Abstract
Background
In this report, we present annual data of the intensive care unit (ICU) module of the Korean National Healthcare-associated Infections Surveillance System (KONIS) from July 2014 through June 2015.
Methods
We performed prospective surveillance of nosocomial urinary tract infection (UTI), bloodstream infection (BSI), and pneumonia (PNEU) cases at 169 ICUs in 96 hospitals using the KONIS surveillance system. Nosocomial infection (NI) rates were calculated as the numbers of infections per 1,000 patient-days or device-days.
Results
A total of 2,524 NIs were found during the study period: 699 UTIs (675 cases were urinary catheter-associated), 1,090 BSIs (932 were central line-associated), and 735 PNEUs (443 were ventilator-associated). The rate of urinary catheter-associated UTIs (CAUTI) was 0.91 cases per 1,000 device-days (95% confidence interval, 0.84-0.98), and the urinary catheter utilization ratio was 0.84 (0.839-0.841). The rate of central line-associated BSIs (CLABSI) was 2.04 (1.91-2.17), and the utilization ratio was 0.52 (0.519-0.521). The rate of ventilator-associated PNEUs was 1.23 (1.12-1.35), and the utilization ratio was 0.41 (0.409-0.411). The urinary catheter utilization ratio was lower; however, CAUTIs were more common in the ICUs of hospitals with 300-699 beds than in the ICUs of hospitals with more than 900 beds.
REFERENCES
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Table 1.
Table 2.
Nosocomial infection rate |
No. of hospital beds |
|||
---|---|---|---|---|
≥900 | 700-899 | 300-699 | All | |
No. of units | 41 | 62 | 66 | 169 |
Patient-days | 227,623 | 349,535 | 305,980 | 883,138 |
Infection rate* | ||||
No. of infections | 594 | 1,090 | 840 | 2,524 |
Pooled mean | 2.61 | 3.12 | 2.75 | 2.86 |
95% CI | 2.41-2.83 | 2.94-3.31 | 2.57-2.94 | 2.75-2.97 |
UTI rate† | ||||
No. of UTI | 140 | 283 | 276 | 699 |
Pooled mean | 0.62 | 0.81 | 0.90 | 0.79 |
95% CI | 0.52-0.73 | 0.72-0.91 | 0.80-1.01 | 0.73-0.85 |
BSI rate‡ | ||||
No. of BSI | 310 | 459 | 321 | 1,090 |
Pooled mean | 1.36 | 1.31 | 1.05 | 1.23 |
95% CI | 1.22-1.52 | 1.20-1.44 | 0.94-1.17 | 1.16-1.31 |
PNEU rate§ | ||||
No. of PNEU | 144 | 348 | 243 | 735 |
Pooled mean | 0.63 | 1.00 | 0.79 | 0.83 |
95% CI | 0.54-0.74 | 0.90-1.11 | 0.70-0.90 | 0.77-0.89 |
Table 3.
No. of hospital beds | No. of units | No. of infection | Device days | Pooled mean | 95% CI | 10‰ | 25‰ | 50‰ | 75‰ | 90‰ |
---|---|---|---|---|---|---|---|---|---|---|
Urinary catheter-associated UTI rate* | ||||||||||
≥900 | 41 | 134 | 193,951 | 0.69 | 0.58-0.82 | 0 | 0 | 0.45 | 0.67 | 2.87 |
700-899 | 62 | 276 | 304,684 | 0.91 | 0.81-1.02 | 0 | 0.20 | 0.51 | 1.28 | 2.12 |
300-699 | 66 | 265 | 247,132 | 1.07 | 0.95-1.21 | 0 | 0.29 | 0.74 | 1.59 | 2.39 |
All | 169 | 675 | 745,767 | 0.91 | 0.84-0.98 | 0 | 0.20 | 0.56 | 1.34 | 2.32 |
Central line-associated BSI rate† | ||||||||||
≥900 | 41 | 278 | 137,720 | 2.02 | 1.79-2.27 | 0 | 0.84 | 1.34 | 2.86 | 4.07 |
700-899 | 62 | 392 | 193,050 | 2.03 | 1.84-2.24 | 0.42 | 1.07 | 1.92 | 3.02 | 3.66 |
300-699 | 66 | 262 | 127,118 | 2.06 | 1.83-2.33 | 0 | 0.20 | 1.49 | 3.10 | 4.82 |
All | 169 | 932 | 457,888 | 2.04 | 1.91-2.17 | 0 | 0.84 | 1.54 | 3.01 | 3.99 |
Ventilator-associated PNEU rate‡ | ||||||||||
≥900 | 41 | 90 | 103,137 | 0.87 | 0.71-1.07 | 0 | 0 | 0.56 | 1.81 | 2.64 |
700-899 | 62 | 234 | 153,033 | 1.53 | 1.35-1.74 | 0 | 0.27 | 1.03 | 2.03 | 4.41 |
300-699 | 66 | 119 | 103,883 | 1.15 | 0.96-1.37 | 0 | 0 | 0.50 | 1.60 | 3.87 |
All | 169 | 443 | 360,053 | 1.23 | 1.12-1.35 | 0 | 0 | 0.67 | 1.82 | 3.89 |
Table 4.
No. of hospital beds | No. of units | Device days | Patient days | Pooled mean | 95% CI | 10‰ | 25‰ | 50‰ | 75‰ | 90‰ |
---|---|---|---|---|---|---|---|---|---|---|
Urinary catheter utilization ratio* | ||||||||||
≥900 | 41 | 193,951 | 227,623 | 0.85 | 0.849-0.851 | 0.71 | 0.81 | 0.89 | 0.93 | 0.97 |
700-899 | 62 | 304,684 | 349,535 | 0.87 | 0.869-0.871 | 0.75 | 0.83 | 0.90 | 0.94 | 0.98 |
300-699 | 66 | 247,132 | 305,980 | 0.81 | 0.809-0.811 | 0.63 | 0.76 | 0.85 | 0.91 | 0.96 |
All | 169 | 745,767 | 883,138 | 0.84 | 0.839-0.841 | 0.69 | 0.81 | 0.88 | 0.93 | 0.98 |
Central line utilization ratio† | ||||||||||
≥900 | 41 | 137,720 | 227,623 | 0.61 | 0.608-0.612 | 0.40 | 0.50 | 0.65 | 0.75 | 0.85 |
700-899 | 62 | 193,050 | 349,535 | 0.55 | 0.548-0.552 | 0.40 | 0.43 | 0.53 | 0.68 | 0.78 |
300-699 | 66 | 127,118 | 305,980 | 0.42 | 0.418-0.422 | 0.25 | 0.32 | 0.41 | 0.51 | 0.59 |
All | 169 | 457,888 | 883,138 | 0.52 | 0.519-0.521 | 0.30 | 0.40 | 0.51 | 0.64 | 0.77 |
Ventilator utilization ratio‡ | ||||||||||
≥900 | 41 | 103,137 | 227,623 | 0.45 | 0.448-0.452 | 0.19 | 0.29 | 0.47 | 0.66 | 0.76 |
700-899 | 62 | 153,033 | 349,535 | 0.44 | 0.438-0.442 | 0.27 | 0.35 | 0.42 | 0.51 | 0.60 |
300-699 | 66 | 103,883 | 305,980 | 0.34 | 0.338-0.342 | 0.15 | 0.24 | 0.36 | 0.45 | 0.53 |
All | 169 | 360,053 | 883,138 | 0.41 | 0.409-0.411 | 0.19 | 0.30 | 0.39 | 0.51 | 0.63 |
Table 5.
Type of ICU | No. of units | No. of infection | Device days | Pooled mean | 95% CI | 10‰ | 25‰ | 50‰ | 75‰ | 90‰ |
---|---|---|---|---|---|---|---|---|---|---|
Urinary catheter-associated UTI rate* | ||||||||||
MICU | 68 | 261 | 309,194 | 0.84 | 0.75-0.95 | 0 | 0 | 0.38 | 1.13 | 2.09 |
MCICU | 31 | 122 | 150,769 | 0.81 | 0.68-0.97 | 0 | 0.24 | 0.57 | 1.28 | 1.94 |
SCICU | 23 | 95 | 87,684 | 1.08 | 0.86-1.33 | 0 | 0 | 0.80 | 1.59 | 2.41 |
SICU | 22 | 80 | 88,445 | 0.91 | 0.73-1.13 | 0 | 0.19 | 0.50 | 1.14 | 1.99 |
NSICU | 25 | 117 | 109,675 | 1.07 | 0.89-1.28 | 0.08 | 0.27 | 0.64 | 2.13 | 2.66 |
Central line-associated BSI rate† | ||||||||||
MICU | 68 | 468 | 201,581 | 2.32 | 2.12-2.54 | 0.22 | 1.13 | 2.12 | 3.39 | 4.75 |
MCICU | 31 | 152 | 83,413 | 1.82 | 1.55-2.14 | 0 | 0.27 | 1.15 | 3.18 | 3.96 |
SCICU | 23 | 100 | 55,571 | 1.80 | 1.48-2.19 | 0 | 0 | 1.45 | 2.41 | 4.27 |
SICU | 22 | 133 | 59,572 | 2.23 | 1.88-2.65 | 0 | 0.92 | 1.73 | 3.10 | 3.80 |
NSICU | 25 | 79 | 57,751 | 1.37 | 1.10-1.71 | 0 | 0.61 | 1.30 | 2.34 | 3.25 |
Ventilator-associated PNEU rate‡ | ||||||||||
MICU | 68 | 134 | 174,117 | 0.77 | 0.65-0.91 | 0 | 0 | 0.44 | 1.10 | 2.06 |
MCICU | 31 | 66 | 61,650 | 1.07 | 0.84-1.36 | 0 | 0 | 0.46 | 1.37 | 3.32 |
SCICU | 23 | 63 | 39,684 | 1.59 | 1.24-2.03 | 0 | 0.50 | 0.88 | 1.98 | 3.81 |
SICU | 22 | 75 | 44,002 | 1.70 | 1.36-2.14 | 0 | 0 | 1.33 | 2.91 | 5.07 |
NSICU | 25 | 105 | 40,600 | 2.59 | 2.14-3.13 | 0 | 0.60 | 1.82 | 4.76 | 6.24 |
Table 6.
Type of ICU | No. of units | Device days | Patient days | Pooled mean | 95% CI | 10‰ | 25‰ | 50‰ | 75‰ | 90‰ |
---|---|---|---|---|---|---|---|---|---|---|
Urinary catheter utilization ratio* | ||||||||||
MICU | 68 | 309,194 | 377,167 | 0.82 | 0.819-0.821 | 0.67 | 0.78 | 0.83 | 0.90 | 0.95 |
MCICU | 31 | 150,769 | 176,191 | 0.86 | 0.858-0.862 | 0.73 | 0.83 | 0.87 | 0.92 | 0.96 |
SCICU | 23 | 87,684 | 103,223 | 0.85 | 0.848-0.852 | 0.59 | 0.77 | 0.91 | 0.95 | 0.99 |
SICU | 22 | 88,445 | 102,978 | 0.86 | 0.858-0.862 | 0.81 | 0.85 | 0.89 | 0.94 | 0.96 |
NSICU | 25 | 109,675 | 123,579 | 0.89 | 0.888-0.892 | 0.72 | 0.86 | 0.93 | 0.98 | 0.99 |
Central line utilization ratio† | ||||||||||
MICU | 68 | 201,581 | 377,167 | 0.53 | 0.528-0.532 | 0.32 | 0.40 | 0.53 | 0.64 | 0.79 |
MCICU | 31 | 83,413 | 176,191 | 0.47 | 0.468-0.472 | 0.26 | 0.34 | 0.45 | 0.53 | 0.77 |
SCICU | 23 | 55,571 | 103,223 | 0.54 | 0.537-0.543 | 0.31 | 0.43 | 0.53 | 0.66 | 0.75 |
SICU | 22 | 59,572 | 102,978 | 0.58 | 0.577-0.583 | 0.28 | 0.45 | 0.63 | 0.73 | 0.83 |
NSICU | 25 | 57,751 | 123,579 | 0.47 | 0.467-0.473 | 0.35 | 0.41 | 0.45 | 0.52 | 0.66 |
Ventilator utilization ratio‡ | ||||||||||
MICU | 68 | 174,117 | 377,167 | 0.46 | 0.458-0.462 | 0.28 | 0.37 | 0.45 | 0.58 | 0.69 |
MCICU | 31 | 61,650 | 176,191 | 0.35 | 0.348-0.352 | 0.10 | 0.20 | 0.41 | 0.47 | 0.55 |
SCICU | 23 | 39,684 | 103,223 | 0.38 | 0.377-0.383 | 0.21 | 0.28 | 0.37 | 0.42 | 0.55 |
SICU | 22 | 44,002 | 102,978 | 0.43 | 0.427-0.433 | 0.16 | 0.28 | 0.38 | 0.48 | 0.67 |
NSICU | 25 | 40,600 | 123,579 | 0.33 | 0.327-0.333 | 0.14 | 0.21 | 0.31 | 0.44 | 0.60 |
Table 7.
Table 8.
Table 9.
Parameter | July 2010-June 2011 | July 2011-June 2012 | July 2012-June 2013 | July 2013-June 2014 | July 2014-June 2015 | |
---|---|---|---|---|---|---|
No. of hospitals | 72 | 81 | 91 | 94 | 96 | |
No. of units | 130 | 143 | 161 | 166 | 169 | |
Patient-days | 585,325 | 698,595 | 867,683 | 832,428 | 883,138 | |
Device-days | ||||||
Urinary catheter-days | 503,365 | 590,793 | 679,076 | 701,932 | 745,767 | |
Central line-days | 309,500 | 362,576 | 426,783 | 437,456 | 457,888 | |
Ventilator-days | 233,640 | 282,472 | 321,601 | 340,075 | 360,053 | |
No. of infections | ||||||
Urinary catheter-associated UTI | 1,949 | 1,366 | 854 | 846 | 675 | |
Central line-associated BSI | 932 | 1,091 | 1,096 | 1,021 | 932 | |
Ventilator-associated PNEU | 410 | 481 | 526 | 498 | 443 | |
Device utilization ratio (95% CI) [range*] | ||||||
Urinary catheter | 0.86 | 0.85 | 0.78 | 0.84 | 0.84 | |
(0.859-0.861) | (0.849-0.851) | (0.779-0.781) | (0.839-0.841) | (0.839-0.841) | ||
[0.73-0.97] | [0.71-0.97] | [0.70-0.98] | [0.71-0.97] | [0.69-0.98] | ||
Central line | 0.53 | 0.52 | 0.49 | 0.53 | 0.52 | |
(0.529-0.531) | (0.519-0.521) | (0.489-0.491) | (0.529-0.531) | (0.519-0.521) | ||
[0.31-0.81] | [0.30-0.79] | [0.29-0.80] | [0.29-0.79] | [0.30-0.77] | ||
Ventilator | 0.40 | 0.40 | 0.37 | 0.41 | 0.41 | |
(0.399-0.401) | (0.399-0.401) | (0.369-0.371) | (0.409-0.411) | (0.409-0.411) | ||
[0.19-0.61] | [0.20-0.65] | [0.17-0.66] | [0.21-0.62] | [0.19-0.63] | ||
Rate per 1,000 device-days (95% CI) [range*] | ||||||
Urinary catheter-associated UTI | 3.87 | 2.26 | 1.26 | 1.21 | 0.91 | |
(3.70-4.05) | (2.14-2.39) | (1.18-1.34) | (1.13-1.29) | (0.84-0.98) | ||
[0-8.80] | [0-5.61] | [0-4.08] | [0-2.71] | [0-2.32] | ||
Central line-associated BSI | 3.01 | 3.01 | 2.57 | 2.33 | 2.04 | |
(2.82-3.21) | (2.84-3.19) | (2.42-2.72) | (2.20-2.48) | (1.91-2.17) | ||
[0-6.92] | [0-6.64] | [0-7.35] | [0-5.08] | [0-3.99] | ||
Ventilator-associated PNEU | 1.75 | 1.70 | 1.64 | 1.46 | 1.23 | |
(1.59-1.93) | (1.56-1.86) | (1.50-1.78) | (1.34-1.60) | (1.12-1.35) | ||
[0-5.88] | [0-5.96] | [0-6.67] | [0-3.93] | [0-3.89] |