Infection prevention in a connected world: The case for a regional approach

Ciccolini, Mariano; Donker, Tjibbe; Köck, Robin; Mielke, Martin; Hendrix, Ron; Jurke, A; Rahamat‐Langendoen, Janette; Becker, Karsten; Niesters, Hubert G. M.; Grundmann, Hajo; Friedrich, Alexander

doi:10.1016/j.ijmm.2013.02.003

Cited by 71 publications

(64 citation statements)

References 48 publications

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“…This entails close collaboration of all health-care facilities (i.e. hospitals, but also general practices and long-term care facilities) within a clearly defined region [18]. Harmonization of guidelines and practices can be a first start regarding this aspect [19].…”

Section: Importance Of a Broad Stewardship Programmentioning

confidence: 99%

Measuring the impact of antimicrobial stewardship programs

Dik

Hendrix

Poelman

et al. 2016

Expert Review of Anti-infective Therapy

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Antimicrobial Stewardship Programs (ASPs) are being implemented worldwide to optimize antimicrobial therapy, and thereby improve patient safety and quality of care. Additionally, this should counteract resistance development. It is, however, vital that correct and timely diagnostics are performed in parallel, and that an institution runs a well-organized infection prevention program. Currently, there is no clear consensus on which interventions an ASP should comprise. Indeed this depends on the institution, the region, and the patient population that is served. Different interventions will lead to different effects. Therefore, adequate evaluations, both clinically and financially, are crucial. Here, we provide a general overview of, and perspective on different intervention strategies and methods to evaluate these ASP programs, covering before mentioned topics. This should lead to a more consistent approach in evaluating these programs, making it easier to compare different interventions and studies with each other and ultimately improve infection and patient management. ARTICLE HISTORY

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Section: Importance Of a Broad Stewardship Programmentioning

confidence: 99%

Measuring the impact of antimicrobial stewardship programs

Dik

Hendrix

Poelman

et al. 2016

Expert Review of Anti-infective Therapy

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“…In addition, it has already been demonstrated that patient transfers between hospitals significantly increase the transmission of hospital-acquired infections at the regional and national scale [11]. …”

Section: Introductionmentioning

confidence: 99%

Cross-border comparison of the Dutch and German guidelines on multidrug-resistant Gram-negative microorganisms

Müller

Voß

Köck

et al. 2015

Antimicrob Resist Infect Control

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BackgroundIn all European countries, hospital-acquired infections caused by Gram-negative multidrug-resistant microorganisms (GN-MDRO) are a major health threat, as these pathogens cannot be adequately treated anymore, or the start of effective antibiotic treatment is delayed. The efforts to limit the selection and spread of GN-MDRO remains a problem in cross-border healthcare, as the national guidelines on hygiene standards applicable for patients colonized or infected with GN-MDRO in hospitals are not harmonized between European countries.MethodsIn order to point out the similarities and differences in the national guidelines of Germany and The Netherlands regarding GN-MDRO, guidelines were compared and an expert workshop was organized by the INTERREG IVa project EurSafety Health-net.ResultsBoth guidelines divide the Gram-negative organisms into subgroups based on bacterial species and antibiotic susceptibility patterns in order to define multidrug-resistant variants of these bacteria. However, the Dutch guideline defines that GN-MDRO Enterobacteriaceae requires testing for certain mechanisms causing antibiotic resistance, whereas the German guideline makes use of a newly created classification scheme, based on phenotypic characterization. Besides diagnostic issues, the main difference between the Dutch and German guideline is the divergent evaluation of ESBL-producing Enterobacteriaceae. Special hygiene measures are required for all patients with ESBL-producing Enterobacteriaceae in The Netherlands, whereas the German guideline recommends special precautions only for those cases in which patients are colonized or infected with strains showing co-resistance to ciprofloxacin (“3MRGN”).ConclusionsThe usage of consistent terminology and harmonized diagnostic procedures would improve the possibilities for infection prevention, treatment and patient safety. Prevention of severe non-treatable infections and outbreaks due to MDRO, caused by an increased population seeking medical treatment abroad together with an increased number of highly susceptible individuals demands gathering of regional data, and data comparable between the two sides of the Dutch-German border. The necessity to cooperate multidisciplinary and across borders is required to prevent a post-antibiotic era – in which common infections and minor injuries may lead to death.

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“…The implementation of harmonised preventive standards in the regional healthcare cluster, where the nosocomial pathogen spreads predominantly is more likely to be successful. The hospitals of the Dutch-German border region EUREGIO have been confirmed to represent such a regional healthcare cluster using mathematical modelling [14]. Therefore, the governments of the 16 German Bundesländer (i.e.…”

Section: Introductionmentioning

confidence: 97%

“…To reinforce regional cooperation and overcome the problem of limited local implementation, all 40 hospitals in the Münsterland region in NRW are cooperating in the EU-funded Dutch-German EUREGIO MRSA-net (www.mrsa-net.eu) and EurSafety HealthNet (www.eursafety.eu) projects since 2005. Since these 40 hospitals form a connected healthcare cluster [14], and contain all hospitals in the region, they can be considered to form a single patient catchment area.…”

Section: Introductionmentioning

confidence: 99%

Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011

Jurke¹,

Köck

Becker

et al. 2013

Eurosurveillance

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Meticillin-resistant Staphylococcus aureus (MRSA) disseminates between hospitals serving one patient catchment area. Successful prevention and control requires concerted efforts and regional surveillance. Forty hospitals located in the German EUREGIO have established a network for combating MRSA. In 2007 they agreed upon a synchronised strategy for screening of risk patients and a standard for transmission-based precautions (search and follow). The same year, the hospitals started synchronised MRSA prevention and annually reporting MRSA-data to the public health authorities. The median rate of screening cultures per 100 patients admitted increased from 4.38 in 2007 to 34.4 in 2011 (p<0.0001). Between 2007 and 2011, the overall incidence density of MRSA (0.87 MRSA cases/1,000 patient days vs 1.54; p<0.0001) increased significantly. In contrast, both the incidence density of nosocomial MRSA cases (0.13 nosocomial MRSA cases/1,000 patient days in 2009 vs 0.08 in 2011; p=0.0084) and the MRSA-days-associated nosocomial MRSA rate (5.51 nosocomial MRSA cases/1,000 MRSA days in 2009 vs 3.80 in 2011; p=0.0437) decreased significantly after the second year of the project. We documented adherence to the regional screening strategy resulting in improved detection of MRSA carriers at admission. Subsequently, after two years the nosocomial MRSA-incidence density was reduced. Regional surveillance data, annually provided as benchmarking to the regional hospitals and public health authorities, indicated successful prevention.

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Infection prevention in a connected world: The case for a regional approach

Cited by 71 publications

References 48 publications

Measuring the impact of antimicrobial stewardship programs

Measuring the impact of antimicrobial stewardship programs

Cross-border comparison of the Dutch and German guidelines on multidrug-resistant Gram-negative microorganisms

Reduction of the nosocomial meticillin-resistant Staphylococcus aureus incidence density by a region-wide search and follow-strategy in forty German hospitals of the EUREGIO, 2009 to 2011

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