Epidemiology and prevention of hospital-acquired/ventilator

95 Pages·2011·12.62 MB·English

Epidemiology and prevention of
hospital-acquired/ventilator-
associated pneumonia
Philippe Eggimann, MD
Adult ICU and Burn Centre
Lausanne, Switzerland
Welcome to
The hospital
The world of nosocomial infections
The world of nosocomial infections
Incidence 18.9% (2.3%-49.2%)
50 %
may 1997-may 1998
8353 patients >24h (28 USI)
45
1851 nosocomial infections
40
35
30
25
20
15
10
5
0
England Canada France Germany Italy Portugal Spain Israël
Alberti et al. ICM 2002
The world of nosocomial infections
Prevalence 27% (9.7%-31.6%)
Pneumonia 47 %
Surgical wound 7 %
Other NI 16 %
Bloodstream 12 %
Urinary tract 18 %
Risk factors RR
urinary catheter 1.41 1,417 European ICUs
mec. ventilation 2.07 10’038 patients
central venous cath. 4.40
EPIC study
stay 7-13 days 30.75
Vincent JAMA 1995
stay > 14 days 60.30
The world of nosocomial infections
1’265 worldwide ICU
14’414 patients
51% with infection
(08.05.2007)
EPIC II study
Vincent JAMA 2009
The world of nosocomial infections
1’265 worldwide ICU
14’414 patients
51% with infection
(08.05.2007)
Risk factors OR
urinary catheter 1.41 EPIC II study
mechanical ventilation 2.07 EPIC I study
Vincent JAMA 2009
central venous cath. 4.40 Vincent JAMA 1995
The world of infections
1’265 worldwide ICU
14’414 patients
51% with infection
(08.05.2007)
EPIC II study
Vincent JAMA 2009
Epidemiology of nosocomial infections
Upper respiratory Skin and soft tissue
tract infections 9% infections 15%
Other 2%
Urinary tract
Infections 11%
Bloodstream 20%
N=159
Pneumonia 29%
Catheter exit-site 14%
Medical ICU
1995-1997 Hugonnet et al. Emerging Infect Dis 2004
Hôpitaux Universitaires de Genève
Impact of nosocomial infections
Crude mortality
30% to 60%
Attributable mortality
0% to 40%
Prolongation of length of stay
5 to 25 days
Increase of costs
5,000 to 40,000 euros
i
m
p
a
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t
Wey et al. Arch Intern Med 1988; Voss et al. Infection 1997
Eggimann et al. Chest 2001; Blot et al. Am J Med 2002