Nosocomiale Infecties in België, deel II: Impact op Mortaliteit ... - KCE

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4 Nosocomial Infections – Mortality and Costs KCE reports 102 1 BACKGROUND AND INTRODUCTION 1.1 INTRODUCTION A nosocomial infection (NI), or hospital-acquired infection (HAI), or cross-infection (MESH term) occurs during a hospital stay and is not present at hospital admission. Nosocomial infections are the most common type of complication affecting hospitalized patients and affect primarily the urinary tract, the gastrointestinal tract, the surgical site, the lower respiratory tract, and the bloodstream. These infections increase patient morbidity and mortality, prolong hospital stay and generate substantial costs. All hospitals in Belgium have a hospital control unit headed by a medical doctor hygienist. These teams promote good practices that reduce nosocomial infections. In a first part of this report, published as KCE report no 92 1 , we reviewed the literature on the prevalence of nosocomial infections in Europe and estimated the incidence and prevalence of nosocomial infections in Belgian acute care hospitals. This was based on a point prevalence study, by the hospital infection control teams of more than half of the Belgian acute hospitals. An overall prevalence of 6.2% was found, which is similar to the most recently published prevalence for the neighbouring countries. In this second part of the report we estimate for each nosocomial infection subgroup, the healthcare costs and its main drivers, as well as the overall annual cost of nosocomial infections in Belgium from a healthcare payer perspective. Also the excess mortality caused by the nosocomial infections will be estimated. 1.2 MAIN RESULTS FROM THE PREVALENCE SURVEY In total, 63 out of the 113 acute hospitals participated (53%), constituting a representative sample, both in terms of country region, distribution of wards, hospital size and status (general or university). Most hospitals included all patients hospitalized. Some mainly larger hospitals participated with all wards but selected to study 50% of all patients per ward (selected at random). In total 17 343 hospitalized patients were surveyed. The prevalence of patients infected in Belgian hospitals was 6.2% (95%CI 5.9-6.5). These rates are very similar to recent data published in 2007 for the Netherlands (6.9%) and France (5.03-6.77% depending on the type of acute hospital). Also the prevalence for bloodstream infections in Belgium (0.96%) is similar when compared with the Netherlands (0.9%) and somewhat higher compared with the prevalence published for France (0.33-0.67%). Intensive care units (both for adults and for neonates) have a high prevalence of patients infected (25.3% for adults and 12.6% for neonates). Surgical and medical units have a lower prevalence of nosocomial infections (5.9% and 5.2%) but comprise approximately half of the observed infections. SP services have a prevalence of 7.6%.
KCE reports 102 Nosocomial Infections – Mortality and Costs 5 I- Intensive care N- Neonatal intensive care Sp- Revalidation and treatment G- Geriatrics C- Surgical diagnosis and treatment n- Non-intensive neonatal care D- Medical diagnosis and treatment E- Pediatrics A- Psychiatry M- Maternity 0 5 10 15 20 25 30 prevalence of patients infected (%) The most prevalent nosocomial infection types are urinary tract infections (UTI) (23.9%), lower respiratory tract infections (LRI) (20.1%), SSI (14.6%), bloodstream infections (BSI) (13.6%) and gastrointestinal infections (GI) (12.5%). These proportions are very dependent on the type of ward. On surgical wards, the most prevalent nosocomial infection type is SSI (38.7%), while on medical wards the types of infections are more heterogeneous (UTI 23.6%, BSI 22.8%, LRI 20.4%, SSI 6.2%). On geriatrics wards the nosocomial infection types are mainly UTI (37%) and GI (24.4%). In intensive care units half of infections are LRI (50.8%), and 20% are BSI. On SP wards more than half of the infections are UTI (54.5%). 12,5 13,6 15,3 14,6 23,9 20,1 UTI (urinary tract) LRI (lower respiratory tract) SSI (surgical site) BSI (bloodstream) GI (gastrointestinal) Other The prevalence results obtained at a single day were extrapolated to a full year and for all Belgian acute hospitals. Of the roughly 15 million hospitalisation days in acute hospitals in Belgium every year, 900 000 hospitalisation bed days are complicated by the presence of at least one nosocomial infection present that day. The bed days linked to a patient suffering from a nosocomial infection are seen mainly on five types of ward: medical and surgical (+- 200 000 days each), geriatrics (+- 150 000 days), SPs and Intensive Care (+- 100 000 days each).
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