Bakgrunn Materiale og metode Resultater Oppsummering

Transkript

1

2 Bakgrunn Materiale og metode Resultater Oppsummering

3 apotek1.no trialx.com ijcasereportsandimages.com

4

5 Min x 2 kostnad ved infeksjon Broex et al, J Hosp Inf,2009 7% additional hospital expenses due to postoperative wound infections = 45 THR /year = 100 HCS/year Loraas et al, EBJIS,Milano, 2005

6 Hva skal vi med bakterier? Ufarlig tilstede koloniserere Nyttige og nødvendige (tarmbakterier) Sykdomsfremkallende 1500 arter antibiotikaresistens.se 10 x antall bakterier versus celler i kroppen

7 Stafylokokker Staphyle (gr)= drueklase Staphylococcus aureus (Gule stafylokokker)= S.aureus frukt.no thebonearchitect:worldpress.com

8 Spredningsmåter Grafisk design: K. Lauveng

9 Spørsmål 1 Hvilke gule stafylokokker (S.aureus) har ortopediske helsearbeidere i nesen? 2 Hvilke gule stafylokokker (S.aureus) har befolkningen i nesen? 3 Har ortopediske pasienter samme gule stafylokokker i nese ved sykehusinnleggelse som sårprøvene fra de pasientene som utvikler infeksjon etter ortopedisk kirurgi? 4 Infeksjonsovervåking etter ortopedisk kirurgi betyr det noe?

10 Ortopediske helsearbeidere Ahus - Ortopediske pasienter Ahus - Normalbefolkning Ahus opptaksområde dexor.se ssb.no

11 Molekylærbiologiske metoder (gentyping) Multilocus sequence typing (MLST) Stabilt område av genomet (7 husholdnings-gener ) +:Reproduserbar, egnet for oppfølging og sammenligning, stort geografisk område :Tidkrevende, kostbar Spa-typing (S.aureus specific staphylococcal protein A) "Repeat" region av spa gen (1 gen) +: Enkel, rask, rimelig, reproduserbar.utbrudd og lokal overvåking : Sårbar for raske endringer 11 applied-maths.com

12 Artikkel 1

13 Artikkel 2 rb.no

14 The majority of isolates(71%) were classified as CC 15,30 or 45. The study may indicate that microbial and host factors may be stronger determinants for S.aureus colonization than exposures associated with the hospital environment

15 Artikkel 3 JBJS (Am), in press

16 Table 2. Distribution of genotypes among orthopedic patients admitted for elective orthopedic surgery who subsequently developed S.aureus SSI NC=non carrier Artikkel 3 Table 2. Distribution of genotypes among orthopedic patients admitted for elective orthopedic surgery who subsequently developed S.aureus SSI Patient MLST/MLST-CC/ spa type MLST/MLST-CC/ spa type SSI isolate Nasal carrier isolate 1 730/5/t /5/t //45/t630 45/45/t /30/t037 39/30/t /15/t346 15/15/t /121/t /121/t /30/t726 30/30/t /30/t /45/t /15/t803 NC 9 45/45/t065 NC 10 45/45/t445 NC

17 Artikkel 4

18 Fig 3. Schematic presentation of the orthopedic SSI surveillance at Akershus University Hospital (Ahus) Surgical procedures Data collection and completion by infection control unit (ICU) Evaluation: Improvements, changes or status quo Analysis of data by ICU and dedicated orthopedic surgeon Educational meetings and reporting to clinicians, surgical staff and leaders

19 Decreasing time trend in SSI incidence for orthopaedic procedures: Surveillance matters! Inge Skråmm¹-², Jūratė Šaltytė Benth²-³, Geir Bukholm 4 ¹ Department of Orthopaedic Surgery, Akershus University Hospital, ² Institute of Clinical Medicine, Campus Ahus, University of Oslo,³ HØKH, Research Centre, Akershus University Hospital, 4 Institute of Society and Medicine, University of Oslo, Norway Table I Distribution of procedures according to level of emergency Operative procedure Total N (%) Acute n (%) Elective n (%) Total hip replacement (THR) 1008 (24.1) 79 (7.8) 929 (92.2) Total knee replacement (TKR) 263 (6.3) (100) Osteosynthesis trochanteric femoral fractures 1601 (38.3) 1601 (100) 0 (HCS /Intertan nail) Osteosynthesis ankle fracture 1305 (31.2) 1305 (100) 0 All procedures 4177 (100) 2985 (71.5) 1192 (28.5)

20 Decreasing time trend in SSI incidence for orthopaedic procedures: Surveillance matters! Inge Skråmm¹-², Jūratė Šaltytė Benth²-³, Geir Bukholm 4 ¹ Department of Orthopaedic Surgery, Akershus University Hospital, ² Institute of Clinical Medicine, Campus Ahus, University of Oslo,³ HØKH, Research Centre, Akershus University Hospital, 4 Institute of Society and Medicine, University of Oslo, Norway Table II Number of performed procedures according to National Nosocomial Infections Surveillance system (NNIS) risk index and actual surgical site infections (SSI) All Classifiable NNIS risk index Total N (%) n (%) n (%) n (%) n (%) Superficial SSI 101 (2.4) 101 (2.5) 46 (2.1) 42 (2.7) 13 (4.5) Deep SSI 85 (2.0) 83 (2.1) 34 (1.6) 33 (2.2) 16 (5.5) No SSI 3991 (95.6) 3796 (95.4) 2080 (96.3) 1453 (95.1) 263 (90.0) Total * 2160 (54.3) 1528 (38.4) 292 (7.3)

21 Decreasing time trend in SSI incidence for orthopaedic procedures: Surveillance matters! Inge Skråmm¹-², Jūratė Šaltytė Benth²-³, Geir Bukholm 4 ¹ Department of Orthopaedic Surgery, Akershus University Hospital, ² Institute of Clinical Medicine, Campus Ahus, University of Oslo,³ HØKH, Research Centre, Akershus University Hospital, 4 Institute of Society and Medicine, University of Oslo, Norway Time trend for incidence of SSIs during the 11 year observation period (left and middle panels). Average duration of surgery (in minutes) for all procedures throughout the surveillance period (right panel) 9 SSI total SSI superficial SSI deep 9 SSI total SSI emergency SSI elective %SSI %SSI average duration of surgery (min) years years years

22 Spørsmål Resultat Svar 1 Hvilke gule stafylokokker (S.aureus) har ortopediske helsearbeidere i nesen? Stor spredning 27% S.aureus nesebærere CC 15, 30 og 45 vanligst hos ortopediske helsearbeidere (nesebærere) 2 Hvilke gule stafylokokker (S.aureus) har befolkningen i nesen? 3 Har ortopediske pasienter samme gule stafylokokker i nesen ved sykehusinnleggelse som pasienter har i sårinfeksjonsprøvene etter ortopedisk kirurgi? Stor spredning 27% S.aureus nesebærere Stor spredning 30% S.aureus nesebærere CC 15, 30 og 45 vanligst hos utvalg av befolkning Ingen forskjell helsearbeidere og befolkning CC 15, 30 og 45 vanligst i begge grupper. 6 av7 nesebærere hadde samme gentype i nese og sårisolat 4 Infeksjonsovervåking etter ortopedisk kirurgi betyr det noe? 57% relativ reduksjon av SSI ila 11 år Incidensovervåking kan resultere i færre infeksjoner over tid

23 Take home Optimizing all perioperative preventive efforts and strict adherence to hygiene routines still remain essential. Surgical site infections might be more frequently caused by endogenous transmission than was previously assumed. New routines to further decrease the risk of SSIs after orthopedic surgery should focus more on the endogenous transmission route than the traditional strategy of preventing crosstransmission in clinical practice. 23

24 Acknowledgements Geir Bukholm Tom Øresland Asbjørn Årøen Jūratė Šaltytė Benth Aina Elisabeth Fossum Moen Odd G Granlund Universitetet i Oslo Akershus universitetssykehus Epigen Avdeling for smittevern og mikrobiologi Ortopedisk avdeling Pasienter og andre frivillige

25

26 Parvis sammenligning For NNIS=0 vs NNIS=1 er p=0.196 For NNIS=0 vs NNIS=2 er p<0.001 For NNIS=1 vs NNIS=2 er p=0.001

27 Dyrkorn et al, BMJ Qual Saf, 2012