team (HICT) of Dr Jan Biziel University Hospital No 2 in Bydgoszcz developed and implemented the principles of a rational antibiotic therapy in 2008. A behavior algorithm has worked since 01.10.2008. Implementation of the principles of a rational antibiotic therapy was part of the hospital antibiotic policy. THE AIM OF THE STUDY: is to evaluate either introductory principles of the rational antibiotic therapy, after five-year experience lived up to expectations in the range specified by the authors. MATERIAL AND METHODS: Hospital microbiological maps, comparisons of antibiotic cost, specification of microbiological tests made before and after introduction of the principles of a rational antibiotic therapy have been analyzed. Annual antibiotic consumption has been counted according to the defined daily dose (DDD) index created by the WHO. RESULTS: After 6 years of implementation of the rational antibiotic therapy principles, the decrease in number of isolated strains which are resistant to Klebsiella pneumoniae ESBL and Acinetobacter baumanii (resistant to carbapenems) has been indicated. The number of the Pseudomonas aeruginosa isolates has increased approximately three times, and the number of resistant isolates to carbapenem has grown six times. The cost of antibiotics has been gradually decreased in 2012 in order to represent 9,66% of all drug budget (without drug programs). Detailed analysis of antibiotic consumption has showed that after the implementation of rational antibiotic therapy principles the consumption of meropenem has increased twice in comparison to the all drugs. The number of microbiological tests grew from 0,20 to 0,29 per one patient, which means material to microbiological tests has been taken from every third patient. Annual DDD index calculated on 100 person-days has been reduced from 59,552 in 2007 to 39,90 in 2009, and it is 47,88 in 2013. The principles of rational antibiotic therapy in comparison with the other elements of antibiotic policy in hospital have caused positive changes in antibiotic ordinance. CONCLUSIONS: 1. It is required to adhere to the principles of a rational antibiotic therapy by medical staff mainly on the administrative restriction of access to antibiotics. 2. Monitoring changes in drug resistance of hospital flora is an essential element of the principles of a rational antibiotic therapy modification.

[Molecular epidemiology of Acinetobacter baumannii strains isolated in the years 2008-2010 in University Hospital no. 2 in Bydgoszcz]. / Epidemiologia molekularna szczepów acinetobacter baumannii izolowanych w latach, 2008-2010 w szpitalu uniwersyteckim nr 2 w bydgoszczy.

INTRODUCTION: Hospital infection registers prepared by Anaesthesiology and Intensive Care Unit (AICU) of J. Biziel University Hospital no. 2 in Bydgoszcz in the years 2007-2010 indicated to high incidence of bacterial infections of Acinetobacter baumannii aetiology. The specificity of the Unit poses the risk of hospital infection with environmental bacteria constituting the bacterial flora of the Unit to other units of the hospital in accordance with the direction of the patients relocation. MATERIAL AND METHODS: [corrected] In order to determine the aforementioned risk, the authors had collected and stored (in frozen state) Acinetobacter strains of similar phenotype as regards the resistance (146 isolates were collected in total) for 3 years and then the genotype of 12 selected isolates was determined. Differential molecular diagnosis was performed using pulsed field gel electrophoresis (PFGE). RESULTS. Results of the molecular tests of Acinetobacter strains (isolated from clinically significant material) were analysed in the context of epidemiologic investigations. On the basis of the results, the authors found out that there are at least two epidemic strains of Acinetobacter baumannii; one of them was isolated from patients treated in AICU only. It is alarming that genotype has been isolated from the patient who has never been treated in AICU. Transfer of hospital infections caused by Acinetobacter baumannii strains isolated so far from AICU

[Legionella contamination of hospital hot water supply systems in the light of research conducted in 2008-2010 as part of supervision by the Country Sanitary Inspector in Bydgoszcz]. / Kolonizacja szpitalnych sieci wody cieplej Legionella sp. w swietle badan prowadzonych w latach 2008 - 2010 w ramach nadzoru przez Panstwowego Powiatowego Inspektora Sanitarnego w Bydgoszczy.

The aim of the study was to assess the level of Legionella sp. contamination in the hot water supply systems at the premises of inpatient healthcare facilities. In the years 2008-2010 the State Poviat Sanitary Inspector in Bydgoszcz tested the hot water supply systems in 8 hospitals. A total of 88 samples of hot water were collected in the years 2008-2010. The analysis involved temperature measurements and microbiological testing of the hot water. Contamination levels exceeding the applicable standards were discovered in 6 hospitals. The corrective measures introduced allowed for a significant improvement in each case. The hospital hot water systems revealed Legionella sp. contamination levels considerably exceeding the approved standards. Of the 88 water samples tested, 37 contained excessive numbers of Legionella sp. bacteria (i.e. above 100 CFU in 100 ml of water), which constituted 63.6% of the samples tested. In 6 of the 8 investigated hospitals the Legionella sp. contamination of the hot water supply system was found to be on the medium or high level. The analysis of temperature measurements revealed that the lowest temperature readings were associated with high bacterial colonization of the plumbing system. After the implementation of corrective measures, 50 control samples were collected, and in 37 of them the bacterial levels were below 100 CFU per 100 ml of water. The Legionella sp. contamination was found to be associated with low temperature of the hot water.

[Score method evaluation of the sanitary condition of the University Hospital in Bydgoszcz and personnel education in 2007 - 2010]. / Punktowa metoda oceny stanu sanitarno-higienicznego i wyszkolenia personelu Szpitala Uniwersyteckiego w Bydgoszczy w latach 2007-2010.

UNLABELLED: The Quality Management System ISO 9001:2008 introduced by the Management Board of the hospital in the year 2007 resulted in change of the methods used by the Hospital Infection Control Team (HICT) to assess the sanitary-and-hygienic condition. The inspection protocol used by HICT was modified as part of the Quality Management System. It was supplemented by the score sheet which made the inspection results more objective. The purpose of the study was to assess the results of the supervision over the sanitary and epidemiologic condition of the hospital as well as personnel training carried out in the years 2007-2010 by the Hospital Infection Control Team (HICT) of Szpital Uniwersytecki nr 2 im. dr. J.Biziela (J.Biziel University Hospital no. 2). 407 inspection protocols issued in the years 2007-2010 were analysed. The sanitary/hygienic condition indicators and personnel education indicators were calculated based on the analysed data. The sanitary/hygienic condition indicator for the entire hospital in the years 2008-2010 amounted to over 91.50% and only in the year 2007 it was 89.33%. While the personnel education indicator for the entire hospital increased from 90.35% in 2007 to 93.75% in 2010. CONCLUSIONS: the assessment of hospital units performed on the basis of the new protocol of the sanitary/hygienic condition has been proven in practice, i.e. insufficient personnel education as regards hospital hygiene is efficiently detected by HICT at individual workstations and the Management Board of the hospital is notified on the ongoing basis on the results of supervision provided by HICT.

[Practical aspects of implementation quality management system ISO 9001:2000 by hospital infection control team]. / Praktyczne aspekty wdrazania systemu zarzadzania jakoscia ISO 9001:2000 przez Zespól Kontroli Zakazen Szpitalnych.

In 2006 the Board of the Jan Biziel Hospital in Bydgoszcz decided to include procedures of health services in the implementation process within the confines of ISO 9001:2000 certification. The hospital infection control team that has operated in the hospital since 1989 performed the analysis of the forms of activities to date and on that basis the team prepared original plan of quality management. In April 2007, this plan was successfully accepted by the certifying team. The aim of this study is to present the aforementioned plan which is the result of 18 years experience of the team. At the same time, I hope that this study will be very helpful for all professionals interested in hospital epidemiology, especially in the context of implementing quality management systems.

[Anti-nicotine education applied in relation of parents of the diseased children on chronic allergic diseases of respiratory system]. / Edukacja antynikotynowa stosowana wobec rodziców dzieci chorych na przewlekle alergiczne choroby ukladu oddechowego.

The allergies of respiratory system are at children the frequent illnesses. Among favorable them factors, risk on passive smoking tobacco can be also. Passive smoking is defined as risk non-smoking on tobacco smoke in environment. Recent reports represent that smoking in home environment tobacco increase on passive smokers' asthma morbidity, especially children in school age. It in it was report the necessity of leadership of anti-nicotine education was underlined in the face of smoking parents. It bets that she should motivate she better parents to cessation smoking, using authority of doctor and love parental. Acting we decided with these principles to analyze effectiveness two year anti-nicotine education which be applied in the face of all treated smoking parents of children with reason of chronic allergic diseases of respiratory system in out-patients. The study comprised parents of 146 children at the Allergy out-Patients clinic, who were diagnosed and cured in years 2003-2005. Generally were 292 persons. The children be treated with reason of bronchial asthma and allergic rhinitis. It the data on subject of smoking of tobacco were collected was on basis of interview got from parents during visits at information bureau on beginning the treatment the children, in his track as well as after two years of education. The anti-nicotine education was applied by whole period of observation during routine medical visits. In moment beginning of treatment in studied group the parents' and education children (n = 292) it 79 the parents' couple did not smoke. Smoking parents among remaining 67 steams were. From among them parents 13 children smoked both, only father in 36 cases smoked and mother in remaining 18 parents' couple smoked. 80 parents smoked with generally. 63 persons after two years of anti-nicotine education the nonsmoking committed one from group smoking. 22 persons among them were from among 24 fathers and 17 mothers' peer in which smoked both parents. Remaining smoking and non-smoking parents granted that children tried to restrain to minimum stay in environment smoking. We on basis of received results to affirm that child's disease has on parents' behaviour essential influence can. It in child was affirmed was all analyzed situations characteristic decrease number with diseased child of smokers' families. Recapitulating anti-nicotine education of the children's parents diseased on chronic allergic diseases of respiratory system is very good restrictive agent their exposition on smoking the tobacco. Contemporaneously in effective way influences on decisions of adults about cessation smoking and the healthy style of life promotes.

[Hepatitis B virus infections in 2002-2004 in Kujawsko-Pomorskie voivodeship]. / Zakazenia wirusem zapalenia watroby typu B w latach 2002-2004 na terenie województwa kujawsko-pomorskiego.

UNLABELLED: The aim of this study was to review epidemiological status of HBV infections in our province by using new clinical findings. 1836 reported cases of infection HBV were analysed on the basis of available documentation. Diagnosis of the acute, chronic or carrier infection were agreed on the basis of interview and presented clinical, biochemical and immunoserological exponents. 152 cases of acute hepatitis B were reported in analysed period. Among them one child under 9. Remaining cases were new detected chronic infections. The registered morbidity of acute hepatitis B was 58% lower during 3 years. All together 17671 persons were infected HBV in our province and the prevalence was 0, 85%. CONCLUSIONS: The incidence of acute hepatitis B in 2002-2004 demonstrated a strong tendency for decrease, especially among children under 9. The prevalence of hepatitis B was comparable with european average. The results of our analysis demonstrated that epidemiological status of HBV infections in our province presented in previous publications was incorrect. Statistical data did not differentiate new cases of hepatitis B for acute and chronic which resulted in incorrect outcomes.

[Early adverse reactions after vaccination against influenza in chronically ill people]. / Wczesne objawy niepozadane obserwowane po szczepieniu przeciwgrypowym zastosowanym u przewlekle chorych.

The objective was to assess the early adverse reactions after vaccination against influenza with the use of Fluarix vaccine (SmithKline Beecham) in chronically ill people. 1010 people were selected to undergo vaccination. The group included 621 women aged on average 44.2 years and 389 men aged on average 48.2. The vaccination was conducted simultaneously and the period of adverse reactions monitoring lasted 14 days. The vaccination was performed in accordance with recommendations of manufacturer. All the vaccinated people suffered from circulatory system disorders, bone system disorders, mental disorders and endocrinological problems. They were in the period of remission during the vaccination. The observed symptoms were classified into two categories: local and general. The local symptoms included swelling, reddening and pain in the vaccinated area. 67 people (6.6%) reported swelling, 85 (8.4%) reported reddening, 12 people (1.2%) reported pain in the vaccinated area. The general symptoms included headache, bad mood and temperature over 37.5 degrees C. 19 people (1.9%) reported bad mood, 10 people (1%)--headache and 8 people (0.8%) reported temperature over 37.5 degrees C. Coexistence of two or three types of symptoms was present in 15 cases (1.5%). The low percentage of early adverse reactions encourages a wider use of vaccines against influenza in chronically ill people.

[Adverse reactions after vaccination against influenza in chronically ill people]. / Objawy niepozadane u przewlekle chorych po szczepieniu przeciwko grypie.

The objective was to assess the early and late adverse reactions after vaccination against influenza with the help of SmithKline Beecham's Fluarix vaccine in chronically ill people. 1010 people was selected to undergo vaccination. These included 621 woman aged average 44.2 and 389 men aged average 48.2. The vaccination was conducted simultaneously and the period of monitoring adverse reactions lasted 9 months. The vaccination was done in accordance with recommendations of manufacturer. All the vaccinated people suffered from circulatory system disorders, bone system disorders, mental disorders and endocrinological problems, during the vaccination they were in period of remission. The observed early symptoms fell into two categories: local and general. The late adverse reaction assessed with appearance of aggravation of main chronic disease or with appearance of the new chronic disease. The local symptoms included swelling, reddening and pain in the vaccinated area. 67 people (6.6%) reported swelling, 85 (8.4%) reported reddening, 12 people (1.2%) reported pain in the vaccinated area. The general symptoms included headache, bad mood and temperature over 37.5 degrees C. 19 people (1.9%) reported bad mood, 10 people (1%)--headache and 8 people (0.8%) reported temperature over 37.5 degrees C. Coexistence of two or three types of symptoms was present in 15 cases (1.5%). There were no late adverse reactions in the study group. The low percentage of early adverse reactions and no late adverse reactions encourages a wider use of vaccines against influenza in chronically ill people.