Blog | Wednesday, July 27, 2011

QD: News Every Day--Health care acquired infections the ire of WHO's new patient safety envoy

The World Health Organization's new patient safety envoy will take on health care acquired infections in his new role, he announced last week. Liam Donaldson, England's former Chief Medical Officer, pointed out in his first report as envoy that patient safety incidents occur in 4% to 16% of all hospitalized patients, and that hospital-acquired infections affect hundreds of millions of patients globally.

A WHO report outlined the problem.

High-income countries had pooled health care acquired infection rates of 7.6%. The European Centre for Disease Prevention and Control estimated that 4.1 million Europeans incur 4.5 million health care acquired infections annually. In the U.S. the incidence rate was 4.5% in 2002, or 9.3 infections per 1,000 patient-days and 1.7 million affected patients.

In Europe, these infections cause 16 million extra days of hospitalization and 37,000 deaths, and contribute to 110,000 more every year. Annual financial losses are estimated at approximately 7 billion Euros in direct costs. In the U.S., such infections caused 99,000 deaths in 2002. The annual economic impact was estimated at approximately $6.5 billion in 2004.

Intensive care unit stays lead to significantly more infections of about 30% of patients. Pooled cumulative incidence density was 17 episodes per 1,000 patient-days in adult high-risk patients in industrialized countries, according to the WHO report. Pooled cumulative incidence densities included 3.5 catheter-related bloodstream infections per 1,000 central line days, 4.1 urinary tract infections per 1,000 urinary catheter days, and 7.9 ventilator-associated pneumonias per 1,000 ventilator days.

The picture in the developing world was more fragmented:
--Hospital-wide prevalence of health care acquired infections varied from 5.7% to 19.1% with a pooled prevalence of 10.1%, with higher-quality studies providing higher incidence rates (15.5% vs. 8.5%).
--Surgical site infections were the most common source, with incidence rates ranging from 1.2 to 23.6 per 100 surgical procedures and a pooled incidence of 11.8%. Surgical site infections range from 1.2% to 5.2% in developed countries.
--ICU-acquired infection rates in developing countries varied from 4.4% up to 88.9% and pooled cumulative incidence density was 42.7 episodes per 1,000 patient-days.
--Pooled cumulative incidence densities were 12.2 bloodstream infections per 1,000 central line days, 8.8 urinary tract infections per 1,000 urinary catheter days, and 23.9 ventilator-associated pneumonias per 1,000 ventilator days.