ONCO-KISS nosocomial infection surveillance during neutropenia Petra Gastmeier, MD Charité – University Medicine Berlin, Germany and German National Reference.

ONCO-KISS nosocomial infection surveillance during

neutropenia

Petra Gastmeier, MD

Charité – University Medicine Berlin, Germanyand German National Reference Center for Surveillance of Nosocomial Infections

2

KISS componentswww.nrz-hygiene.de

ICU-KISS

OP-KISS

DEVICE-KISS

AMBU-KISS

MRSA-KISS

NEO-KISS

CDAD-KISS

ONKO-KISS

Patients with bone marrow and peripheral steam cell transplantation

ONKO-KISS

Start:January 2003

Objectives of ONKO-KISSObjectives 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

Nosocomial infections in BMT Nosocomial infections in BMT patients in Freiburgpatients in Freiburg

Nosocomial infections

Total NI during neutropenic

period

Total 239 171 (71.5 %)

Primary BSI 85 70

Pneumonia 77 60

UTI 11 8

Surveillance over a 5 year period with 351 patients

Dettenkofer et al. Bone Marrow Transplant 2003; 31:795-801

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Method ONKO-KISS

Infections Standardization Stratification•Pneumonia•Primary blood stream infection

Neutropenia days

• allogen• autolog

Dettenkofer, Bone Marrow Ttransplant 2003; 31: 795-01

Which data are recorded ?Which data are recorded ?

Neutropenic daysNosocomial BSINosocomial pneumonia

• BSI: according to CDC criteria• Pneumonia: modified CDC criteria

(Carlisle et al., 1993)

Which definitions are used?Which definitions are used?

Laboratory confirmed BSI (CDC)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

Nosocomial pneumonia Nosocomial pneumonia ONKO-KISS (Carlisle et al., 1993)ONKO-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

coughdyspnearhonchi or rales polymorphonuclear leucocytes on a sputum gram stainpleural rub

Which rates are calculated ?Which rates are calculated ?

number of BSI casesBSI rate = ----------------------------------

number of neutropenic days

number of pneumonia cases

Pneumonia rate = ---------------------------------------

number of neutropenic days

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

Standardization according to the number of neutropenia

daysTrans-plantation

Depart-ments

Patients 25th Percentile

Median 75th Percentile

autolog 25 2 225 8.0 8.9 10.4

allogen 19 3 096 15.7 18.3 20.2

ONKO-KISS data 12/2007

Stratification according to the type of transplantation

Trans-plantation

Depart-ments

Patients Neutropenia days

Sepsis/1000

neutropenia days

Pneumonia/1000

neutropenia days

autolog 25 2 225 20 382(Ø 9,2 days)

16,4 5,5

allogen 19 3 096 58 170(Ø 18,8 days)

9,2 5,8

ONKO-KISS data 12/2007

ONKO-KISS-Reference data 12/2007

CVC associated BSI rates in various KISS components

Patientengruppe wards CVC days CVC days associated BSI rates /1000 CVC days

Interdisciplinary ICUs 143 889 013 1.6

Surgical ICUs 80 654 023 2.0

Medical ICUs 61 300 106 1.9

Neurosurgical ICUs 11 87 695 1.4

Pediadric ICUs 7 24 116 4.2

Newborns 1000-< 1500g 37 13 945 8.1

Newborns < 1000g 36 27 823 13.1

BMT patients 17 22 032 14.0

Non-ICU patients 70 5 171 3.9

Gastmeier P et al. Dt. Ärztebl 2005; 102: A2098-2101

Reduction of BSI rates by surveillance and intervention over a 36 months

period

Chaberny et al. submitted

0

5

10

15

20

25

30

1.period 2.period

BSI/1000 neutropenic days

Intervention

OR= 0.58 (CI95 0.34-0.99)

268 patients, 87 BSI

autolog allogen autolog allogen

Centers 5 6 25 19

patients 21 166 2 225 3 096

Neutropenia days

241 3 740 20 382 58 170

Ø number of neutropenia days

11,5 22,5 9.2 18.8

ONKO-KISS surveillance among children with BMT/PBSCT

ONKO-KISS 6/2007

Children Adults

ONKO-KISS surveillance among children

Primary BSI per 1000 neutropenia days

ONKO-KISS analysis 6/2007

Acute myeloic

leucaemiaAML

Acute lymphatic leucaemia

ALL

BMT/PBSCTautolog

BMT/PBSCTallogen

Centers 6 6 25 19

patients 614 186 2 225 3 096

Neutropenia days

10 529 2 288 20 382 58 170

Ø number of neutropenia days

17.1 12.3 9.2 18.8

ONKO-KISS surveillance among patient with acute

leucaemia

ONKO-KISS 12/2007

ONKO-KISS surveillance among patient with acute leucaemia

Primary BSI per 1000 neutropenia days

ONKO-KISS analysis 6/2007

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.

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German national hand hygiene

campaign

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HAND-KISS

25

HAND-KISS

Annual amount of alcoholic hand rub (ml)

____________________________

Annual number of patient days

for each unit/ward of the hospital:

HAND-KISS

0

20

40

60

80

100

120

140

ICUs

non-ICUs

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

Group Number of ICUs

25th percentile

Median 75th percentile

Internal medicine

23 34 57 71

Surgery 22 58 101 113

Pediatrics 8 40 69 98

Neonatology 14 67 116 178

interdisciplinary

57 44 59 91

Distribution of the amount of alcoholic hand rub used (ml) per patient day 2007 (ICUs only)

Total 136 43 59 95

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