Introduction: In the third Slovenian national healthcare-associated infections (HAIs) prevalence survey, conducted within the European point prevalence survey of HAIs and antimicrobial use in acute care hospitals, we estimated the prevalence of all types of HAIs and identified factors associated with them.
Methods: Patients were enrolled into a one-day cross-sectional study in November 2017. Descriptive analyses were performed to describe the characteristics of patients, their exposure to invasive procedures and the prevalence of different types of HAIs. Univariate and multivariate analyses of association of having at least one HAI with possible risk factors were performed to identify risk factors.
Results: Among 5,743 patients, 4.4% had at least one HAI and an additional 2.2% were still treated for HAIs on the day of the survey, with a prevalence of HAIs of 6.6%. The prevalence of pneumoniae was the highest (1.8%), followed by surgical site infections (1.5%) and urinary tract infections (1.2%). Prevalence of blood stream infections was 0.3%. In intensive care units (ICUs), the prevalence of patients with at least one HAI was 30.6%. Factors associated with HAIs included central vascular catheter (adjusted odds ratio [aOR] 4.1; 95% confidence intervals [CI]: 3.1-5.4), peripheral vascular catheter (aOR 3.0; 95% CI: 2.3-3.9), urinary catheter (aOR 1.8; 95% CI: 1.4-2.3).
Conclusions: The prevalence of HAIs in Slovenian acute care hospitals in 2017 was substantial, especially in ICUs. HAIs prevention and control is an important public health priority. National surveillance of HAIs in ICUs should be developed to support evidence-based prevention and control.
Izhodišča: Tretja slovenska nacionalna presečna raziskava bolnišničnih okužb (BO) je potekala v okviru evropske presečne raziskave okužb, povezanih z zdravstvom in uporabe protimikrobnih zdravil v bolnišnicah za akutno oskrbo. Naši cilji so bili oceniti prevalenco vseh vrst BO in opredeliti dejavnike, ki so povezani z BO.
Metode: V enodnevno presečno raziskavo smo vključili vse bolnike, ki so bili na izbrani dan v novembru 2017 zdravljeni v slovenskih bolnišnicah za akutno oskrbo. Z deskriptivnimi analizami smo opisali značilnosti bolnikov, izpostavljenost invazivnim posegom in ocenili prevalenco različnih vrst BO. Z univariatnimi in multivariatnimi analizami povezanosti BO z možnimi dejavniki tveganja smo opredelili dejavnike tveganja.
Rezultati: Na dan raziskave je imelo BO 4,4 % (95 % interval zaupanja (IZ): 3,9 %–4,9 %) bolnikov in dodatnih 2,2 % (95% IZ: 1,8 %–2,6 %) bolnikov je bilo še vedno zdravljenih zaradi BO, torej je imelo BO 6,6 % (95% IZ: 6,0 %–7,3 %) bolnikov oziroma je bila prevalenca BO 6,6 %. Na 100 bolnikov je bilo 7,1 epizod BO, ker so nekateri bolniki imeli več kot eno epizodo. Najvišja je bila prevalenca pljučnic (1,8 %), sledile so okužbe kirurške rane (1,5 %) in okužbe sečil (1,2 %). Prevalenca okužb krvi je bila 0,3 %. Delež bolnikov z vsaj eno BO je bil najvišji v enotah za intenzivno zdravljenje (30,6 %). Na 100 bolnikov v enotah za intenzivno zdravljenje je bilo 38,3 epizod BO. V primerjavi z bolniki brez različnih invazivnih posegov so imeli bolniki s centralnim žilnim katetrom 4,1-krat višji obet BO (prilagojeno razmerje obetov (pRO) 4,1; 95 % interval zaupanja (IZ): 3,1–5,4), bolniki s perifernim žilnim katetrom 3,0-krat višji obet BO (pRO 3,0; 95 % IZ: 2,3–3,9), bolniki z urinskim katetrom 1,8-krat višji obet BO (pRO 1,8; 95 % IZ: 1,4–2,3) in bolniki z operacijo v času hospitalizacije 1,6-krat višji obet BO (pRO 1,6; 95% IZ: 1,2–2,0).
Zaključki: Prevalenca BO v slovenskih bolnišnicah za akutno oskrbo je bila v letu 2017 precejšnja. Predvsem je bila visoka v enotah za intenzivno zdravljenje. Preprečevanje in obvladovanje BO je pomembna javnozdravstvena prednostna naloga. Za preprečevanje in obvladovanje BO, ki temelji na dokazih, je treba vzpostaviti nacionalno epidemiološko spremljanje BO tudi v enotah za intenzivno zdravljenje.
Keywords: Slovenia; healthcare-associated infections; prevalence; survey, risk factors.