MedUni Vienna: Hospital-acquired infections: Austria comes out in the middle of the Europe-wide comparison

Nosocomial infections, that is to say infections acquired in hospital, result in a protracted period of illness, loss of quality of life and even in increased mortality. Both the World Health Organisation (WHO) and the European Commission are focused on combating healthcare associated infections (HAI) as part of their patient safety strategy. The University Department of Hospital Hygiene and Infection Control at the Medical University of Vienna is the national reference center for nosocomial infections and, in association with the Federal Ministry of Health (BMG), it has now completed the second point prevalence study in 51 Austrian hospitals. The results: Austria comes out in the middle of the Europe-wide comparison.

According to extrapolated figures from the ECDC (European Center for Disease Prevention and Control), around three million patients a year develop at least one HAI in a European hospital. This means that in Europe around 6% of patients acquire a nosocomial infection. The recent prevalence study for Austria shows that, out of 13,814 patients, a total of 727 developed an HAI, that is 5.3%. That represents a slight improvement over a similar study conducted in 2012 – the prevalence rate at that time was 6.2% (however, only nine hospitals were involved).

"We are on the right track but we are constantly being faced with new challenges when it comes to hospital hygiene. These figures therefore help us with our strategic planning, to make improvements and to take specific measures to protect patients and contribute to a higher level of patient safety," says Elizabeth Presterl, Head of the University Department of Hospital Hygiene at the Medical University of Vienna. Additional measures such as training, audits and feedback as well as structural measures to combat the commonest hospital-acquired infections should help to bring about a long-term reduction in the infection rate.

Austria is one of the few European countries that has legislated on hospital hygiene in the form of the Federal Law on Hospitals and Sanatoria. Austria is also the first country in Europe to present these figures for 2015 in accordance with a revised ECDC protocol. The next prevalence study is already being planned and is due to be completed in 2017.
"I support the studies to survey hospital-acquired infections and I am glad that a lot more hospitals are now taking part. We need this epidemiological data in order to plan our national strategy. The more we know about the situation, the more accurately we are able to define and implement the quality standard," confirms Health Minister Sabine Oberhauser. The BMG is working with the Federal States and the Association of Austrian Social Security Institutions to develop a uniform concept for tackling hospital-acquired infections throughout Austria. Together with the Federal Quality Standard on hospital hygiene, this would then provide two important instruments for reducing the rate of hospital-acquired infections.

The distribution of HAI over the individual medical specialisms correlates with the number of patients admitted: surgery and internal medicine each account for one third of patients and hence of infections. The commonest infections were pneumonia, urinary tract infections, post-operative wound infections and gastrointestinal infections. Around half of all cases involved multi-resistant pathogens, the commonest being Enterobacteriaceae.

"The sensible use of antibiotics is very important when it comes to hospital-acquired infections," says Presterl. After exhausting the diagnostic possibilities, the aim is to administer individually targeted antibiotic therapy, because more and more hospital organisms are becoming multi-resistant. The results: around 26% of patients receive antibiotics, which, according to the MedUni Vienna expert, is a "respectable value" – and represents a slight improvement over 2012 (33%). The low rate of administration (in 5% of all cases) of carbapenems, a drug belonging to the beta-lactam group of antibiotics, was pleasing.

There had been an increase in the use of hand disinfectant and hence in hand hygiene generally: "The use of 28 ml of hand disinfectant for nine patient contacts per day indicates that hand disinfection is being done correctly," explains Presterl. "I am sure there is still room for improvement but it is better than in 2012 and definitely better than the EU [TN: average?] usage of 23.9 ml."

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