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Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics.

ABSTRACT: Objectives:To compare the predicted vs observed mortality rate, criticality, and length of stay of the patients with healthcare-associated infections (HAIs) in intensive care units (ICUs) of a tertiary health center through acute physiology and chronic health evaluation (APACHE) IV scoring. To analyze the drug sensitivity pattern of the isolated pathogen. Design:This is a prospective observational study involving the patients admitted to various ICUs of a tertiary care teaching hospital. Among 1,229 patients who were admitted in the ICUs for a period of 2.5 months (74 days), 767 patients stayed beyond 48 hours. They were monitored and 87 of them who developed HAIs were included in the study. The organisms isolated from the infection site were identified, and the drug resistance pattern was reported as per standard guidelines. The patients were followed up till their discharge, and adequate details pertaining to the study were collected including demographic details and physiological and biochemical parameters to calculate APACHE IV score, length of stay, and prognosis. Setting:Intensive care units of JSS Hospital, Mysuru, Karnataka, India. Subjects/patients:All patients who developed HAI in ICUs. Interventions:Nil. Measurements and main results:The HAI rate observed in this study was 15.7%. Ventilator-associated pneumonia (VAP) was the most common type of infection. Klebsiella and Acinetobacter were the frequently isolated organisms. There was a high prevalence of drug resistance among these pathogens. The ICU mortality in infected patients was 21.83%, roughly twice as that of uninfected patients. The observed length of stay was 11.66 (±8.53) days. Conclusion:Healthcare-associated infection was associated with long duration of ICU stay. There was a high prevalence of drug resistance to various antibiotics. Acute physiology and chronic health evaluation IV score was not found to be good scoring system to predict the mortality and length of stay in the patients who had HAI. How to cite this article:Gunasekaran S, Mahadevaiah S. Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics. Indian J Crit Care Med 2020;24(4):252-257.

SUBMITTER: Gunasekaran S

PROVIDER: S-EPMC7297239 | biostudies-literature | 2020 Apr

REPOSITORIES: biostudies-literature

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Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics.

Gunasekaran Santosh S Mahadevaiah Sumana S

Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine 20200401 4

<h4>Objectives</h4>To compare the predicted vs observed mortality rate, criticality, and length of stay of the patients with healthcare-associated infections (HAIs) in intensive care units (ICUs) of a tertiary health center through acute physiology and chronic health evaluation (APACHE) IV scoring. To analyze the drug sensitivity pattern of the isolated pathogen.<h4>Design</h4>This is a prospective observational study involving the patients admitted to various ICUs of a tertiary care teaching ho ...[more]

PMID: 32565635

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Project description:BACKGROUND:Healthcare-associated infections (HAIs) represent serious complications for patients within pediatric cardiac intensive care units (CICU). HAIs are associated with increased morbidity, mortality and resource utilization. There are few studies describing the epidemiology of HAIs across the entire spectrum of patients (surgical and nonsurgical) receiving care in dedicated pediatric CICUs. METHODS:Retrospective analyses of 22,839 CICU encounters from October 2013 to September 2016 across 22 North American CICUs contributing data to the Pediatric Cardiac Critical Care Consortium clinical registry. RESULTS:HAIs occurred in 2.4% of CICU encounters at a rate of 3.3 HAIs/1000 CICU days, with 73% of HAIs occurring in children <1 year. Eighty encounters (14%) had ?2 HAIs. Aggregate rates for the 4 primary HAIs are as follows: central line-associated blood stream infection, 1.1/1000 line days; catheter-associated urinary tract infections, 1.5/1000 catheter days; ventilator-associated pneumonia, 1.9/1000 ventilator days; surgical site infections, 0.81/100 operations. Surgical and nonsurgical patients had similar HAIs rates/1000 CICU days. Incidence was twice as high in surgical encounters and increased with surgical complexity; postoperative infection occurred in 2.8% of encounters. Prematurity, younger age, presence of congenital anomaly, Society of Thoracic Surgeons-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality Categories (STAT) 4-5 surgery, admission with an active medical condition, open sternum and extracorporeal membrane oxygenation were independently associated with HAIs. In univariable analysis, HAI was associated with longer hospital length of stay and durations of urinary catheter, central venous catheter and ventilation. Mortality was 24.4% in patients with HAIs versus 3.4% in those without, P < 0.0001. CONCLUSIONS:We provide comprehensive multicenter benchmark data regarding rates of HAIs within dedicated pediatric CICUs. We confirm that although rare, HAIs of all types are associated with significant resource utilization and mortality.

Project description:ObjectiveTo survey the healthcare professionals' background and experiences from work with patients with COVID-19 in intensive care units (ICUs) during the first wave of the COVID-19 pandemic in Norway.DesignObservational cohort study.SettingCOVID-ICUs in 27 hospitals across Norway.ParticipantsHealthcare professionals (n=484): nurses (81%), medical doctors (9%) and leaders (10%), who responded to a secured, web-based questionnaire from 6 May 2020 to 15 July 2020.Primary and secondary measuresHealthcare professionals': (1) professional and psychological preparedness to start working in COVID-ICUs, (2) factors associated with high degree of preparedness and (3) experience of working conditions.ResultsThe age of the respondents was 44.8±10 year (mean±SD), 78% were females, 92% had previous ICU working experience. A majority of the respondents reported professional (81%) and psychological (74%) preparedness for working in COVID-ICU. Factors significantly associated with high professional preparedness for working in COVID-19-ICU in a multivariate logistic model were previous ICU work experience (p<0.001) and participation in COVID-ICU simulation team training (p<0.001). High psychological preparedness was associated with higher age (p=0.003), living with spouse or partner (p=0.013), previous ICU work experience (p=0.042) and participation in COVID-ICU simulation team training (p=0.001). Working with new colleagues and new professional challenges were perceived as positive in a majority of the respondents, whereas 84% felt communication with coworkers to be challenging, 46% were afraid of being infected and 82% felt discomfort in denying access for patient relatives to the unit. Symptoms of sweating, tiredness, dehydration, headache, hunger, insecurity, mask irritation and delayed toilet visits were each reported by more than 50%.ConclusionsHealthcare professionals working during the first wave of COVID-ICU patients in Norway were qualified and prepared, but challenges and potential targets for future improvements were present.Trial registration numberNCT04372056.

Dataset Information

Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics.

Publications

Healthcare-associated Infection in Intensive Care Units: Overall Analysis of Patient Criticality by Acute Physiology and Chronic Health Evaluation IV Scoring and Pathogenic Characteristics.

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