1
|
Xu C, Liu R, Wang J, Nicholas S. Hospitalization expenses of coronary heart disease inpatients in China: evidence from two hospitals in Ningxia Hui autonomous region. Front Public Health 2024; 12:1266456. [PMID: 38756881 PMCID: PMC11096531 DOI: 10.3389/fpubh.2024.1266456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 04/16/2024] [Indexed: 05/18/2024] Open
Abstract
Aim The increasing morbidity from coronary health disease (CHD) has imposed a significant social and economic burden in China. We analyzed the factors affecting hospitalization expenses of CHD patients. Design From 2012 to 2018, data on 16,726 CHD patients were collected from the hospital information system in Ningxia Hui Autonomous Region. Methods A multiple ordered logistic regression model was used to analyze the factors affecting hospitalization expenses. Results The average hospitalization expense was RMB30998.26 ± 29890.03. Hospital materials expenses accounted for roughly 60% of total hospitalization costs. The older adult, patients who were male, in critical health status, with longer hospital stays, unemployed, using antibiotics and undergoing an operation without incision had significantly raised hospital expenses, while those with fewer complications, no operations and self-paying for health care had reduced hospitalization costs (p < 0.05). The length of hospital stay played a partial mediator role (p < 0.05). Public contribution Controlling the increase of medical materials costs and preventing over-consumption of hospital services by insured patients are recommended.
Collapse
Affiliation(s)
- Chuanchuan Xu
- School of Humanities and Management, Ningxia Medical University, Yinchuan, China
| | - Rugang Liu
- School of Health Policy and Management, Nanjing Medical University, Nanjing, China
- Center for Global Health, Nanjing Medical University, Nanjing, China
- Jiangsu Provincial Institute of Health, Nanjing Medical University, Nanjing, China
- School of Public Health, Nanjing Medical University, Nanjing, China
| | - Jian Wang
- Dong Fureng Economic and Social Development School, Wuhan University, Beijing, China
- Center for Health Economics and Management at School of Economics and Management, Wuhan University, Wuhan, China
| | - Stephen Nicholas
- Health Services Research and Workforce Innovation Centre, Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
- Australian National Institute of Management and Commerce, Sydney, NSW, Australia
| |
Collapse
|
2
|
Blatnik P, Bojnec Š. Analysis of impact of nosocomial infections on cost of patient hospitalisation. Cent Eur J Public Health 2023; 31:90-96. [PMID: 37451240 DOI: 10.21101/cejph.a7631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/22/2023] [Indexed: 07/18/2023]
Abstract
OBJECTIVES The scale of the economic problem of the occurrence of nosocomial infections and the resulting high additional costs of treatment can only be assessed using economic analyses. The aim of the study was to analyse the impact of a nosocomial infection in a patient in the treatment process and the direct costs of patient hospitalisation. The article contributes to a cost analysis, which is a relevant basis for adopting effective solutions and decisions on the introduction of new programmes and measures to reduce nosocomial infections and associated costs. METHODS In the first phase of the micro-economic analysis, we analysed the course of hospitalisation of a non-colonised patient treated in an ordinary hospital room. In the second phase, we analysed the process of hospitalisation of a patient who developed a nosocomial infection and was transferred to an isolation room. The difference in cost of both types of treatment allowed us to carry out an economic analysis to estimate the direct costs of nosocomial infection, which are not related to the initial diagnosis of the patient but only to the patient hospitalisation. To calculate the individual types of direct costs of both alternative treatments, we first used the process flow diagram method, which then enabled us to analyse the impact of the occurrence of nosocomial infection on the efficiency and costs of the hospital. RESULTS The results showed that the total direct cost of hospitalisation of a non-colonised patient was 1,317.58 euro per day, and the direct cost of hospitalisation of a patient with a nosocomial infection was 2,268.14 euro per day of hospitalisation. CONCLUSIONS We found that reducing nosocomial infections would have a significant impact on the savings or reduction in healthcare costs associated with a different work process for patients in isolation. It would save 950.56 euro per patient for each day of hospitalisation for individual treatment of a patient hospitalised in an isolation room as consequence of a nosocomial infection.
Collapse
Affiliation(s)
- Patricia Blatnik
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
| | - Štefan Bojnec
- Department of Economics, Faculty of Management, University of Primorska, Koper, Slovenia
| |
Collapse
|
3
|
Naz H, Korkmaz P, Arslanal E, Mıstanoğlu-Özatağ D, Gürbüz H. Prospective Evaluation of Infections in Geriatric Patients in Intensive Care Units. INFECTIOUS DISEASES & CLINICAL MICROBIOLOGY 2022; 4:268-273. [PMID: 38633716 PMCID: PMC10986692 DOI: 10.36519/idcm.2022.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/15/2022] [Indexed: 04/19/2024]
Abstract
Objective Nosocomial infections (NIs) are major health problems with morbidity and mortality. Geriatric patients require intensive care unit (ICU) admission more frequently, and serious challenges occur during treatment. We aimed to evaluate the risk factors of NI and mortality in geriatric patients admitted to the ICU. Materials and Methods The study was conducted between April 2018 and April 2019 in two hospitals. We prospectively recorded the data on the forms prepared according to daily ICU visits. Results During the study period, 600 patients were hospitalized in the ICUs. Geriatric patients constituted 446 (74.3%) of the total number. The NI rate was 59% in adult patients and 80% in geriatric patients. The most frequent NI in geriatric patients was pneumonia (42%). Furthermore, the need for mechanical ventilation support, prolongation of hospital stay, total parenteral nutrition, and tracheostomy were statistically higher in geriatric patients with NI. The mortality rate in geriatric patients was statistically higher than in non-geriatric. We found the rates of prolonged hospitalization, NI development, malignancy, and cerebrovascular disease diagnosis significantly higher in geriatric patients than in non-geriatric patients. Conclusion NI and mortality rate are higher in geriatrics than in adult patients. Pneumonia is the most common type of NI in the ICU. Identification of risk factors regarding NI and mortality in geriatric patients in ICU will contribute to developing strategies for prevention.
Collapse
Affiliation(s)
- Hasan Naz
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Pınar Korkmaz
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Esra Arslanal
- Department of Infectious Diseases and Clinical Microbiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Duru Mıstanoğlu-Özatağ
- Department of Infectious Diseases and Clinical Microbiology, Kütahya Health Sciences University School of Medicine, Kütahya, Turkey
| | - Hande Gürbüz
- Department of Anesthesiology and Reanimation, University of Health Sciences School of Medicine, Derince Training and Research Hospital, Kocaeli, Turkey
| |
Collapse
|
4
|
Momen-Heravi M, Afzali H, Moravveji A, Taghvaee R. Epidemiology and risk factors of nosocomial infection among trauma patients hospitalized in kashan shahid beheshti hospital. INTERNATIONAL ARCHIVES OF HEALTH SCIENCES 2021. [DOI: 10.4103/iahs.iahs_67_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
5
|
Arora HS, Kamat D, Choudhry S, Asmar BI, Abdel-Haq N. Are Stethoscopes, Coats, and Pagers Potential Sources of Healthcare Associated Infections? Glob Pediatr Health 2020; 7:2333794X20969285. [PMID: 33195748 PMCID: PMC7604979 DOI: 10.1177/2333794x20969285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 09/02/2020] [Accepted: 09/30/2020] [Indexed: 11/15/2022] Open
Abstract
We conducted a study to determine the rate of bacterial colonization of
stethoscopes, coats, and pagers of residents at a pediatric residency training
program as compared to that of badges, sleeves, and pagers of non-patient care
staff (control group). Among 213 cultures obtained from 71 residents, 27
potential pathogens were isolated from 22 residents (27/213, 12.7%) as compared
to 10 potential pathogens out of 162 samples obtained from 54 control
participants (10/162, 6.2%) (P = .0375). The most common
pathogen isolated from residents and control participants was methicillin
sensitive Staphylococcus aureus (MSSA). The source of positive
cultures among the residents was the stethoscope (8/22, 36.3%), pager (8/22,
36.3%), and coat sleeve (11/22, 50%). The rates of colonization with potential
pathogens were higher among residents than control participants and about 12% of
residents’ stethoscopes, coats and pagers were colonized with bacterial
pathogens. These are potential sources of nosocomial transmission of pathogenic
organisms.
Collapse
Affiliation(s)
- Harbir S Arora
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Deepak Kamat
- UT Health Sciences Center San Antonio, San Antonio, TX, USA
| | | | - Basim I Asmar
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| | - Nahed Abdel-Haq
- Children's Hospital of Michigan, Detroit, MI, USA.,Wayne State University, Detroit, MI, USA
| |
Collapse
|
6
|
Abstract
Aim: In this study our aim was to evaluate the nosocomial infections and to understand factors affecting the cost of used antibiotics in palliative care unit.Materials and methods: Between 2016 and 2017, 113 patients were included in the study in palliative care unit of University of Health Sciences Bursa Yuksek Ihtisas Research and Training Hospital. Patients medical records were analyzed retrospectively for nosocomial infections, chronic diseases, presence of decubitis ulcers, opioid use, enteral, parenteral feedings, mortality and antibiotic cost.Results: Nosocomial infections were observed in 74.3% of the cases and 92.0% of patients used antibiotics. The mean duration of antibiotic use was 23.13 ± 18.06 days; and the average antibiotic cost was 2009.72 ± 2153.37 TL. Length of stay, male sex, presence of decubitus ulcers, tracheostomy, enteral and parenteral nutrition significantly increased antibiotic cost. Antibiotic cost and mortality were not related statistically.Conclusions: A vicious circle in palliative care involves the following order: length of stay, increased rate of infection, use of antibiotics, infection with resistant microorganisms, use of broad spectrum antibiotics, increased length of stay; all affecting each other. Therefore, using antibiotics for aggressive treatment of infections in palliative care is contraindicated as it opposes to real philosophy of palliative care.
Collapse
Affiliation(s)
- Ozgur Dagli
- Department of Infectious Diseases and Clinical Microbiology, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Eyyup Tasdemir
- Department of Internal Medicine, Palliative Unit, Health Sciences University Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | | |
Collapse
|
7
|
TÜRKEN M, YAZTÜRK Ş, YILMAZ M, YILMAZ BOZOĞLAN M. PAN ANTİBİYOTİK DİRENÇLİ PSEUDOMONAS (P. aeruginosa) VE STENOTROPHOMONAS’LARA (S. maltophilia) KARŞI SON SEÇENEK AJANLARDAN BİRİ OLAN KOLİSTİN (COLİSTİN)’İN IN VİTRO ETKİNLİĞİNİN ARAŞTIRILMASI. KAHRAMANMARAŞ SÜTÇÜ İMAM ÜNIVERSITESI TIP FAKÜLTESI DERGISI 2020. [DOI: 10.17517/ksutfd.536070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
|
8
|
Kara AV, Tanrikulu S, Aydın E, Aydın F, Yıldırım Y, Yılmaz Z, Kadiroğlu AK, Yılmaz ME. Evaluation of the effect of red cell distribution width on the development of acute renal failure in patients with sepsis. DICLE MEDICAL JOURNAL 2017. [DOI: 10.5798/dicletip.319769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
9
|
|
10
|
Costs of hospital-acquired infection and transferability of the estimates: a systematic review. Infection 2011; 39:185-99. [PMID: 21424853 DOI: 10.1007/s15010-011-0095-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/28/2011] [Indexed: 12/24/2022]
Abstract
Hospital-acquired infections (HAIs) present a substantial problem for healthcare providers, with a relatively high frequency of occurrence and considerable damage caused. There has been an increase in the number of cost-effectiveness and cost-savings analyses of HAI control measures, and the quantification of the cost of HAI (COHAI) is necessary for such calculations. While recent guidelines allow researchers to utilize COHAI estimates from existing published literature when evaluating the economic impact of HAI control measures, it has been observed that the results of economic evaluations may not be directly applied to other jurisdictions due to differences in the context and circumstances in which the original results were produced. The aims of this study were to conduct a systematic review of published studies that have produced COHAI estimates from 1980 to 2006 and to evaluate the quality of these estimates from the perspective of transferability. From a total of 89 publications, only eight papers (9.0%) had a high level of transferability in which all components of costs were described, data for costs in each component were reported, and unit costs were estimated with actual costing. We also did not observe a higher citation level for studies with high levels of transferability. We feel that, in order to ensure an appropriate contribution to the infection control program decision-making process, it is essential for researchers who estimate COHAI, analysts who use COHAI estimates for decision-making, as well as relevant journal reviewers and editors to recognize the importance of a transferability paradigm.
Collapse
|
11
|
Borg MA, Cookson BD, Scicluna E. Survey of infection control infrastructure in selected southern and eastern Mediterranean hospitals. Clin Microbiol Infect 2007; 13:344-6. [PMID: 17391397 DOI: 10.1111/j.1469-0691.2006.01595.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A structured questionnaire concerning hospital infection control (IC) organisation and initiatives was sent to 45 hospitals in Algeria, Cyprus, Egypt, Jordan, Lebanon, Libya, Malta, Morocco, Tunisia and Turkey. Hospitals bordering the eastern Mediterranean appeared to have more established IC infrastructures than southern Mediterranean hospitals. However, there were no significant differences among hospitals in the two regions in surveillance activities, the presence of an antibiotic policy or feedback of resistance data to prescribers, all of which were at a low level. Only a minority of hospitals had published antimicrobial treatment guidelines or gave feedback on antimicrobial resistance data to prescribers.
Collapse
Affiliation(s)
- M A Borg
- Infection Control Unit, St. Luke's Hospital, G'Mangia, Malta.
| | | | | |
Collapse
|
12
|
Kuzu N, Ozer F, Aydemir S, Yalcin AN, Zencir M. Compliance with hand hygiene and glove use in a university-affiliated hospital. Infect Control Hosp Epidemiol 2005; 26:312-5. [PMID: 15796286 DOI: 10.1086/502545] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
OBJECTIVE The hands of healthcare workers often transmit pathogens causing nosocomial infections. This study examined compliance with handwashing and glove use. SETTING A university-affiliated hospital. DESIGN Compliance was observed covertly. Healthcare workers' demographics, hand hygiene facilities, indications for hand hygiene, compliance with handwashing and glove use in each procedure, and duration of handwashing were recorded. RESULTS Nine nurses and 33 assistant physicians were monitored during the study. One researcher recorded 1400 potential opportunities for handwashing during 15-minute observation periods. The mean duration of handwashing was 10 +/- 2 seconds. Most healthcare workers (99.3%) used liquid soap during handwashing, but 79.8% did not dry their hands. For all indications, compliance with handwashing was 31.9% and compliance with glove use was 58.8%. Compliance with handwashing varied inversely with both the number of indications for hand hygiene and the number of patient beds in the hospital room. Compliance with handwashing was better in dirty high-risk situations. CONCLUSION Compliance with handwashing was low, suggesting the need for new motivational strategies such as supplying feedback regarding compliance rates
Collapse
Affiliation(s)
- Nevin Kuzu
- Pamukkale University, School of Health, Nursing Department, Denizli, Turkey.
| | | | | | | | | |
Collapse
|
13
|
Inan D, Saba R, Gunseren F, Ongut G, Turhan O, Yalcin AN, Mamikoglu L. Daily antibiotic cost of nosocomial infections in a Turkish university hospital. BMC Infect Dis 2005; 5:5. [PMID: 15679899 PMCID: PMC548682 DOI: 10.1186/1471-2334-5-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2004] [Accepted: 01/31/2005] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many studies associated nosocomial infections with increased hospital costs due to extra days in hospital, staff time, extra investigations and drug treatment. The cost of antibiotic treatment for these infections represents a significant part of hospital expenditure. This prospective observational study was designed to determine the daily antibiotic cost of nosocomial infections per infected adult patient in Akdeniz University Hospital. METHODS All adult patients admitted to the ICUs between January 1, 2000, and June 30, 2003 who had only one nosocomial infection during their stay were included in the study. Infection sites and pathogens, antimicrobial treatment of patient and it's cost were recorded. Daily antibiotic costs were calculated per infected patient. RESULTS Among the 8460 study patients, 817 (16.6%) developed 1407 episodes of nosocomial infection. Two hundred thirty three (2.7%) presented with only one nosocomial infection. Mean daily antibiotic cost was 89.64 dollars. Daily antibiotic cost was 99.02 dollars for pneumonia, 94.32 dollars for bloodstream infection, 94.31 dollars for surgical site infection, 52.37 dollars for urinary tract infection, and 162.35 dollars for the other infections per patient. The treatment of Pseudomonas aeruginosa infections was the most expensive infection treated. Piperacillin-tazobactam and amikacin were the most prescribed antibiotics, and meropenem was the most expensive drug for treatment of the nosocomial infections in the ICU. CONCLUSIONS Daily antibiotic cost of nosocomial infections is an important part of extra costs that should be reduced providing rational antibiotic usage in hospitals.
Collapse
Affiliation(s)
- Dilara Inan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Rabin Saba
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Filiz Gunseren
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Gozde Ongut
- Department of Medical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ozge Turhan
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Ata Nevzat Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Latife Mamikoglu
- Department of Infectious Diseases and Clinical Microbiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| |
Collapse
|
14
|
Erbay RH, Yalcin AN, Zencir M, Serin S, Atalay H. Costs and risk factors for ventilator-associated pneumonia in a Turkish university hospital's intensive care unit: a case-control study. BMC Pulm Med 2004; 4:3. [PMID: 15109397 PMCID: PMC419357 DOI: 10.1186/1471-2466-4-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2004] [Accepted: 04/26/2004] [Indexed: 11/10/2022] Open
Abstract
Background Ventilator-associated pneumonia (VAP) which is an important part of all nosocomial infections in intensive care unit (ICU) is a serious illness with substantial morbidity and mortality, and increases costs of hospital care. We aimed to evaluate costs and risk factors for VAP in adult ICU. Methods This is a-three year retrospective case-control study. The data were collected between 01 January 2000 and 31 December 2002. During the study period, 132 patients were diagnosed as nosocomial pneumonia of 731 adult medical-surgical ICU patients. Of these only 37 VAP patients were assessed, and multiple nosocomially infected patients were excluded from the study. Sixty non-infected ICU patients were chosen as control patients. Results Median length of stay in ICU in patients with VAP and without were 8.0 (IQR: 6.5) and 2.5 (IQR: 2.0) days respectively (P < 0.0001). Respiratory failure (OR, 11.8; 95%, CI, 2.2–62.5; P < 0.004), coma in admission (Glasgow coma scale < 9) (OR, 17.2; 95% CI, 2.7–107.7; P < 0.002), depressed consciousness (OR, 8.8; 95% CI, 2.9–62.5; P < 0.02), enteral feeding (OR, 5.3; 95% CI, 1.0–27.3; P = 0.044) and length of stay (OR, 1.3; 95% CI, 1.0–1.7; P < 0.04) were found as important risk factors. Most commonly isolated microorganism was methicillin resistant Staphylococcus aureus (30.4%). Mortality rates were higher in patients with VAP (70.3%) than the control patients (35.5%) (P < 0.003). Mean cost of patients with and without VAP were 2832.2+/-1329.0 and 868.5+/-428.0 US Dollars respectively (P < 0.0001). Conclusion Respiratory failure, coma, depressed consciousness, enteral feeding and length of stay are independent risk factors for developing VAP. The cost of VAP is approximately five-fold higher than non-infected patients.
Collapse
Affiliation(s)
- Riza Hakan Erbay
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Ata Nevzat Yalcin
- Department of Infectious Diseases and Clinical Microbiology, Medicine Faculty, Akdeniz University, Antalya, Turkey
| | - Mehmet Zencir
- Department of Public Health, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Simay Serin
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
| | - Habip Atalay
- Department of Anaesthesiology and Reanimation, Medicine Faculty, Pamukkale University, Denizli, Turkey
| |
Collapse
|
15
|
Yalcin AN, Turgut H, Cetin B, Erbay H, Serin S. Nosocomial infections in a Turkish university hospital: a 2-year survey. Infect Control Hosp Epidemiol 2003; 24:235-6. [PMID: 12725348 DOI: 10.1086/503477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
16
|
Yalçin AN, Serin S, Gurses E, Zencir M. Surgical antibiotic prophylaxis in a Turkish university hospital. J Chemother 2002; 14:373-7. [PMID: 12420855 DOI: 10.1179/joc.2002.14.4.373] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
A prospective study was performed to assess the practice of antibiotic prophylaxis for surgical procedures in Pamukkale University Hospital, Denizli, Turkey. All surgical procedures performed between April 1 and July 31, 2001, were included. During the study period 897 operations were reviewed. 96% of all procedures were elective, 4% emergencies. Approximately 70.7% were clean surgery, 25.3% clean-contaminated, 2.8% contaminated, and 1.2% dirty. 98% of patients (879) received antibiotic prophylaxis. Although timing of prophylaxis was appropriate in all procedures, the duration of prophylaxis was optimal in only 47.7% of all cases. Sulbactam/ampicillin (SAM), cefazolin and cefepime were the most commonly used antibiotics during the study period. The results of our study suggest that the choice of prophylactic antimicrobial agent was inappropriate in most cases. In conclusion, we think that compliance regarding the optimal choice, frequency, and duration of perioperative antibiotic prophylaxis is not adequate in our hospital, and that more education on the subject is necessary.
Collapse
Affiliation(s)
- A N Yalçin
- Pamukkale University, Medicine Faculty, Dept. of Infectious Diseases, Denizli, Turkey.
| | | | | | | |
Collapse
|
17
|
Abstract
This article describes the current organization of infection control in Turkey in regard to regulations, functions and responsibilities of infection control committees and the national NosoLINE project. Also, incidence and prevalence of hospital infections and antimicrobial resistance in Turkey are reported.
Collapse
Affiliation(s)
- H Leblebicioglu
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University, Medical School, Samsun, Turkey.
| | | |
Collapse
|
18
|
Akalin HE. Surgical prophylaxis: the evolution of guidelines in an era of cost containment. J Hosp Infect 2002; 50 Suppl A:S3-7. [PMID: 11993641 DOI: 10.1053/jhin.2001.1121] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Postoperative infections account for a large proportion of hospital-acquired infections, are associated with a high morbidity and mortality, and place a large burden upon the inpatient healthcare budget. Prophylaxis is desirable and is based on a combination of preoperative preparation, surgical techniques, perioperative antibiotic prophylaxis and postoperative wound care. There is considerable evidence that antibiotics are used excessively and inappropriately in the prevention and treatment of hospital-acquired infections, including surgical-site infections. In the case of the latter, timing of prophylaxis is crucial to success yet antibiotics are often administered at the wrong time or for too long a period, with implications for the cost of patient care. Several studies have shown that the local implementation of practice guidelines can yield significant improvements in antibiotic use and the cost of surgical prophylaxis. More rational use of antibiotics is likely to benefit the treatment of future surgical patients by reducing the pressure to select for antibiotic-resistant bacterial pathogens.
Collapse
Affiliation(s)
- H Erdal Akalin
- Pfizer Pharmaceuticals Group, Pfizer Ilaçlari A.S., Istanbul, Turkey.
| |
Collapse
|
19
|
Singh-Naz N, Sprague BM, Patel KM, Pollack MM. Risk assessment and standardized nosocomial infection rate in critically ill children. Crit Care Med 2000; 28:2069-75. [PMID: 10890666 DOI: 10.1097/00003246-200006000-00067] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop and validate a pediatric nosocomial infection risk (PNIR) assessment model, and to compare the daily trends in risk factors between patients with nosocomial infection (cases) and without nosocomial infection (controls) in the pediatric intensive care unit (ICU). DESIGN Prospective cohort. SETTING A 16-bed pediatric ICU in an urban, university-affiliated, multidisciplinary, regional referral center. PATIENTS Patients available for study included consecutive admissions to the unit between May 1, 1992, and April 30, 1993, and between May 9, 1995, and December 11, 1995. Patients from both data collection periods were pooled and randomly divided into training (70%) and validation (30%) samples. MEASUREMENTS AND MAIN RESULTS In the logistic regression analysis using admission day data, three factors were shown to remain as independent risk factors. Invasive device use, parenteral nutrition, and the interaction between severity of illness-modified Pediatric Risk of Mortality III-24 score and postoperative care were associated with 2, 6, and 1.5 times the risk of developing nosocomial infection, respectively. This PNIR model performed well in both the training and validation samples as indicated by the goodness-of-fit test, which evaluated standardized nosocomial infection rates (observed vs. predicted nosocomial infection rates). The internal validity of the PNIR model was good. In trend analysis, severity of illness and invasive device use appear to have similar trend patterns, during the first week of pediatric ICU stay. There was no difference in any of these risk factors between cases and controls after 7 days of pediatric ICU stay. CONCLUSIONS The PNIR assessment model incorporates intrinsic factors, such as patient severity of illness, and extrinsic factors contributing to the development of nosocomial infection in this high-risk population. The methodology using intrinsic and extrinsic factors to adjust for nosocomial infections should be taken into consideration when evaluating interhospital comparison of nosocomial infection rates, quality assessment, intervention strategies, and use of treatment modalities.
Collapse
Affiliation(s)
- N Singh-Naz
- George Washington University School of Medicine and Health Sciences, and the Center for Health Services and Clinical Research, Children's National Medical Center, Washington, DC 20010, USA.
| | | | | | | |
Collapse
|