Ventilator-associated pneumonia in Polish intensive care unit dedicated to COVID-19 patients.

BACKGROUND: Healthcare-Associated Infections (HAI) are most frequently associated with patients in the Intensive Care Unit (ICU). Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), led to ICU hospitalization for some patients. METHODS: The study was conducted in 2020 and 2021 at a hospital in southern Poland. The Healthcare-Associated Infections Surveillance Network (HAI-Net) of the European Centre for Disease Prevention and Control (ECDC) was used for HAI diagnosis. The aim of this case-control study was to retrospectively assess the epidemiology of HAIs in ICU patients, distinguishing between COVID-19 and non-COVID-19 cases. RESULTS: The study included 416 ICU patients: 125 (30%) with COVID-19 and 291 (70%) without COVID-19, p < 0.05. The mortality rate was 80 (64%) for COVID-19 patients and 45 (16%) for non-COVID-19 patients, p < 0.001. Ventilator-Associated Pneumonia (VAP) occurred in 40 cases, with an incidence rate density of 6.3/1000 patient-days (pds): 14.1/1000 pds for COVID-19 patients vs. 3.6/1000 pds for non-COVID-19 patients. Odds Ratio (OR) was 2.297, p < 0.01. Acinetobacter baumannii was the most often isolated microorganism in VAP, with 25 cases (incidence rate 8.5%): 16 (18.2%) in COVID-19 patients vs. 9 (4.4%) in non-COVID-19 patients. OR was 4.814 (1.084-4.806), p < 0.001. CONCLUSIONS: Patients treated in the ICU for COVID-19 faced twice the risk of VAP compared to non-COVID-19 patients. The predominant microorganism in VAP cases was Acinetobacter baumannii.

Five-Year Analysis of Surgical Site Infections in Three Orthopaedics and Trauma Wards under HAI-Net from the South of Poland in 2014-2018 Considering the Standardized Infection Ratio.

Background and Objectives: Surgical site infections (SSIs) are the most common healthcare-associated infections (HAIs) in surgical wards. The highest risk of developing SSI is carried by operations involving implants, such as: hip prosthesis (HPRO), knee prosthesis (KPRO), open reduction of fracture (FX), and closed reduction of fracture with internal fixation (CR). Objectives. The objective of the study was to assess the incidence of SSI in patients subjected to HPRO, KPRO, FX, and CR procedures in orthopaedics and trauma wards in 2014-2018 considering risk factors included in the SIR index. Materials and Methods: The study included 6261 patients who were subjected to orthopaedic surgery in 2014-2018. The investigation covered three hospitals with orthopaedics and trauma wards. The research was conducted in the framework of the national HAI surveillance programme according to the methodology of the HAI-Net, ECDC. Results: A total of 6261 surgeries were investigated, of which 111 cases of SSI were detected. The incidence was 1.8%; HPRO (incidence 2.1%, median (Me) surgery duration 90 min, and standardized infection ratio (SIR) above 1 in all units tested); KPRO (incidence 2.0%, Me 103 min, and SIR above 1 for all units tested); FX (incidence 1.9%, Me 70 min, and SIR above 1 for two units tested and below 1 in one unit); CR (incidence 1.0%, Me 55 min, and SIR-not calculated). The etiological agents that were most frequently isolated from patients with SSI were Staphylococcus aureus, coagulase-negative Staphylococcus, and Klebsiella pneumoniae. Conclusions: HPRO, KPRO, and FX operations performed in the studied wards carried a higher risk of developing SSI than that predicted by SIR. SSIs accounted for a significant percentage of the overall infection pool in CR surgeries. Actions should be undertaken to reduce the incidence of SSI in these surgeries. There should be a hospital network which facilitates cooperation in order to better monitor and analyse the incidence of SSI.

Hospital knowledge and practice of doctors and nurses regarding hand hygiene in a survey.

INTRODUCTION: The guidelines issued by the World Health Organization (WHO) in 2009 regarding hand hygiene (HH) in health care provided health care professionals with scientific evidence that argued that HH principles should be respected when dealing with patients. Despite the passage of years and strenuous attempts to introduce these recommendations to the Polish health care facilities for the prevention of healthcare-associated infections (HAI), these principles are still not being implemented in an optimal way for the patient's safety. OBJECTIVE OF WORK: The aim was to examine the views and attitudes of physicians (L) and nurses (P) towards the WHO rules of hand hygiene. MATERIAL AND METHODS: The study was performed by means of a diagnostic survey using a questionnaire of our own design; random sampling was used. The study involved 231 LP: 173 (74.9%) women, 58 (25.1%) men, including 93 (40.3%) doctors and 138 (59.7%) nurses. The study was conducted in a multiprofile hospital in Malopolska in 2017. The difference between what the respondents think (their views) and what they do in reality (what attitudes they display) was examined in relation to WHO principles, such as wearing natural short nails and jewelry on their hands. RESULTS: Negative practice of observing these HH principles in relation to views was detected (R = -0.014, p<0.05, R2 = 0.016). Respondents supported the view that the ring could affect HAI and rarely used it in practice, the practice was positive (R = 0.298, p <0.001, R2 = 0.085). Women strongly emphasized the view that wearing long nails has an impact on HAI spread, but in practice they often declared keeping long nails, practice was negative (R = -0.241, p <0.01, R2 = 0.054). In response to the question about the impact of nail painting on the spread of HAI, this view was poorly represented, in practice some of them wore painted nails, the practice was negative (R = -0.226, p <0.01, R2 = 0.045). CONCLUSION: Despite high support for the principles of hand hygiene, in practice, these principles were not always respected, the impact on the practice was negative in areas such as: general adherence to the HH principles, wearing long and painted nails. The compatibility of views with practice was detected in relation to wearing a wedding ring.

Analysis of the incidence of surgical site infections after open reposition of long bone fractures and closed fracture settings in a 7-year follow-up in an orthopedic and trauma ward in southern Poland.

INTRODUCTION: Surgical Site Infection (SSI) is the most common clinical form of Healthcare-Associated Infections (HAI) in orthopedic and trauma wards. MATERIAL AND METHOD: A retrospective study was conducted at the Department of Orthopedics and Trauma Surgery in Tarnów in 2012-2018. 3 155 patients treated for bone fractures were analyzed, including 1961 Open Reduction of Fracture (FX) and 1 194 Closed Reduction of Fracture with Internal Fixation (CR) surgeries. The study was conducted in accordance with the methodology recommended by the Surveillance Network (HAI-Net), European Centre for Disease Prevention and Control (ECDC). The aim of the study was to assess the incidence of SSI in patients undergoing the FX and CR procedures. RESULTS: 28 SSIs were identified in the examined ward; 16 SSI cases related to the FX procedure and 12 cases related to CR. The incidence for FX was 0.8% and for CR 1%. In patients with diagnosed SSI, the stay in the ward was longer (p <0.001) than in patients without SSI. In FX operations, the standardized risk index (SIR) did not exceed the value of one. Staphylococcus aureus was the most common organism isolated from materials from patients with SSI. CONCLUSIONS: In the examined period, the median age of women was higher than that of men, which may indicate a higher incidence of fractures in women. Patients with diagnosed SSI had a longer stay in the ward than patients without SSI. The incidence of SSI in FX and CR has been reduced compared to previous studies in the same ward.

Epidemiology of Ventilator-Associated Pneumonia, microbiological diagnostics and the length of antimicrobial treatment in the Polish Intensive Care Units in the years 2013-2015.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common nosocomial infection in intensive care units (ICUs). The objective of this study was to describe the epidemiology and microbiology of VAP in Polish ICUs from 2013 to 2015, as well as to understand how these depended on the diagnostic methods used to identify VAP pathogens and the clinical strategy for VAP treatment. METHODS: This observational study was carried out in seven Polish adult ICUs. VAP surveillance was based on the European Healthcare-associated Infections Surveillance Network recommendations and was defined as pneumonia occurring more than 48 h after receiving mechanical ventilation, with symptom onset 3 days or more after the hospital stay. Depending on the microbiological diagnostic method, VAP cases were classified as PNEU-1 (positive quantitative culture from minimally contaminated lower respiratory tract specimen such as broncho-alveolar lavage, protected brush or distal protected aspirate) or other VAP cases. RESULTS: The incidence of VAP was 8.0% and the incidence density: 12.3/1000 ventilator days. Microbiological diagnosis was made using PNEU-1 in 80 cases (39%); over the study duration, the proportion of cases diagnosed with PNEU-1 increased from 14 to 60% (p < 0.001). The predominant etiologic agents causing VAP were Enterobacteriaceae (32.6%) and non-fermenting Gram-negative bacteria (27.6%). The causative microbe varied significantly depending on the diagnostic method: in cases diagnosed using PNEU-1, Staphylococcus aureus (21.3%) and Klebsiella pneumoniae (12.5%) were the dominant organisms, whereas in other VAP cases, Acinetobacter baumannii (23.8%) was commonly observed. The length of antibiotic treatment in cases diagnosed with PNEU-1 was shorter than for other VAP cases (7.2 vs. 9.1 days, p < 0.005), as was the duration of hospitalization (49 vs. 51.8 days, p < 0.001). Antibiotic resistance was a particular concern for A.baumannii isolates, which were highly resistance to imipenem (70.6%) and meropenem or doripenem (52.9%). K. pneumoniae isolates demonstrated resistance to ampicillin (90.3%), ceftazidime (71.0%) and third-generation cephalosporins (74.2%). CONCLUSION: A change over time was observed in the microbiological diagnostic methods used for patients with VAP. A. baumannii was observed mainly in VAP cases diagnosed using substandard methods (non-PNEU-1). The duration of treatment for VAP patients diagnosed properly using PNEU-1 was shorter.

Microbiology and Drug Resistance of Pathogens in Patients Hospitalized at the Nephrology Department in the South of Poland.

A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli ( E. coli ) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E. coli , of which 29 (8.0%) can produce extended-spectrum ß-lactamases (ESBL). E. coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/ tazobactam (87.0%) and cephalosporins (79.7-89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3-70.4%). E. coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p = 0.017), amikacin (61.1% vs. 90.7%; p = 0.001), gentamicin (70.0% vs. 93.2%; p = 0.002), cefalexin (41.2% vs. 83.3%; p < 0.001), cefotaxime (63.6% vs. 89.4%; p = 0.002), ceftazidime (61.9% vs. 85.6%; p = 0.008), cefepime (73.7% vs. 91.1%; p = 0.025), ciprofloxacin (54.1% vs. 72.2%; p = 0.024) and norfloxacin (40.5% vs. 62.5%; p = 0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E. coli showed a higher sensitivity to cephalosporins than in the young-old group. E. coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.A retrospective study was conducted among 498 patients with urinary tract infections (UTI) referred to our department from January 2013 to December 2015. This study was performed to evaluate the etiology of UTI and the antibiotic susceptibility profile of Escherichia coli (E. coli) as the main etiological factor in different age groups. Urine samples were examined using standard microbiological methods. Three hundred sixty-three samples (72.9%) were identified as E. coli, of which 29 (8.0%) can produce extended-spectrum ß-lactamases (ESBL). E. coli was highly sensitive to imipenem (100.0%), gentamicin (91.0%), nitrofurantoin (89.4%), amikacin (88.2%), piperacillin/ tazobactam (87.0%) and cephalosporins (79.7­89.5%). Low sensitivity was found in relation to fluoroquinolones (60.3­70.4%). E. coli was least sensitive to ampicillin (30.2%) and amoxicillin/clavulanic acid (49.9%). We observed a significant fall in susceptibility level to piperacillin/tazobactam (68.4% vs. 88.8%; p = 0.017), amikacin (61.1% vs. 90.7%; p = 0.001), gentamicin (70.0% vs. 93.2%; p = 0.002), cefalexin (41.2% vs. 83.3%; p < 0.001), cefotaxime (63.6% vs. 89.4%; p = 0.002), ceftazidime (61.9% vs. 85.6%; p = 0.008), cefepime (73.7% vs. 91.1%; p = 0.025), ciprofloxacin (54.1% vs. 72.2%; p = 0.024) and norfloxacin (40.5% vs. 62.5%; p = 0.011) among patients with catheter-associated UTI (CAUTI) compared to those with non-CAUTI. A similar susceptibility profile was observed between different age groups. In the longevity, E. coli showed a higher sensitivity to cephalosporins than in the young-old group. E. coli susceptibility to fluoroquinolones was low, which excludes them as a first-line drug in our department. Nitrofurantoin may be used as an alternative drug to carbapenems. Monitoring of susceptibility pattern is of great importance.

Polish infection control nurses - Self-assessment of their duties and professional autonomy in different types of hospitals.

BACKGROUND: The objective of the study is self-assessment of Polish infection control nurses (ICNs) in terms of the structure of professional tasks and autonomy of decision-making. MATERIAL AND METHODS: A questionnaire survey was filled out by 208 ICNs (around 21% of all Polish ICNs) in 15 provinces located in Poland. The research encompassed ICNs surveillance healthcare-associated infections (HAIs) in 2014. RESULTS: The work time that ICNs devote to professional tasks and decision autonomy on the scale of 1-100% was as follows: 34% (67% of decision autonomy) was dedicated to detecting and registering HAIs, 12% (71%) - internal control, 10% (58%) - devising and implementing infection prevention practices, 10% (68%) - staff trainings, 8% (65%) - identification and study of outbreaks, 7% (58%) - promoting hand hygiene, 6% (51%) - consults with infected patients, 4% (57%) - consults on decontamination, 4% (54%) - consults on maintaining cleanliness, 3% (51%) - isolation and application of personal protective measures, 2% - other tasks. Infection prevention and control nurses estimated, on average, that their autonomy of decisions concerning the professional tasks performed amounted to 60%. CONCLUSIONS: Infection control nurses in Poland have difficulty in achieving balance between tasks they perform and the authority they exercise. The ICN professional task structure is dominated by duties associated with monitoring hospital infections, however, the greatest decision autonomy is visible regarding internal control. Decision-making concentrated on internal control may hinder building a positive image of an ICN. We should strive to firmly establish professional tasks and rights of ICNs in legislation concerning performing the duties of a nurse and midwife. Med Pr 2018;69(6):605-612.

Assessment of the occurrence of nosocomial infections in the Intensive Care Unit in the St. Lukas District Hospital in Tarnów in 2012-2016

INTRODUCTION: Healthcare-Associated Infections (HAI) are the cause of complications in the treatment process. The possibility of infecting a sick person in the Intensive Care Unit (ICU) is many times greater than in other hospital departments OBJECTIVES: The objective of the study was to investigate the epidemiological indicators and to determine the clinical types of HAI that are present in the ICU during the 5-year period in the St. Lukas District Hospital in Tarnów MATERIALS AND METHODS: HAI has been detected and documented in patients in ICU in the years 2012-2016 by the use of the active monitoring method. We studied patients who spent over 2 days in ICU with a general profile. These studies were conducted in accordance with the methodology recommended by Healthcare-Associated Infections Surveillance Network (HAI-Net) European Center for Disease Prevention and Control (ECDC) RESULTS: Among 886 patients who were hospitalized for a total of 6711 days, HAI was diagnosed in 195 patients (22.0% incidence rate), the incidence density rate was 29.1 per 1000 person-days of hospitalization. The rate for Ventilator-Associated Pneumonia (VAP) was 12.5 per 1000 ventilator days, for Central Line Associated Bloodstream Infection (CA-BSI) the rate was 8.2 per 1000 central line days, for Catheter-Associated Urinary Tract Infection (CA-UTI) the rate was 3.3 per 1000 urinary catheter days. The average duration of a patient stay in ICU was 24 days (19 days for patients without HAI and 43 days for patients with HAI). The following microorganisms isolated from HAI were prevailing: Acinetobacter baumannii 46 (27%), Staphylococcus aureus 12 (21%), Enterococcus faecalis 17 (10%) CONCLUSIONS: A five-year HAI study in ICU showed that the most common types of infections were bloodstream infections and pneumonia. The incidence rate of VAP remained at similar levels in subsequent years. The CA-BSI rates were reduced over the next three years of the study, but their rise in the last year can prove the lack of stability of the preventive actions. CA-UTI was detected twice less frequently, which can suggest poor detection of this type of infection

Prolonged hospitalization of patients with hospital acquired pneumoniae in the intensive care unit ­ morbidity, mortality and costs of

BACKGROUND: The objective of this study was to determine epidemiological rates of hospital-acquired pneumonia (HAP) in the Polish ICU and direct costs associated with excess length of stay incurred by the hospital. MATERIAL AND METHODS: The studied data concern patients hospitalized in the years 2010­2012 in a 9-bed ICU of a multi-profile hospital in the Malopolskie Province. Centers for Disease Control and Prevention diagnostic criteria were the basis for the development of definitions of infections. RESULTS: HAP developed in 34 patients, of which 94.1% were cases associated with the use of mechanical ventilation. Cumulative incidence of HAP was 5.74%, and incidence density amounted to 3.00‰. Median length of stay of patients with HAP amounted to 36 days and this value was more than twenty percent higher than in the case of other forms of infection (27 days), and almost three times higher than in patients without infections (14 days). Annually, costs associated with the excess hospitalization of patients with this form of infection should be evaluated at over PLN 300,000 (72.290€) per hospital; average per patient is PLN 29,106 (7013€). CONCLUSIONS: HAP is one of the most common hospital-acquired infections in intensive care units. It is connected with the greatest additional costs for hospital comparing to other forms of HAIs. For patients, the occurrence of HAP in ICU patients involves the highest risk of death. Detailed, targeted studies concerning financial burden of HAI in Poland should be performed.

The risk factors for hospital-acquired pneumonia in the Intensive Care Unit.

INTRODUCTION: Patients in the intensive care units (ICU) are exposed to many factors that may cause hospital acquired pneumonia (HAP), a particular type of which is ventilator-associated pneumonia (VAP). The specific risk factors for developing VAP affect patients already on the day of their admission to a unit and are associated with their underlying diseases and invasive medical procedures, which they undergo. The aim of this study was to evaluate the risk factors for VAP associated with a patient and the used invasive treatment. MATERIAL AND METHODS: 1227 patients were subject to the retrospective analysis. These patients were hospitalized between 2010 and 2014 in Intensive Care Unit (ICU) in the St. Luke District Hospital in Tarnów. Data about procedures used in ICU were obtained from the electronic hospital registration system and the decursus from each day when a patient stayed in the hospital, while information about hospital infections was obtained from the periodic department reports prepared by the Infection Control Team. In the diagnosis of VAP infections the definitions of nosocomial infections issued by CDC (Centers for Disease Control and Prevention) and ECDC (European Center for Disease Prevention and Control) were used. RESULTS: In the analyzed unit, 58 cases of VAP were detected in patents who underwent mechanical ventilation. Infections were more common among men (43 cases, that is 6%) than in women (15 cases, that is 3%). Mechanical ventilation longer than 20 days was a major determinant of VAP (p < 0.001). Patient's underlying diseases (which are the reason for patient's admission to a unit) had an impact on the incidence of VAP, and the most important of them are: multiple trauma (20 cases of VAP per 217 patients (9.2% incidence)), sepsis (3 cases of VAP per 31 patients (9.7% incidence)), central nervous system disease (10 cases of VAP per 124 patients (8.1% incidence)), endocrine system (1 case of VAP per 12 patients (8.3% incidence)), respiratory diseases (11 cases of VAP per 168 patients (6.5% incidence)). Invasive medical procedures performed in the patients' respiratory tract were significant risk factors (p < 0.001) for developing VAP: reintubation (R=0.271), tracheostomy (R=0.309) and bronchoscopy (R=0.316). In the period from 2010 to 2014 VAP incidence was 4.7% and incidence density per 1000 ventilation-days was 10.5 and the mortality rate with VAP was 32.8%. The most common etiological factors of VAP were Acinetobacter Baumannie (21 isolates, that is 36.4%), Pseudomonas aeruginosa (8 isolates, that is 13.8%), Escherichia coli (7 isolates, that is 12%).

The analysis of the occurrence of nosocomial infections in the neurosurgical ward in the District Hospital from 2003-2012.

INTRODUCTION: The patients in the neurosurgical ward are exposed to many risk factors causing nosocomial infections. These factors are related to operations, invasive diagnosing and monitoring of the nervous system and mechanical support of vital functions. Therefore, the objective of the undertaken studies was to assess the prevalence and structure of the healthcare-associated infections (HAI) in patients hospitalized in the neurosurgical ward in the St. Lukas District Hospital in Tarnów. MATERIAL AND METHODS: The analyzed data concerned 13,351 patients hospitalized from 2003 to 2012. To analyze the data, the standard epidemiological methods and standardized definitions of nosocomial infections proposed by European Center for Disease Prevention and Control (ECDC) were used (1, 2). RESULTS: 516 cases of nosocomial infections were detected. The most common infections among these cases were surgical site infections (SSI). The number of SSIs cases was 140 and cumulative incidence rate (CI) per 100 operations was 1.72%, including: 52 cases of craniotomy (CRAN) (CI per 100 operations was 2.44%); 50 cases of spinal fusion (FUSN) (CI was 3.32%); 24 cases of laminectomy (LAM) (CI was 0.93%); 10 cases of ventricular shunt operations (VSHN) (CI was 3.75%); 4 cases of other operations (OTH) (CI was 0.23%). The second most common infections were bloodstream infections (BSI) with 128 cases (CI was 0.96%), including: 91 cases of primary BSI and 37 cases of secondary BSI and the incidence density rate (ID) was 4.75 per 1000 central catheter days. The third most common infection was pneumonia (PN) with 127 cases (CI was 1.02%), with incidence density rate of 51.07 per 1000 intubation-days. The next most common detected infections were urinary tract infections (UTI) with 74 cases (CI was 0.58%). This type of infections included: 65 cases of infections associated with a urinary catheter and 9 cases not associated with a urinary catheter. The incidence density for UTI with a urinary catheter was 1.93 per 1000 urinary catheter days. The list of detected infections is closed by gastrointestinal system infections (GI) with 35 cases (CI was 0.23%) and the skin and soft tissue infections (SST) with 12 cases (CI was 0.07%). The etiological agent that was most frequently isolated from materials gathered from patients diagnosed with SSI, BSI and SST was Staphylococcus aureus. Acinetobacter baumannii was the most frequently detected in the cases of PN, Escherichia coli in the cases of UTI, and Clostridium difficile in the cases of GI. CONCLUSIONS: Ten-year observation of infections detected in the neurosurgery ward gave the possibility to conduct a thorough epidemiological analysis of prevalence of nosocomial infections with recommendation aiming at reasons for prevention.

Incidence of healthcare-associated gastroenteritis in children hospitalized on paediatric ward in provincial hospital in 2007-2013.

OBJECTIVE: This article aimed at evaluating the incidence and distribution of healthcare-associated (HAI) gastroenteritis (GE) in patients hospitalized on paediatric ward in St. Lukas Provincial Hospital in Tarnów. INTRODUCTION: Gastroenteritis remains a common manifestation of healthcare-associated infections on paediatric wards. In Poland, there are limited data on the proportion of healthcare-associated GE in the epidemiology of healthcare-associated infections. It was decided to present the incidence and etiology of these infections in a 7 year study period. METHODS: For the purpose of this study, standard definitions of healthcare-associated infections issued by the European Centre for Disease Prevention and Control (ECDC) were adopted. Cumulative incidence rates and incidence density rates were calculated. RESULTS: A total of 11,966 records of children hospitalized in 2007-2013 were subject to analysis. In this period, 251 healthcare-associated gastroenteritis cases of viral etiology were identified. For these infections, cumulative incidence rate (CIR) and incidence density rate (IDR) were 2.11% and 3.37/1,000 person-days, respectively. GE was most frequently reported in children aged less than 2 years (average - 1.6, SD - 2.1). Average hospitalization of a child who was not diagnosed with healthcare-associated GE was 6.2 days while for GE case it amounted to 11.2 days. GE was equally present in girls and boys, i.e. 2.1%. Rotavirus-induced GE was the most commonly diagnosed (GE-RV - Rotavirus Gastroenteritis). Such virus was identified in 189 children (CIR - 1.58%, IDR - 2.51/1,000 person-days). Rotavirus GE was followed by concomitant infections with rotaviruses and adenoviruses. A total of 12 patients were diagnosed with such co-infection (CIR - 0.10%, IDR - 0.16/1,000 person-days). Infections caused by adenoviruses (GE-AV - Adenovirus Gastroenteritis) occurred in 7 patients (CIR - 0.06%, IDR - 0.09/1,000 person-days). For 43 (17%) children, etiological agents of healthcare-associated GE were not determined. SUMMARY: Rotaviruses were the most commonly identified etiological agents of healthcare-associated gastroenteritis on paediatric ward. Children aged less than 2 years were those most frequently affected.

Re-evaluating the suitability of using fluoroquinolones in the treatment of infections in the context of FQ consumption and correlating changes to microorganism resistance levels in EU/EEA countries between 2016 and 2021.

The aim of this study was to re-evaluate fluoroquinolone (FQ) use in treatment by analyzing the consumption of FQ and the resistance levels of selected Gram­negative bacilli, as well as Neisseria gonorrhoeae and Mycobacterium tuberculosis complex in EU/EEA countries and in Poland between 2016 and 2021. Data from ECDC surveillance systems EARS-Net, Euro-GASP, and the European Tuberculosis Surveillance Network were included in the description of pathogen resistance. And the ESAC-Net project for determining FQ consumption. In over half of the EU/EEA countries, the consumption of fluoroquinolones decreased in both the community sector and the hospital sector between 2016 and 2021. The prevalence of FQ-R Escherichia coli, Klebsiella pneumoniae, Acinetobacter spp., Mycobacterium tuberculosis complex, and Neisseria gonorrhoeae exceeded 20%. The prevalence of fluoroquinolone-resistant (FQ-R) Pseudomonas aeruginosa in EU/EEA countries was less than 20% except for 2017. In most EU/EEA countries, the use of FQ has reduced in last years, except for countries like Poland where FQ were an overused group of antibiotics in the treatment of various types of infections. Fluoroquinolones, as life-saving antibiotics in severe infections, should be withdrawn from empirical treatment in Poland and in countries with a high prevalence of FQ-R microorganisms.

Surgical site infections in patients of orthopedic - trauma unit in district hospital in 2008-2012.

THE PURPOSE OF THE STUDY: The purpose of this study was to evaluate the prevalence and structure of surgical site infections in the Department of Orthopaedis - Trauma Unit in Regional Hospital. St. Luke in Tarnow in 2008-2012. MATERIALS AND METHODS: Data analysis included 7189 patients operated in 2008-2012. The data collection and analysis used standard statistical tools and definitions for nosocomial infections issued by the U.S. Centers for Disease Control and Prevention (CDC). RESULTS: In the study group it was 91 cases of SSI (surgical site infection), including 35 patients (38%) with post-operative open reduction of long bone fracture (FX), 16 (18%) with reduction of closed fractures (CR), 15 patients (16%) undergoing hip endoprosthesis (HPRO), 13 (14%) with open reduction surgery of small bones (OR-OTHER), 4 (4%) after knee endoprosthesis surgery (KPRO), and 8 (9%), after treatments of other infections (OTHER). The latter have not been taken into account in the further analysis due to the small number and variety of surgical procedures. The incidence of SSI was for: FX from 2.6 (2008) to 4.1 (2011); CR from 1.2 (2012) 4.8 (2008), HPRO from 0.7 (2012) to 1.3 (2009 r.), OR-OTHER from 0 (2009) to 4.5 (2010); KPRO from 0 (2010-2012) to 2.1 (2009). Among the etiological factors isolated from clinical materials derived from patients diagnosed with infections dominated Gram-positive bacteria, especially Staphylococcus-aureus: HPRO-40%, KPRO-75% FX-46%, OR-OTHER-62%, CR-63%, OTHER -38%. Strains resistant to methicillin (MRSA) were not reported. CONCLUSION: Prevention measures implemented in many areas of the potential impact on risk factors for SSI, has helped to achieve in 2012, the lowest rate of infection for all the analyzed procedures in the last 5 years. Conducting targeted surveillance of surgical site infection keeps morbidity associated with SSI at an acceptably low level and allows for precise planning of the preventive measures in this area.

Polish infection control nurses' job satisfaction and cooperation with their colleagues reflect how the value of infection control is appreciated by other health care workers: findings from surveys conducted before and during the COVID-19 pandemic.

BACKGROUND: Infection prevention and control (IPC) is based on the activity of specialized, trained and highly qualified personnel, especially infection control nurses (ICNs). Effective implementation of IPC procedures demands close cooperation between IPC teams (IPCTs) and hospital personnel. Based on disturbing results on the epidemiology of health care-associated infections (HAIs) and compliance with preventive procedures, we suspect that cooperation between ICNs and different groups of hospital staff is poor. The aim of this study was to assess the perceptions of ICNs working in Polish hospitals with regard to difficulties in working with various professional groups in the hospital, their organizational conditions, and their job satisfaction before and after the COVID-19 pandemic. METHODS: The study was conducted twice, in 2014 and 2021, among ICNs working in Polish hospitals. The survey used an anonymous questionnaire designed by the authors. RESULTS: In 2014, 183 ICNs participated in the study, and 175 ICNs participated in 2021. The respondents' average age and seniority (duration of work as an ICN) were higher in 2021. Depending on the ward specialty, approximately 30-48.8% of the ICNs had difficulty cooperating with physicians. However, the ICNs declared better cooperation with nurses in various hospital wards and with other professionals. For some groups of hospital staff, there was a negative correlation between poor cooperation and ICNs' job satisfaction. The job satisfaction data were disturbing; for example, more than half of the respondents considered changing jobs, and the lack of a sense of purpose in their work was declared by 29.7% of ICNs in 2014 and by 54.3% of ICNs in 2021. CONCLUSIONS: Our results suggest that infection prevention and control is not highly appreciated by health care workers and hospital management. Our study reveals difficulties in ICNs' cooperation with hospital staff and managers in both 2021 and 2014, moderate job satisfaction, a high level of willingness to change jobs, and insufficient training in interpersonal skills and the implementation of changes. These findings clearly indicate an urgent need to introduce modern competence development systems in infection control beyond the scope of traditional training.

[Bloodstream infections related to catheterization of venous-analysis of preventive actions in district hospital]. / Zakazenia krwi zwiazane z cewnikowaniem naczyn zylnych- analiza dzialan prewencyjnych w szpitalu wojewódzkim.

OBJECTIVES: The evaluation of effectiveness of implemented actions to limit intravascular catheter-related bloodstream infection rates. INTRODUCTION: We have analyzed actions taken in nineteen wards in the St. Lukas District Hospital in Tarnów. During seven-year study period, from 2005 to 2011, 207 673 hospitalized patients were supervised. A study was done among all patients with peripheral intravenous catheters and central venous catheters. MATERIAL AND METHODS: Standard statistic tools and definitions of nosocominal infections used by US Centers for Disease Control and Prevention were used. Intravascular catheter-related bloodstream infection rates has been calculated by a formula: (number of catheter-related bloodstream infections/number of person-days with catheters) x1000. RESULTS: During the period study, decrease in frequency of occurrence was obtained: venous catheter-related bloodstream infections decreased from 2.8 to 0.4 per 1000 person-days, central venous catheter-related bloodstream infections decreased from 8.9 to 3.0 per 1000 person-days, peripheral intravenous catheter-related bloodstream infections decreased from 0.6 to 0.3 per 1000 person-days. The most common causative agent of venous catheter-related bloodstream infections was in 44% of cases Staphylococcus CNS and in 19% of cases Staphylococcus aureus. CONCLUSIONS: It is possible to significantly decrease intravascular catheter-related bloodstream infection rates by taking preventive actions combined with intensive education of medical personnel.

[Nosocomial infection in patients hospitalized in 2005-2011. the St. Lukas District Hospital in Tarnów]. / Zakazenia szpitalne u pacjentów hospitalizowanych w latach 2005- 2011. Szpital Wojewódzki im. sw. Lukasza w Tarnowie.

OBJECTIVE: To evaluate the occurrence and the structure of nosocomial infections in hospitalized patients, and also to indicate the possibility of lowering the infection rates in the St. Lukas District Hospital in Tarnow. MATERIAL AND METHODS: Data from 207 673 patients hospitalized in the years 2005-2011 have been collected and analyzed using standard statistical tools and definitions of nosocomial infections, issued by the U.S. Centers for Disease Control and Prevention (CDC). RESULTS: The surgical side infections (SSI) were proved to be the most commonly found, with 20% of all infections. There were also frequent bloodstream infections (BSI) 19%, as well as urinary tract (UTI) and gastrointestinal infections (IPP) 18%, while pneumonia (PNEU) appeared to be slightly less common, with 13% of all infections. The other types of infections represented 11%. The infection rates for clean surgical sites per 100 clean procedures were on average 0.7. Subsequently, average amounts per 1000 person-days were as follows: 16.7 for pneumonia (VAP, ventilator-associated pneumonia), 2.4 for catheter-related urinary tract infections (UTI), and 6.2 for bloodstream infections (CLA-BSI, central line-associated). CONCLUSIONS: Knowing the structure of infections is crucial for planning precise and cautious actions aimed at reducing the frequency of nosocomial infections.

Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units.

Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was to investigate the epidemiology and microbiology of HAIs and to assess the effectiveness of surveillance conducted in two hospital units. Both hospitals ran (since 2012) the unified prospective system, based on continuous surveillance of HAIs designed and recommended by the European Centre for Disease Prevention and Control (protocol version 4.3) in the Healthcare-Associated Infections Surveillance Network (HAI-Net). In study hospitals, HAIs were detected by the Infection Prevention Control Nurse (IPCN). The surveillance of healthcare infections in hospital A was based mainly on analysis of microbiological reports and telephone communication between the epidemiological nurse and the neurosurgery unit. HAI monitoring in hospital B was an outcome of daily personal communication between the infection prevention and control nurse and patients in the neurosurgery unit (HAI detection at the bedside) and assessment of their health status based on clinical symptoms presented by the patient, epidemiological definitions, microbiological and other diagnostic tests (e.g., imaging studies). In hospital A, HAI monitoring did not involve personal communication with the unit but was rather based on remote analysis of medical documentation found in the hospital database. Results: A total of 12,117 patients were hospitalized. There were 373 HAIs diagnosed, the general incidence rate was 3.1%. In hospital A, the incidence rate was 2.3%, and in hospital B: 4.8%. HAI types detected: pneumonia (PN) (n = 112, 0.9%), (urinary tract infection (UTI) (n = 108, 0.9%), surgical site infection (SSI) (n = 96, 0.8%), bloodstream infection (BSI) (n = 57, 0.5%), gastrointestinal system infection (GI) (n = 13, 0.1%), skin and soft tissue (SST) (n = 9, 0.1%). HAI with invasive devices: 44 ventilator-associated pneumonia (VAP) cases (45.9/1000 pds with ventilator); catheter-associated urinary tract infection (CA-UTI): 105 cases (2.7/1000 pds with catheter); central venous catheter (CVC-BSI): 18 cases (1.9/1000 pds with CVC). The greatest differences between studied units were in the incidence rate of PN (p < 0.001), UTI (p < 0.001), and SSI (p < 0.05). Conclusions: The way HAIs are diagnosed and qualified and the style of work of the infection control team may have a direct impact on the unit epidemiology with the application of epidemiological coefficients. Prospective surveillance run by the infection prevention and control nurse in hospital B could have been associated with better detection of infections expressed in morbidity, especially PN and UTI, and a lower risk of VAP. In hospital A, the lower incidence might have resulted from an inability to detect a UTI or BSI and less supervision of VAP. The present results require further profound research in this respect.

The Incidence of Healthcare-Associated Infections, Their Clinical Forms, and Microbiological Agents in Intensive Care Units in Southern Poland in a Multicentre Study from 2016 to 2019.

INTRODUCTION: Healthcare-associated infections (HAIs) are a serious problem of modern medicine. Patients hospitalized in intensive care units (ICUs) develop HAI significantly more often than patients in other hospital units. MATERIALS AND METHODS: Analysis involved HAIs from three ICUs in southern Poland. The study was conducted in 2016-2019 on the basis of methodology recommended by the Healthcare-Associated Infections Surveillance Network (HAI-Net) and European Centre for Disease Prevention and Control (ECDC). The objective was to analyse HAIs, their clinical forms, and microbiological agents. RESULTS: The study included 3028 patients hospitalized for 26,558 person-days (pds) in ICU. A total of 540 HAIs were detected; incidence per 100 hospitalizations was 17.8%, incidence density per 1000 pds was 20.3. The mortality of patients with HAI was 16%, and in Clostridioidesdifficile infection (CDI), the mortality was 28%. The most common clinical form of HAI was bloodstream infection (BSI): 209 cases (incidence rate 6.9%), followed by pneumonia (PN): 131 (incidence rate 4.3%), and urinary tract infection (UTI): 110 cases (incidence rate 3.6%). The most frequently isolated bacteria were Klebsiella pneumoniae 16.4%, Acinetobacter baumannii 14.4%, Staphylococcus aureus 11.8%, and Escherichia coli 11.4%. CONCLUSIONS: A two-fold higher incidence rate of BSI was detected compared to the average incidence in European countries. BSI of unknown source (BSI-UNK) was predominant. K. pneumoniae and A. baumannii bacteria were the most often isolated microorganisms causing HAI. Infection control based on incidence rate for each type of infection is necessary in ICU to assess the epidemiological situation.

[Effectiveness of hand disinfection depending on the type of nail plate coating - a study among nurses working in a specialist hospital]. / Skutecznosc dezynfekcji rak w zaleznosci od rodzaju pokrycia plytki paznokciowej ­ badanie wsród pielegniarek szpitala specjalistycznego.

BACKGROUND: Keeping short, unpainted nails is a significant element of effective hand disinfection among nurses. The aim of the study was to examine the qualitative microbiological purity of painted nails after hand disinfection, taking into account the type of the nail varnish. MATERIAL AND METHODS: Materials were collected from 188 nurses. The results were compiled according to the type of the nail varnish applied on the nail plate. The control group consisted of 24 nurses with natural nails. An indicator of the effectiveness of hand disinfection was the number and type of bacteria grown from the materials collected from the participants' hands - from the nail plate, from under the nail plate and from the skin around the nail plate. RESULTS: In the case of the nail plate swab method, the highest percentage of pathogenic microorganisms grew on the nails covered with a regular varnish (21.7%, p < 0.05). A long-lasting (10 days on average) regular nail varnish was likely to result in ineffective hand disinfection (p < 0.001). In the test involving dipping the finger in tryptic soy broth combined with the technique of collecting swabs from under the nail plate, the highest percentage of pathogenic microorganisms was grown from the nail plate coated/extended with gel and then painted with a 14.8% hybrid varnish (p < 0.05). CONCLUSIONS: The risk of growing a pathogenic microorganism after hand disinfection due to nails coated with a conditioner or a hybrid varnish was similar to that of natural nails. A long-lasting regular nail varnish increases the risk of ineffective hand disinfection. Modeling and/or extending the nail plate with a LED/UV light curing gel, and then painting it with a hybrid varnish, also increases the risk of ineffective hand disinfection. Med Pr. 2021;72(1):29-37.