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Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study

Published online by Cambridge University Press:  10 November 2023

Romain Mahieu Open the ORCID record for Romain Mahieu [Opens in a new window] ,
Melody Yannart ,
Nicolas Dauby Open the ORCID record for Nicolas Dauby [Opens in a new window] ,
Boudewijn Catry Open the ORCID record for Boudewijn Catry [Opens in a new window]  and
Sam Newton
Romain Mahieu*
Affiliation:
London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom Department of Infectious Disease Prevention and Control, Common Community Commission, Brussels–Capital Region, Brussels, Belgium
Melody Yannart
Affiliation:
Brussels–Capital Health and Social Observatory, Common Community Commission, Brussels–Capital Region, Brussels, Belgium
Nicolas Dauby
Affiliation:
School of Public Health, Université Libre de Bruxelles (ULB), Brussels–Capital Region, Brussels, Belgium Department of Infectious Diseases, CHU Saint-Pierre, Université Libre de Bruxelles (ULB), Brussels–Capital Region, Brussels, Belgium
Boudewijn Catry
Affiliation:
School of Public Health, Université Libre de Bruxelles (ULB), Brussels–Capital Region, Brussels, Belgium Epidemiology and Public Health, Sciensano, Brussels–Capital Region, Brussels, Belgium
Sam Newton
Affiliation:
London School of Hygiene & Tropical Medicine, University of London, London, United Kingdom Department of Global and International Health, School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
*
Author for correspondence: Romain Mahieu, MD, MSc, Common Community Commission, Rue Belliard 71/1 - 1040 Brussels, Belgium. Email: romain.mahieu@gmail.com
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Abstract

Objectives:

To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels–Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs).

Design:

Cross-sectional analyses of yearly hospital administrative data.

Setting:

All Belgian hospitals and discharge destinations, focusing on LTCFs.

Participants:

All individuals from the Brussels–Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572).

Methods:

We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections.

Results:

Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22–1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85–0.90).

Conclusions:

Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 45 , Issue 4 , April 2024 , pp. 434 - 442
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Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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References

Report on the Burden of Endemic Health Care-Associated Infection Worldwide. World Health Organization website. https://apps.who.int/iris/bitstream/handle/10665/80135/9789241501507_eng.pdf. Published 2011. Accessed August 4, 2022.Google Scholar
Guidelines on Prevention and Control of Hospital Associated Infections. World Health Organization website. https://apps.who.int/iris/bitstream/handle/10665/205187/B0007.pdf. Published 2002. Accessed August 4, 2022.Google Scholar
Ducel, G, Fabry, J, Nicolle, L. Prevention of Hospital-Acquired Infections: A Practical Guide, Second Edition. Geneva, Switzerland: World Health Organization; 2002.Google Scholar
Goering, RV, Zuckerman, MA, Dockrell, HM, Chiodini, PL, Mims, CA. Mims’ Medical Microbiology and Immunology, Sixth Edition. Edinburgh: Elsevier; 2019.Google Scholar
Zarb, P, Coignard, B, Griskeviciene, J, et al. The European Centre for Disease Prevention and Control (ECDC) pilot point-prevalence survey of healthcare-associated infections and antimicrobial use. Euro Surveill 2012;17:20316.10.2807/ese.17.46.20316-enCrossRefGoogle ScholarPubMed
Cassini, A, Plachouras, D, Eckmanns, T, et al. Burden of six healthcare-associated infections on European population health: estimating incidence-based disability-adjusted life years through a population prevalence-based modelling study. PLoS Med 2016;13:e1002150.10.1371/journal.pmed.1002150CrossRefGoogle ScholarPubMed
Suetens, C, Latour, K, Kärki, T, et al. Prevalence of healthcare-associated infections, estimated incidence and composite antimicrobial resistance index in acute-care hospitals and long-term care facilities: results from two European point-prevalence surveys, 2016 to 2017. Euro Surveill 2018;23:1800516.CrossRefGoogle ScholarPubMed
Devos, C, Cordon, A, Lefèvre, M, et al. Performance of the Belgian health system—report 2019. Belgian Health Care Knowledge Centre (KCE) website. https://kce.fgov.be/sites/default/files/2021-12/KCE_313C_Performance_Belgian_health_system_Report.pdf. Published 2019. Accessed August 10, 2022.Google Scholar
Damani, N. Manual of Infection Prevention and Control, Fourth Edition. New York: Oxford University Press; 2019.10.1093/med/9780198815938.001.0001CrossRefGoogle Scholar
Whitby, M, McLaws, ML, Collopy, B, et al. Postdischarge surveillance: can patients reliably diagnose surgical wound infections? J Hosp Infect 2002;52:155–160.CrossRefGoogle ScholarPubMed
Emerson, CB, Eyzaguirre, LM, Albrecht, JS, Comer, AC, Harris, AD, Furuno, JP. Healthcare-associated infection and hospital readmission. Infect Control Hosp Epidemiol 2012;33:539–544.10.1086/665725CrossRefGoogle ScholarPubMed
Rahmqvist, M, Samuelsson, A, Bastami, S, Rutberg, H. Direct healthcare costs and length of hospital stay related to healthcare-acquired infections in adult patients based on point-prevalence measurements. Am J Infect Control 2016;44:500–506.CrossRefGoogle Scholar
Khong, CJ, Baggs, J, Kleinbaum, D, Cochran, R, Jernigan, JA. The likelihood of hospital readmission among patients with hospital-onset central-line–associated bloodstream infections. Infect Control Hosp Epidemiol 2015;36:886–892.CrossRefGoogle ScholarPubMed
Chopra, T, Neelakanta, A, Dombecki, C, et al. Burden of Clostridium difficile infection on hospital readmissions and its potential impact under the Hospital Readmission Reduction Program. Am J Infect Control 2015;43:314–317.CrossRefGoogle ScholarPubMed
Sreeramoju, P, Montie, B, Ramirez, AM, Ayeni, A. Healthcare-associated infection a significant cause of hospital readmission. Infect Control Hosp Epidemiol 2010;31:1195–1197.10.1086/656746CrossRefGoogle ScholarPubMed
Manoukian, S, Stewart, S, Graves, N, et al. Evaluating the postdischarge cost of healthcare-associated infection in NHS Scotland. J Hosp Infect 2021;114:51–58.CrossRefGoogle ScholarPubMed
Vrijens, F, Hulstaert, F, Gordts, B et al. Nosocomial infections in Belgium, part 2: impact on mortality and costs. Belgian Health Care Knowledge Centre (KCE) website. https://kce.fgov.be/sites/default/files/2021-11/d20091027303.pdf. Published 2009. Accessed August 10, 2022.Google Scholar
Manoukian, S, Stewart, S, Dancer, S, et al. Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology. J Hosp Infect. 2018;100:222–235.10.1016/j.jhin.2018.06.003CrossRefGoogle ScholarPubMed
Vrijens, F, Hulstaert, F, Devriese, S, van de Sande, S. Hospital-acquired infections in Belgian acute-care hospitals: an estimation of their global impact on mortality, length of stay and healthcare costs. Epidemiol Infect 2012;140:126–136.10.1017/S0950268811000100CrossRefGoogle ScholarPubMed
Point prevalence survey of healthcare-associated infections and antimicrobial use in European acute care hospitals—protocol version 6.1. European Centre for Disease Prevention and Control website. https://www.ecdc.europa.eu/sites/default/files/documents/antimicrobial-use-healthcare-associated-infections-point-prevalence-survey-version6-1.pdf. Published 2022. Accessed February 17, 2023.Google Scholar
Zingg, W, Huttner, BD, Sax, H, Pittet, D. Assessing the burden of healthcare-associated infections through prevalence studies: what is the best method? Infect Control Hosp Epidemiol 2014;35:674–684.CrossRefGoogle ScholarPubMed
McCormick, PJ, Lin, HM, Deiner, SG, Levin, MA. Validation of the All Patient Refined Diagnosis Related Group (APR-DRG) risk of mortality and severity of illness modifiers as a measure of perioperative risk. J Med Syst 2018;42:81.10.1007/s10916-018-0936-3CrossRefGoogle ScholarPubMed
Baker, MA, Sands, KE, Huang, SS, et al. The impact of COVID-19 on healthcare-associated infections. Clin Infect Dis 2022;74:1748–1754.CrossRefGoogle ScholarPubMed
van de Voorde, C, Lefèvre, M, Mistiaen, P, Detollenaere, J, Kohn, L, van den Heede, K. Assessing the management of hospital surge capacity in the first wave of the COVID-19 pandemic in Belgium. Belgian Health Care Knowledge Centre (KCE) website. https://kce.fgov.be/sites/default/files/2021-11/KCE_335_Surge_capacity_during_COVID-19_Belgium_Report.pdf. Published 2020. Accessed September 9, 2022.Google Scholar
Weiner-Lastinger, LM, Pattabiraman, V, Konnor, RY, et al. The impact of coronavirus disease 2019 (COVID-19) on healthcare-associated infections in 2020: a summary of data reported to the National Healthcare Safety Network. Infect Control Hosp Epidemiol 2022;43:12–25.10.1017/ice.2021.362CrossRefGoogle Scholar
Advani, SD, Sickbert-Bennett, E, Moehring, R, et al. The disproportionate impact of COVID-19 pandemic on healthcare-associated infections in community hospitals: need for expanding the infectious disease workforce. Clin Infect Dis 2022;76:e34–e41.CrossRefGoogle Scholar
Duysburgh, E. Surveillance of bloodstream infections in Belgian hospitals: report 2022. Sciensano website. https://www.sciensano.be/sites/default/files/bsi_report_2022.pdf. Published 2022. Accessed March 3, 2023.Google Scholar
De Mot, L, Robalo, Q, Dockx, Y, et al. COVID-19 Clinical Hospital Surveillance Report. Sciensano website. https://covid-19.sciensano.be/sites/default/files/Covid19/COVID-19_Hospital_epidemiology_Part_1.pdf. Published 2023. Accessed January 10, 2023.Google Scholar
Vandael, E, Latour, K, Goossens, H, et al. Point-prevalence survey of antimicrobial use and healthcare-associated infections in Belgian acute-care hospitals: results of the Global-PPS and ECDC-PPS 2017. Antimicrob Resist Infect Control 2020;9:13.CrossRefGoogle ScholarPubMed
Goto, M, Ohl, ME, Schweizer, ML, Perencevich, EN. Accuracy of administrative code data for the surveillance of healthcare-associated infections: a systematic review and meta-analysis. Clin Infect Dis 2014;58:688–696.CrossRefGoogle ScholarPubMed
Redondo-González, O, Tenías, JM, Arias, Á, Lucendo, AJ. Validity and reliability of administrative coded data for the identification of hospital-acquired infections: an updated systematic review with meta-analysis and meta-regression analysis. Health Serv Res 2018;53:1919–1956.CrossRefGoogle ScholarPubMed
Jackson, SS, Leekha, S, Magder, LS, et al. The effect of adding comorbidities to current centers for disease control and prevention central-line–associated bloodstream infection risk-adjustment methodology. Infect Control Hosp Epidemiol 2017;38:1019–1024.CrossRefGoogle ScholarPubMed
Olsen, MA, Ball, KE, Nickel, KB, Wallace, AE, Fraser, VJ. Validation of ICD-9-CM diagnosis codes for surgical-site infection and noninfectious wound complications after mastectomy. Infect Control Hosp Epidemiol 2017;38:334–339.CrossRefGoogle ScholarPubMed
van Mourik, MSM, van Duijn, PJ, Moons, KGM, Bonten, MJM, Lee, GM. Accuracy of administrative data for surveillance of healthcare-associated infections: a systematic review. BMJ Open 2015;5:e008424.CrossRefGoogle ScholarPubMed
Aelvoet, WH, Terryn, N, Windey, F, et al. Miscoding: a threat to the hospital care system. How to detect it? Rev Epidemiol Sante Publique 2009;57:169–177.CrossRefGoogle Scholar
Global report on infection prevention and control. World Health Organization website. https://apps.who.int/iris/bitstream/handle/10665/354489/9789240051164-eng.pdf. Published 2022. Accessed January 7, 2023.Google Scholar
Murray, F, Allen, M, Clark, CM, Daly, CJ, Jacobs, DM. Sociodemographic and -economic factors associated with 30-day readmission for conditions targeted by the hospital readmissions reduction program: a population-based study. BMC Public Health 2021;21:1922.10.1186/s12889-021-11987-zCrossRefGoogle ScholarPubMed
Mertens, E, Sagastume, D, Peñalvo, JL. Quantification of disparities in the distribution of lifestyle and metabolic risk factors, prevalence of noncommunicable diseases and related mortality: the Belgian Health Interview Surveys 1997–2018. BMJ Open 2021;11:e053260.10.1136/bmjopen-2021-053260CrossRefGoogle ScholarPubMed
van de Voorde, C, van den Heede, K, Beguin, C, et al. Required hospital capacity in 2025 and criteria for rationalisation of complex cancer surgery, radiotherapy and maternity services. Belgian Health Care Knowledge Centre (KCE) website. https://kce.fgov.be/en/publications/all-reports/required-hospital-capacity-in-2025-and-criteria-for-rationalisation-of-complex-cancer-surgery. Published 2017. Accessed September 9, 2022.Google Scholar
van de Voorde, C, Gerkens, S, van den Heede, K, Swartenbroekx, N. A comparative analysis of hospital care payments in five countries—synthesis. Belgian Health Care Knowledge Centre (KCE) website. https://kce.fgov.be/sites/default/files/2021-11/KCE_207Cs_Hospital_financing_synthesis2.pdf. Published 2013. Accessed January 7, 2023.Google Scholar
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