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KISS components nrz-hygiene.de

ONCO-KISS nosocomial infection surveillance during neutropenia Petra Gastmeier, MD Charité – University Medicine Berlin, Germany and German National Reference Center for Surveillance of Nosocomial Infections. KISS components www.nrz-hygiene.de. CDAD-KISS. ICU-KISS. MRSA-KISS. OP-KISS.

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KISS components nrz-hygiene.de

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  1. ONCO-KISS nosocomial infection surveillanceduringneutropeniaPetra Gastmeier, MDCharité – University Medicine Berlin, Germanyand German National Reference Center for Surveillance of Nosocomial Infections

  2. KISS componentswww.nrz-hygiene.de CDAD-KISS ICU-KISS MRSA-KISS OP-KISS ONKO-KISS NEO-KISS AMBU-KISS DEVICE-KISS

  3. Start: January 2003 ONKO-KISS Patientswithbonemarrowandperipheralsteamcelltransplantation

  4. Objectives of ONKO-KISS • Establishment of a database with nosocomial infections of patients with bone marrow transplant (BMT) and peripheral blood stem cell transplant (PBSCT) in Germany • Providing reference data for internal quality management • Reduction of nosocomial infections

  5. Nosocomial infections in BMT patients in Freiburg Surveillance over a 5 year period with 351 patients Dettenkofer et al. Bone Marrow Transplant 2003; 31:795-801

  6. Method ONKO-KISS Dettenkofer, Bone Marrow Ttransplant 2003; 31: 795-01

  7. Which data are recorded ? Neutropenic days Nosocomial BSI Nosocomial pneumonia Which definitions are used? • BSI: according to CDC criteria • Pneumonia: modified CDC criteria (Carlisle et al., 1993)

  8. Laboratory confirmed BSI (CDC) At least one of the following criteria: • Recognized pathogen isolated from blood culture that was not related to an infection at another site and/or • One of the following criteria: Fever (>38°C), shivering or hypotension and one of the following: • Isolation of a common skin contaminant from 2 separate blood cultures that was unrelated to an infection at another site • Isolation of a common skin contaminant from 1 blood cultures for patients with an an intravascular device for whom a physician initiated appropriate antimicrobial therapy • Positive antigen blood test and the pathogen is unrelated to an infection at another site

  9. Nosocomial pneumoniaONKO-KISS (Carlisle et al., 1993) • At least one of the following criteria: • Fever (>38°C) and new or worsening infiltrates from chest radiography or a thoracic CT and/or • At least 2 of the following production of sputum cough dyspnea rhonchi or rales polymorphonuclear leucocytes on a sputum gram stain pleural rub

  10. Which rates are calculated ? number of BSI cases BSI rate = ---------------------------------- number of neutropenic days number of pneumonia cases Pneumonia rate = --------------------------------------- number of neutropenic days

  11. Dettenkofer et al. CID 2005; 40: 926-31

  12. Standardization according to the number of neutropenia days ONKO-KISS data 12/2007

  13. Stratification according to the type of transplantation ONKO-KISS data 12/2007

  14. ONKO-KISS-Reference data 12/2007

  15. CVC associated BSI rates in various KISS components Gastmeier P et al. Dt. Ärztebl 2005; 102: A2098-2101

  16. Reduction of BSI rates by surveillance and intervention over a 36 months period 268 patients, 87 BSI BSI/1000 neutropenic days Intervention OR= 0.58 (CI95 0.34-0.99) Chaberny et al. submitted

  17. ONKO-KISS surveillance among children with BMT/PBSCT Children Adults ONKO-KISS 6/2007

  18. ONKO-KISS surveillance among childrenPrimary BSI per 1000 neutropenia days ONKO-KISS analysis 6/2007

  19. ONKO-KISS surveillance among patient with acute leucaemia ONKO-KISS 12/2007

  20. ONKO-KISS surveillance among patient with acute leucaemiaPrimary BSI per 1000 neutropenia days ONKO-KISS analysis 6/2007

  21. Summary • Surveillance of nosocomial infections ist also feasible in the group of hematology/oncology patients • BSI and pneumonia are the most interesting outcomes in this patient group. • A standardization according to the number of neutropenia days seems to be useful.

  22. German national hand hygienecampaign

  23. HAND-KISS

  24. for each unit/ward of the hospital: Annual amount of alcoholic hand rub (ml) ____________________________ Annual number of patient days HAND-KISS

  25. HAND-KISS

  26. Median amount of alcoholic hand rub used (ml) per patient day 2007 (68 hospitals)

  27. Distribution of the amount of alcoholic hand rub used (ml) per patient day 2007 (ICUs only) Total 136 43 59 95

  28. www.nrz-hygiene.de

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