Healthcare-associated infections in Northern Russia: Results of ten point-prevalence surveys in 2006-2010.

BACKGROUND AND OBJECTIVE: Statistics on healthcare-associated infections (HAIs) in Russia is scarce and has been considered to suffer from underreporting. We assessed the prevalence and changes in the prevalence of HAIs over 5 years and identified factors associated with acquiring HAIs in the pediatric hospital in Arkhangelsk, Northern Russia. MATERIALS AND METHODS: Ten cross-sectional studies were conducted in the Arkhangelsk regional pediatric hospital biannually during 2006-2010. We used a standardized protocol, including the criteria of HAI proposed by the Centers for Disease Control and Prevention. Binary logistic regression was applied to study factors associated with HAI. RESULTS: Altogether, 3264 inpatients were enrolled in the study and 347 of them had HAI (11.2%). The prevalence of HAI per survey ranged from 7.1% (95% CI: 4.8%-10.4%) to 16.7% (95% CI: 13.1%-21.2%). The most prevalent HAIs were upper respiratory tract infections 5.1% (95% CI: 4.4%-5.9%), followed by urinary tract infections, 1.5% (95% CI: 1.2%-2.0%), and acute gastroenteritis, 1.4% (95% CI: 1.1%-1.9%). Compared to infants, children aged 5-9 years (OR=0.7, 95% CI: 0.4-1.0), 10-14 years (OR=0.4, 95% CI: 0.3-0.7), and ≥15 years (OR=0.3, 95% CI: 0.2-0.5) were less likely to have HAI. Neutropenia (OR=1.5, 95% CI: 1.0-2.3) and use of intravascular catheter(s) (OR=1.8, 95% CI: 1.1-3.0) were positively associated with HAI. CONCLUSIONS: The observed prevalence of HAIs is within the range reported in several other European countries. We do not recommend generalizing our findings to other Russian settings given considerable variations between regions in both socio-economic situation and conditions of medical facilities.

Evaluation of the national surveillance system for point-prevalence of healthcare-associated infections in hospitals and in long-term care facilities for elderly in Norway, 2002-2008.

BACKGROUND: Since 2002, the Norwegian Institute of Public Health has invited all hospitals and long-term care facilities for elderly (LTCFs) to participate in two annual point-prevalence surveys covering the most frequent types of healthcare-associated infections (HAIs). In a comprehensive evaluation we assessed how well the system operates to meet its objectives. METHODS: Surveillance protocols and the national database were reviewed. Data managers at national level, infection control practitioners and ward personnel in hospitals as well as contact persons in LTCFs involved in prevalence data collection were surveyed. RESULTS: The evaluation showed that the system was structurally simple, flexible and accepted by the key partners. On average 87% of hospitals and 32% of LTCFs participated in 2004-2008; high level of data completeness was achieved. The data collected described trends in the prevalence of reportable HAIs in Norway and informed policy makers. Local results were used in hospitals to implement targeted infection control measures and to argue for more resources to a greater extent than in LTCFs. Both the use of simplified Centers for Disease Control and Prevention (CDC) definitions and validity of data seemed problematic as compliance with the standard methodology were reportedly low. CONCLUSIONS: The surveillance system provides important information on selected HAIs in Norway. The system is overall functional and well-established in hospitals, however, requires active promotion in LTCFs. Validity of data needs to be controlled in the participating institutions before reporting to the national level.

Infection after primary hip arthroplasty: a comparison of 3 Norwegian health registers.

BACKGROUND AND PURPOSE: The aim of the present study was to assess incidence of and risk factors for infection after hip arthroplasty in data from 3 national health registries. We investigated differences in risk patterns between surgical site infection (SSI) and revision due to infection after primary total hip arthroplasty (THA) and hemiarthroplasty (HA). MATERIALS AND METHODS: This observational study was based on prospective data from 2005-2009 on primary THAs and HAs from the Norwegian Arthroplasty Register (NAR), the Norwegian Hip Fracture Register (NHFR), and the Norwegian Surveillance System for Healthcare-Associated Infections (NOIS). The Norwegian Patient Register (NPR) was used for evaluation of case reporting. Cox regression analyses were performed with revision due to infection as endpoint for data from the NAR and the NHFR, and with SSI as the endpoint for data from the NOIS. RESULTS: The 1-year incidence of SSI in the NOIS was 3.0% after THA (167/5,540) and 7.3% after HA (103/1,416). The 1-year incidence of revision due to infection was 0.7% for THAs in the NAR (182/24,512) and 1.5% for HAs in the NHFR (128/8,262). Risk factors for SSI after THA were advanced age, ASA class higher than 2, and short duration of surgery. For THA, the risk factors for revision due to infection were male sex, advanced age, ASA class higher than 1, emergency surgery, uncemented fixation, and a National Nosocomial Infection Surveillance (NNIS) risk index of 2 or more. For HAs inserted after fracture, age less than 60 and short duration of surgery were risk factors of revision due to infection. INTERPRETATION: The incidences of SSI and revision due to infection after primary hip replacements in Norway are similar to those in other countries. There may be differences in risk pattern between SSI and revision due to infection after arthroplasty. The risk patterns for revision due to infection appear to be different for HA and THA.

Gastro-enteritis outbreak among Nordic patients with psoriasis in a health centre in Gran Canaria, Spain: a cohort study.

BACKGROUND: Between November 2 and 10, 2002 several patients with psoriasis and personnel staying in the health centre in Gran Canaria, Spain fell ill with diarrhoea, vomiting or both. Patient original came from Norway, Sweden and Finland. The patient group was scheduled to stay until 8 November. A new group of patients were due to arrive from 7 November. METHODS: A retrospective cohort study was conducted to assess the extent of the outbreak, to identify the source and mode of transmission and to prevent similar problems in the following group. RESULTS: Altogether 41% (48/116) of persons staying at the centre fell ill. Norovirus infection was suspected based on clinical presentations and the fact that no bacteria were identified. Kaplan criteria were met. Five persons in this outbreak were hospitalised and the mean duration of diarrhoea was 3 days. The consequences of the illness were more severe compared to many other norovirus outbreaks, possibly because many of the cases suffered from chronic diseases and were treated with drugs reported to affect the immunity (methotrexate or steroids). During the two first days of the outbreak, the attack rate was higher in residents who had consumed dried fruit (adjusted RR = 3.1; 95% CI: 1.4-7.1) and strawberry jam (adjusted RR = 1.9; 95% CI: 0.9-4.1) than those who did not. In the following days, no association was found. The investigation suggests two modes of transmission: a common source for those who fell ill during the two first days of the outbreak and thereafter mainly person to person transmission. This is supported by a lower risk associated with the two food items at the end of the outbreak. CONCLUSIONS: We believe that the food items were contaminated by foodhandlers who reported sick before the outbreak started. Control measures were successfully implemented; food buffets were banned, strict hygiene measures were implemented and sick personnel stayed at home >48 hours after last symptoms.