Journal List > Korean J Healthc Assoc Infect Control Prev > v.24(2) > 1140854

Kim, Kwak, Kim, Lee, Lee, Kim, Park, Ahn, Yun, Ryu, Kim, Choi, Yoo, Shin, Yoo, Hong, Moon, Cho, Son, Kim, Choi, and Kim: Korean National Healthcare-associated Infections Surveillance System, Intensive Care Unit Module Report: Summary of Data from July 2017 through June 2018

Abstract

Background

In this report, we present annual data from the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2017 through June 2018.

Methods

We performed prospective surveillance of healthcare-associated urinary tract infections (UTIs), bloodstream infections (BSIs), and pneumonia (PNEU) at 308 ICUs in 216 hospitals using the KONIS. Healthcare-associated infection (HAI) rates and device-associated infection rates were calculated as the number of infections per 1000 patient-days (PD) and device-days (DD), respectively. Device utilization was calculated as a ratio of DD to PD.

Results

A total of 4569 HAIs were found during the study period: 1530 UTIs (1476 cases were urinary catheter-associated), 2006 BSIs (1692 were central line-associated), and 1033 PNEU cases (505 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 1.16 cases per 1000 DD (95% confidence interval [CI]: 1.10–1.22) and urinary catheter utilization ratio was 0.86 (95% CI: 0.859–0.861). These results were higher than those in the previous year: 1.01 cases per 1000 DD (95% CI: 0.95–1.07) and 0.85 (95% CI: 0.849–0.851), respectively. The rate of central line-associated BSIs was 2.29 cases per 1000 DD (95% CI: 2.18–2.40) and the central line utilization ratio was 0.50 (95% CI: 0.499–0.501). The rate of ventilator-associated PNEU cases was 0.96 cases per 1000 DD (95% CI: 0.88–1.05) and the ventilator utilization ratio was 0.35 (95% CI: 0.349–0.351).

Conclusion

The overall rate of HAIs was similar to the results from the previous year; however, the rate of CAUTI increased.

Figures and Tables

Table 1

Characteristics of hospitals and intensive care units participated in KONIS from July 2017 through June 2018

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Table 2

Pooled means of healthcare-associated infection rates, by number of hospital beds, July 2017 through June 2018

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*Pooled mean=(No. of UTIs, BSIs, or PNEUs / No. of patient-days)×1,000; Pooled mean=(No. of UTIs / No. of patient-days)×1,000; Pooled mean=(No. of BSIs / No. of patient-days)×1,000; §Pooled mean=(No. of PNEUs / No. of patient-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 3

Pooled means and percentiles of the device-associated infection rates, by number of hospital beds, July 2017 through June 2018

kjhaicp-24-69-i003

*Pooled mean=(No. of urinary catheter-associated UTIs / No. of urinary catheter-days)×1,000; Pooled mean=(No. of central line-associated BSIs / No. of central line-days)×1,000; Pooled mean=(No. of ventilator-associated PNEUs / No. of ventilator-days)×1,000.

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 4

Pooled means and percentiles of the distribution of device-utilization ratios, by number of hospital beds, July 2017 through June 2018

kjhaicp-24-69-i004

*Pooled mean=(No. of urinary catheter-days / No. of patient-days); Pooled mean=(No. of central line-days / No. of patient-days); Pooled mean=(No. of ventilator-days / No. of patient-days).

Abbreviations: UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 5

Pooled means and percentiles of the distribution of device-associated infection rates, by type of ICU, July 2017 through June 2018

kjhaicp-24-69-i005

*Pooled mean=(No. of urinary catheter-associated UTIs / No. of urinary catheter-days)×1,000; Pooled mean=(No. of central line-associated BSIs / No. of central line-days)×1,000; Pooled mean=(No. of ventilator-associated PNEUs / No. of ventilator-days)×1,000.

Abbreviations: ICU, intensive care unit; MICU, medical ICU; MCICU, medical combined ICU; SCICU, surgical combined ICU; SICU, surgical ICU; NSICU, neurosurgical ICU; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 6

Pooled means and percentiles of the distribution of device-utilization ratios, by type of ICU, July 2017 through June 2018

kjhaicp-24-69-i006

*Pooled mean=(No. of urinary catheter-days / No. of patient-days); Pooled mean=(No. of central line-days / No. of patient-days); Pooled mean=(No. of ventilator-days / No. of patient-days).

Abbreviations: ICU, intensive care unit; MICU, medical ICU; MCICU, medical combined ICU; SCICU, surgical combined ICU; SICU, surgical ICU; NSICU, neurosurgical ICU; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

Table 7

Number (%) of microorganisms isolated from clinical specimens of patients with nosocomial infections

kjhaicp-24-69-i007

Abbreviations: UTI, urinary tract infection; SUTI, symptomatic UTI; ABUTI, asymptomatic bacteremic UTI; BSI, bloodstream infection; PNEU, pneumonia.

Table 8

Susceptibilities of major pathogens isolated from patients with healthcare-associated infections

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Table 9

Comparison of the device utilization ratios and the rates of device-associated infections from 2013 through 2018

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Abbreviations: ICU, intensive care unit; UTI, urinary tract infection; BSI, bloodstream infection; PNEU, pneumonia; CI, confidence interval.

*10th to 90th percentile range.

Acknowledgements

This study was supported by a grant of year 2018 (M2018A060000011) from the Korea Centers for Disease Control and Prevention.

References

1. Lee SO, Kim S, Lee J, Kim KM, Kim BH, Kim ES, et al. Korean Nosocomial Infections Surveillance System (KONIS) report: data summary from July through September 2006. Korean J Nosocomial Infect Control. 2006; 11:113–128.
2. Kwak YG, Choi YH, Choi JY, Yoo HM, Lee SO, Kim HB, et al. Korean National Healthcare-associated Infections Surveillance System, intensive care unit module report: summary of data from July 2016 through June 2017. Korean J Healthc Assoc Infect Control Prev. 2018; 23:25–38.
crossref
3. Jeon MH, Park WB, Kim SR, Chun HK, Han SH, Bang JH, et al. Korean Nosocomial Infections Surveillance System, intensive care unit module report: data summary from July 2010 through June 2011. Korean J Nosocomial Infect Control. 2012; 17:28–39.
4. Lee SO, Kim ES, Kim HY, Park ES, Jin HY, Ki HK, et al. Korean Nosocomial Infections Surveillance System, intensive care unit module report: data summary from July 2007 through June 2008. Korean J Nosocomial Infect Control. 2008; 13:69–82.
5. Choi YH. Prospective nationwide healthcare-associated infection surveillance system in South Korea. J Korean Med Assoc. 2018; 61:21–25.
crossref
6. Choi YH, Kim SR. KONIS manual 2016. Seoul: Korean Society for Nosocomial Infection Control;2016.
7. Horan TC, Andrus M, Dudeck MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control. 2008; 36:309–332.
crossref
8. Centers for Disease Control and Prevention. National Healthcare Safety Network (NHSN) Overview: National Healthcare Safety Network (NHSN). Updated on January 2016. https://www.cdc.gov/nhsn/pdfs/validation/2016/pcsmanual_2016.pdf.
9. Kwak YG, Choi JY, Yoo H, Lee SO, Kim HB, Han SH, et al. Korean Nosocomial Infections Surveillance System, intensive care unit module report: summary of data from July 2013 through June 2014. Korean J Nosocomial Infect Control. 2015; 20:49–60.
crossref
10. Kwak YG, Choi JY, Yoo H, Lee SO, Kim HB, Han SH, et al. Korean National Healthcare-associated Infections Surveillance System, intensive care unit module report: summary of data from July 2014 through June 2015. Korean J Healthc Assoc Infect Control Prev. 2016; 21:37–49.
crossref
11. Kwak YG, Choi YH, Choi JY, Yoo HM, Lee SO, Kim HB, et al. Korean National Healthcare-associated Infections Surveillance System, intensive care unit module report: summary of data from July 2015 through June 2016. Korean J Healthc Assoc Infect Control Prev. 2017; 22:9–20.
crossref
12. Schwab F, Geffers C, Bärwolff S, Rüden H, Gastmeier P. Reducing neonatal nosocomial bloodstream infections through participation in a national surveillance system. J Hosp Infect. 2007; 65:319–325.
crossref
13. Haley RW, Culver DH, White JW, Morgan WM, Emori TG, Munn VP, et al. The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol. 1985; 121:182–205.
crossref
14. Gastmeier P, Geffers C, Brandt C, Zuschneid I, Sohr D, Schwab F, et al. Effectiveness of a nationwide nosocomial infection surveillance system for reducing nosocomial infections. J Hosp Infect. 2006; 64:16–22.
crossref
15. Choi JY, Kwak YG, Yoo H, Lee SO, Kim HB, Han SH, et al. Korean Nosocomial Infections Surveillance System. Trends in the distribution and antimicrobial susceptibility of causative pathogens of device-associated infection in Korean intensive care units from 2006 to 2013: results from the Korean Nosocomial Infections Surveillance System (KONIS). J Hosp Infect. 2016; 92:363–371.
crossref
16. Choi JY, Kwak YG, Yoo H, Lee SO, Kim HB, Han SH, et al. Korean Nosocomial Infections Surveillance System (KONIS). Trends in the incidence rate of device-associated infections in intensive care units after the establishment of the Korean Nosocomial Infections Surveillance System. J Hosp Infect. 2015; 91:28–34.
crossref
17. Kim EJ, Kwak YG, Park SH, Kim SR, Shin MJ, Yoo HM, et al. Trends in device utilization ratios in intensive care units over 10-year period in South Korea: device utilization ratio as a new aspect of surveillance. J Hosp Infect. 2018; 100:e169–e177.
crossref
18. Kwak YG, Lee SO, Kim HY, Kim YK, Park ES, Jin HY, et al. Korean Nosocomial Infections Surveillance System (KONIS). Risk factors for device-associated infection related to organisational characteristics of intensive care units: findings from the Korean Nosocomial Infections Surveillance System. J Hosp Infect. 2010; 75:195–199.
crossref
19. Kwak YG, Choi JY, Yoo HM, Lee SO, Kim HB, Han SH, et al. Validation of the Korean National Healthcare-associated Infections Surveillance System (KONIS): an intensive care unit module report. J Hosp Infect. 2017; 96:377–384.
crossref
20. Korean Centers for Disease Control and Prevention. Operation of the Nationwide Surveillance System for Healthcare associated infection in intensive care units. Cheongju: Korean Centers for Disease Control and Prevention;2017. 11. Report No.: 11-1352159-000871-01.
21. Kuriyama A, Takada T, Irie H, Sakuraya M, Katayama K, Kawakami D, et al. Prevalence and appropriateness of urinary catheters in Japanese intensive care units: results from a multicenter point prevalence study. Clin Infect Dis. 2017; 64:suppl_2. S127–S130.
crossref
22. Kim EJ, Kang SY, Kwak YG, Kim SR, Shin MJ, Yoo HM, et al. Steering Committee of KONIS. Ten-year surveillance of central line-associated bloodstream infections in South Korea: surveillance not enough, action needed. Am J Infect Control. in press 2019.
crossref
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Young Hwa Choi
https://orcid.org/0000-0001-5254-3101

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