Swissnoso

Swissnoso: Stratégie nationale contre les infections
nosocomiales : ce qui pourrait changer ou
évolution de Swissnoso: de l'enfant à l'adulte
Andreas F. Widmer,
MD,MS,FIDSA,FSHEA
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Président Swiss-Noso (www.swissnoso.ch)
Task Force WHO Patient Safety (Safe surgery, hand hygiene)
Board of Trustees Society for Healthcare Epidemiology (SHEA)
Treasurer European Study Group Nosocomial Infections (ESGNI)
Board member Schweiz. Gesellschaft für Infektiologie (Sginf)
Scientific Board ONKO Krankenhaus-Infectkions-Surveillance System (KISS)
Swissnoso: «the baby»
La naissance de Swissnoso
Les pères de
Swissnoso
Pierre-Alain
Reber OSP
Office de la santé publique
Patrick Francioli
Division autonome
de l’ Hygiene
hospitalière
Et medicine
preventive (DAMP)
University of Iowa, USA
ICAAC 2004 Chicago
La naissance de Swissnoso
Groupe Swissnoso 1994
Swissnoso
The «toddler»
Le petit enfant
Le premier Bulletin
Time used for Handwashing vs Hand Disinfection
ICU beds (Nurse - bed ratio 1:1)
Nurses per shift
Working hrs per shift
Opportunities for HW / hr
Time committment for hand washing/contact
Handwashing episodes /day/ICU (n=12)
Total time spent (min)ª
Nursing time lost/day (h)/ICU
Nursing hours total (12x24hrs)
Nursing time lost/day (hr)/ICU
ª ICU beds
12
nurses/shift
3
12x3x8x5x2 min (0.5 min)
² Nursing time lost/8h shift = 48/8
Handwashing
Handdisinfection
12
3
8
5
12
3
8
5
2 minutes
0.5 minutes
1440
2880
48
1440
720
12
288
48 (16%)
working hours/shift
patient contacts /h
288
12 (4,1%)
8
5
Widmer AF. Infection control and prevention strategies in
the ICU. Intensive.Care.Med. 1994; 20 Suppl 4:S7-11.
Handwashing Versus Alcoholic Rub
Voss A, Widmer AF. Infect Control Hosp Epidemiol 1997;18:205-208
handwash
Handwashing (HW) Opportunities in Teaching
Hospitals per hour
Opportunities for HW
- Ward
- ICU
20-40 opp/ hr care
43 opp/ hr care
20 opp/ hr care
/HCW
Decrease of compliance by
5% per 10 opportunites per
hour
Correlation between workload and compliance
Pittet D . Ann Intern Med 1999. 130:126-130.
Swissnoso: a école élémentaire
2. SHEA-CDCESGNI
Course in
Hospital
Epidemiology
Didier, Christian
Hugo, Andreas
Geneva 2000 Pittet
Stein a/R 2006 Ruef
Brunnen 2012 Widmer
prévalence des infections nosocomiaux
en Suisse
Les premiers etudes de prévalence en Suisse
Erfolg des Swiss-NOSOsurveillance-Netzwerks
Succès du réseau Swiss-NOSOsurveillance
7540
8000
7000
60
6000
60
4252
40
4000
3000
2000
1000
0
30
2000
20
18
Hsopitals
50
5000
Patients
70
PAT
HOSP
10
4
1996
0
1999
2002
Slide courtesy of Hugo Sax
Prevelance des infections nosocomiales
par des comorbidites
Mean +- 1 SD of Prevalence of Hospitals in Each Group
Mean Prevalence
9‘500 Patienten untersucht
16%
14%
12%
10%
8%
6%
4%
2%
0%
10.7%
9.6%
6.1%
Large
Krankenhausgrösse:
Small: >200 Betten
Intermediate 200-500 Betten
Large: >500 Betten
Intermediate
Small
Sax H. for the Swiss-Noso Group (A.Widmer & D. Pittet) . Arch Intern Med 2002
Risk Adjustment
Analysis [OR; CI95]
Odds Ratio
10
Stratifié par maladies
1
0.1
Large Size Hospitals
Intermediate Size
Small Size Hospital
Hospital
Sax H. for the Swiss-Noso Group (A.Widmer & D. Pittet) . Arch Intern Med 2002
Swissnoso au collège
Hôpitaux snip04
Plus des etudes
de prevalence
De prévalence à l’incidence des
infections nosocomiaux
Surgical site infection surveillance network
N. Troillet, ICHV Sion
Slide: courtesy of N.Troillet
Surveillance of: appendectomy, hernia repair, cholecystectomy,
colectomy, thoracic surgery, hip and knee prostesis
Surgical site infection surveillance network (N. Troillet, Sion)
Example of benchmarking
Slide: courtesy of N.Troillet
Nombre total de cas inclus
Période 01.06.2009 – 12.06.2013
1.6.13: 142 hôpitaux et cliniques en Suisse
> 24.Nov 2014: > 200’000 cas inclus
data Par MC Eisenring
32
Longitudinal data: Période 01.06.2009 – 12.06.2013
Infections rate %
1.6.09 - 30.9.11 (28 months)
20
18
16
14
12
10
8
6
4
2
0
1.10.11 - 30.9.12 (12 months)
1.10.12 - 30.9.13 (12 months)
Période 01.06.2009 –
12.06.2013
Colon
Rectum
CABG
Gastric
Bypass
Cardiac Appen- Cholecys- Caesarian Hip
Hernias Knee
global dectomy tectomy
prosthesis
prosthesis
Swissnoso
le baccalauréat
Projet de validation Swissnoso
Résultats 10 cas randomisés, N=278
Taux d’infection
avant validation
% (N/N)
4.3% (12 / 278 )
après validation
% (N/N)
6.1% (17 / 278)
Différence
rel +41%
Abx + 1.8%
Diapositive par MC Eisenring
Adjusted infection rates for appendectomy between
01.10.2012 and 30.09.2013, by hospital
Adjusted infection rates for colon surgery between
01.10.2012 and 30.09.2013, by hospital
Adjusted infection rates for caesarean section between
01.10.2012 and 30.09.2013, by hospital
Swissnoso
a l’université
Questionnaire 82/103 Hospitals responded
Conventional razors (single use razor blade) are used for
hair removal in
100%
90%
9
80%
70%
15
1
12
2
15
60%
> 75%
50%
51-75%
< 25%
40%
never
30%
20%
10%
0%
53
8
52
digestive surgery (n=78)
cardiac surgery (n=11)
orthopedic surgery (n=80)
Antimicrobial Prophylaxis Report CR/MCE/NT
21st November 2013
Type of surgery
Percentage of timing
within 0-60min during
current time period*
Percentage of timing
within 0-60min during
previous period
change
Cholecystectomy
61.1 %
61.7 %
appendectomy
64.1 %
-
Hernia operation
81.8 %
85.7 %

colon surgery
67.9 %
65.9 %

Rectum surgery
58.5 %
58.4 %

gastric bypass
82.4 %
75.2 %

cardiac surgery
78.8 %
75.4 %

hip prosthesis
84.1 %
-
knee prosthesis
81.4 %
-
Overall
73,3%

*for digestive surgery: follow up 1.10.2010 – 30.09.2011
* for cardiac and orthopedic surgery: follow-up done 01.10.11-30.09.2012
L’avenir de
Swissnoso?
Les Projets Swissnoso 2015-2017
• Intervention active contre les infection
postchirurgicale: compliance avec le «bundle»
sera > 90%
– andre Widmer, Basel
• Intervention contre les inféction urinaire
– Jonas Marschall; Bern
• Compliance des hygiene des mains
• Matthias Schlegel, St.Gallen
European Study Group on Nosocomial Infections
(ESGNI): Steering Group
European Society for Clinical Microbiology and
Infectious Diseases
Basel Walk of Fame
Garden of University of Basel Hospitals
Merci a tous les mebres de Swissnoso
merci pour le support par ANQ
Je me remercie pour votre attention