Prevalence of and factors associated with healthcare-associated infections in Slovenian acute care hospitals: Results of the third national survey

Prevalence of exposures to indwelling devices on the day of the survey, overall and according to different ward specialties, Slovenian national healthcare-associated infection prevalence survey, 2017.

	Intensive care	General medicine	Surgery	Gynaecology, obstetrics & neonatology	Paediatrics	Other/mixed	All	(95% CI)
Peripheral vascular catheter	68.9%	56.8%	49.7%	21.7%	57.3%	22.1%	48.2%	(46.9% - 49.5%)
Central vascular catheter	74.0%	6.9%	9.6%	0.2%	7.1%	5.2%	9.4%	(8.6% - 10.1%)
Urinary catheter	81.1%	20.9%	18.5%	6.8%	1.1%	13.7%	19.1%	(18.1% - 20.2%)
Intubation	48.0%	1.0%	2.3%	0.6%	2.1%	1.3%	3.1%	(2.7% - 3.6%)

Number of patients	196	2190	1997	545	281	534	5743

Table 2

Number and prevalence of different types of healthcare-associated infections (HAIs), overall and according to ward specialties, Slovenian national healthcare-associated infections prevalence survey, 2017.

	Intensive care	General medicine	Surgery	Gynaecology, obstetrics & neonatology	Paediatrics	Other	All

	Number	Number	Number	Number
	(prevalence)	(prevalence)	(prevalence)	(prevalence)	Number	Number	Number
					(prevalence)	(prevalence)	(prevalence)
Pneumoniae	35 (17.9%)	38 (1.7%)	19 (1.0%)	1 (0.2%)
Surgical site infections	5 ( 2.6%)	4 (0.2%)	65 (3.3%)	3 (0.6%)	3 (1.1%)	11 (2.1%)	107 (1.9%)
Urinary tract infections	6 ( 3.1%)	41 (1.9%)	15 (0.8%)	1 (0.2%)	0 (0.0%)	7 (1.3%)	84 (1.5%)
Systemic infections	3 ( 1.5%)	22 (1.0%)	13 (0.7%)	0 (0.0%)	1 (0.4%)	5 (0.9%)	69 (1.2%)
Gastro-intestinal system infections	2 ( 1.0%)	13 (0.6%)	4 (0.2%)	0 (0.0%)	0 (0.0%)	2 (0.4%)	40 (0.7%)
Bloodstream infections with CRI3	6 ( 3.1%)	10 (0.5%)	3 (0.2%)	0 (0.0%)	0 (0.0%)	5 (0.9%)	24 (0.4%)
Skin and soft tissue infections	0 ( 0.0%)	4 (0.2%)	4 (0.2%)	0 (0.0%)	1 (0.4%)	0 (0.0%)	20 (0.3%)
Central nervous system infections	1 ( 0.5%)	3 (0.1%)	3 (0.2%)	0 (0.0%)	0 (0.0%)	2 (0.4%)	10 (0.2%)
Eye, Ear, Nose or Mouth infection	0 ( 0.0%)	5 (0.2%)	1 (0.1%)	1 (0.2%)	1 (0.4%)	0 (0.0%)	8 (0.1%)
Other lower respiratory tract infections	4 ( 2.0%)	3 (0.1%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	1 (0.2%)	8 (0.1%)
Bone and joint infections	0 ( 0.0%)	0 (0.0%)	5 (0.3%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	7 (0.1%)
Cardiovascular system infections	0 ( 0.0%)	1 (0.0%)	4 (0.2%)	0 (0.0%)	0 (0.0%)	1 (0.2%)	6 (0.1%)
Catheter-related infections w/o BSIs	0 ( 0.0%)	2 (0.1%)	1 (0.1%)	0 (0.0%)	0 (0.0%)	0 (0.0%)	5 (0.1%)
Reproductive tract infections	0 ( 0.0%)	0 (0.0%)	0 (0.0%)	2 (0.4%)	0 (0.0%)	0 (0.0%)	3 (0.1%)
Specific neonatal infections	4 ( 2.0%)	0 (0.0%)	0 (0.0%)	8 (1.5%)	0 (0.0%)	0 (0.0%)	2 (0.0%)

Patients with at least one HAI^a	60 (30.6%)	127 (5.8%)	134 (6.7%)	16 (2.9%)	4 (1.4%)	0 (0.0%)	16 (0.3%)

					9 (3.2%)	31 (5.8%)	377 (6.6%)

[i] CRI3: catheter-related bloodstream infection with microbiological documentation of the relationship between the vascular catheter and the bloodstream infection.

[ii] w/o BSIs: without bloodstream infections.

[iii] ^a Patients can have several HAIs, thus the numbers in columns do not necessarily add up to the number of patients with at least one HAI.

Table 3

Microorganisms identified in healthcare-associated infections (HAIs) overall and by most common types of HAIs, Slovenian national healthcare-associated infections prevalence survey, 2017.

	Pneumonia/lower respiratory tract infections	Surgical site infections	Urinary tract infections	Bloodstream infections	Gastrointestinal tract infections	All HAIs

	Number	Number	Number	Number	Number	Number
Number of all HAIs	116	84	69	33	25	409
Number of HAIs with microorganisms all	50	44	50	25	19	214
Number of microorganisms	83	73	60	27	23	301
Gram-positive cocci Staphylococcus aureus	16 9	34 9	10 0	13 4	30	94 30
Streptococcus spp.	4	12	7	3	2	30
Coagulase-negative staphylococci	1	9	3	5	0	23
Other gram-positive cocci	2	4	0	1	1	11
Gram-negative cocci	0	0	0	0	0	0
Enterobacteriaceae	38	20	39	11	6	123
*Escherichia coli*	5	6	19	7	2	40
Enterobacter spp.	10	7	4	2	1	28
Klebsiella spp.	11	2	7	1	1	24
Proteus spp.	3	3	5	0	1	13
Other Enterobacteriaceae	9	2	4	1	1	18
Non-fermenting gram-negative bacteria	18	6	7	0	1	33
*Pseudomonas aeruginosa*	9	4	6	0	1	21
Other non-Enterobacteriaceae	9	2	1	0	0	12
Anaerobic bacilli	0	8	0	1	12	22
*Clostridium difficile*	0	0	0	0	12	12
Other anaerobes	0	8	0	1	0	10
Other bacteria	0	0	0	0	0	0
Fungi	11	5	4	2	0	27
Candida spp.	9	5	4	2	0	25
Other fungi	2	0	0	0	0	2
Virus	0	0	0	0	1	2
Negative codes	62	40	19	7	6	189
Examination not done	37	24	6	0	2	87
Not yet available/missing	11	11	9	6	2	51
Sterile examination	13	5	3	1	1	48
Microorganism not identified	1	0	1	0	1	3

Table 4

Prevalence of healthcare-associated infections (HAIs) acquired during current hospitalisation according to patients’ characteristics, ward specialties, and exposure to extrinsic risks and results of univariate and multivariate analysis of association, Slovenian national healthcare-associated infections prevalence survey, 2017.

	Univariate analyses (whole data)				Univariate analyses (restricted data)		Multivariate analyses (restricted data)

	Prevalence of HAIs	Number of patients (base)	Odds ratio	p-value (95% CI)	Odds ratio	p-value (95% CI)	Adjusted odds ratio	p-value (95% CI)
Age
<50 years	3.9%	1588	1	p<0.001	1	p<0.001
50–79 years	7.7%	3017	2.1	(1.5-2.7)	2.0	(1.5-2.7)
≥80 years	7.3%	1138	1.9	(1.4-2.7)	1.9	(1.4-2.7)
McCabe index
Non-fatal disease	4.7%	4143	1	p<0.001	1	p<0.001
Ultimately fatal disease	10.3%	1128	2.3	(1.8-2.9)	2.3	(1.8-2.9)
Rapidly fatal disease	14.5%	394	3.4	(2.5-4.7)	3.3	(2.4-4.6)
Surgery (during current hospitalisation)
No	4.9%	3904	1	p<0.001	1	p<0.001	1	p<0.01
Yes	10.2%	1827	2.2	(1.8-2.7)	2.2	(1.8-2.7)	1.6	(1.2-2.0)
Intubation
No	5.8%	5565	1	p<0.001	1	p<0.001
Yes	30.3%	178	7.1	(5.0-9.9)	7.1	(5.0-9.9)
Central vascular catheter
No	4.7%	5202	1	p<0.001	1	p<0.001	1	p<0.001
Yes	24.8%	537	6.7	(5.3-8.5)	6.7	(5.3-8.5)	4.1	(3.1-5.4)
Peripheral vascular catheter
No	4.6%	2967	1	p<0.001	1	p<0.001	1	p<0.001
Yes	8.7%	2769	2.0	(1.6-2.5)	2.0	(1.6-2.5)	3.0	(2.3-3.9)
Urinary catheter
No	4.1%	4640	1	p<0.001	1	p<0.001	1	p<0.001
Yes	16.8%	1099	4.7	(3.8-5.8)	4.7	(3.8-5.8)	1.8	(1.4-2.3)
Length of hospital stay^a:
≤3 days	1.1%	1892	1	p<0.001	1	p<0.001	1	p<0.001
4-7 days	3.1%	1434	2.8	(1.7-4.8)	2.8	(1.7-4.8)	2.6	(1.5-4.4)
8-14 days	9.5%	1153	9.3	(5.8-14.9)	9.3	(5.8-14.9)	9.4	(5.8-15.2)
≥15 days	16.1%	1264	17.0	(10.8-26.9)	16.9	(10.7-26.7)	15.5	(9.7-24.8)

[i] 5,719 individuals with information on all risk factors included in the final multivariate model were included in multivariate analyses on the restricted data (99.6% of all individuals surveyed).

[ii] ^a Length of hospital stay was computed until the day of the survey for patients without HAIs and for those with HAIs until the day of occurrence of HAIs (first HAI, if several).

References

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Articles in this issue

DOI: https://doi.org/10.2478/sjph-2019-0008 | Journal eISSN: 1854-2476 | Journal ISSN: 0351-0026

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Language: English, Slovenian

Page range: 62 - 69

Submitted on: Sep 14, 2018

Accepted on: Mar 6, 2019

Published on: Mar 26, 2019

Published by: National Institute of Public Health, Slovenia

In partnership with: Paradigm Publishing Services

Keywords:

healthcare-associated infections,

prevalence,

survey, risk factors,

Slovenia

Related subjects:

Medicine,

Clinical medicine,

Hygiene and environmental medicine

© 2019 Irena Klavs, Mojca Serdt, Aleš Korošec, Tatjana Lejko Zupanc, Blaž Pečavar, published by National Institute of Public Health, Slovenia
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

Volume 58 (2019): Issue 2 (June 2019)