| Abstract [eng] |
Background. The prevalence of healthcare-associated infections is highest in intensive care units, where it is several times higher than in medical or surgical wards. The aim of the study: To assess the prevalence and trends of healthcare-associated infections from 2018 to 2024, as well as the implementation of preventive measures in intensive care units of Lithuanian healthcare facilities. Objectives of the study: 1. To assess the prevalence and trends of healthcare-associated infections in intensive care units of Lithuanian healthcare facilities from 2018 to 2024; 2. To assess the implementation of measures for the prevention of healthcare-associated infections in intensive care units of Lithuanian healthcare facilities; 3. To identify problem areas in the prevention of healthcare-associated infections in intensive care units of Lithuanian healthcare facilities. Methodology. Official data from the Institute of Hygiene were used for the descriptive study. In addition, a survey of healthcare facilities was conducted regarding the implementation of preventive measures. The questionnaire was sent via email to 50 facilities, with a response rate of 54%. Statistical data analysis was performed using Microsoft Excel, OpenEpi, and Social Science Statistics. Results. Of the 25562 patients hospitalized in intensive care units between 2018 and 2024, 4725 (18,5%) acquired a healthcare-associated infection. The incidence of healthcare-associated infections was 20,8 cases per 1000 bed-days, with this rate ranging from 13,9 cases per bed-days in 2020 to 25,8 cases per 1000 bed-days in 2022. The most common healthcare-associated infection was pneumonia (41,7-49,1%), followed by urinary tract infection in 2018-2022 (12,2-19,8%) and bloodstream infection in 2023-2024 (17,9-18,6%). The most common microorganisms causing these infections were Pseudomonas aeruginosa and Staphylococcus aureus. The proportion of carbapenem-resistant Acinetobacter baumannii was 86,0% and that of third-generation cephalosporin-resistant Klebsiella pneumoniae was 48,2%. The main risk factors for acquiring an infection were a urinary catheter or stoma (82,1%), a central venous catheter (61,1%) and an endotracheal tube (51,6%). The use of urinary or vascular catheters for longer than necessary is observed in 55,6% of facilities, and failure to document the implementation of preventive measures is observed in 29,6-37,0% of facilities. The main reasons staff are unable to properly implement infection prevention measures are a lack of practical skills (70,4%), reminders (48,1%), a safe environment (culture) to learn from mistakes and improve (44,4%), human resources (40,7%), and practical (63,0%) and / or specialized longer-term theoretical and practical (70,4%) training. Conclusions. Between 2018 and 2024, 18,5% of patients hospitalized in intensive care units acquired a healthcare-associated infection; the incidence rate of these infections was 20,8 cases per 1000 bed-days; with pneumonia being the most common infection, followed by urinary tract infection or bloodstream infection. A notable concern is the spread of antimicrobial-resistant microorganisms, among which Acinetobacter baumannii, resistant to carbapenems, and Klebsiella pneumoniae, resistant to third-generation cephalosporins, accounted for a particularly large proportion. Urinary catheters or stomas, central venous catheters and endotracheal tubes were the main risk factors for acquiring a healthcare-associated infection. In healthcare facilities, non-compliance with infection prevention measures is frequently related to the use of catheters for longer than necessary and the failure to document the implementation of preventive measures. Employees’ practical skills are insufficient, and the need for practical and / or specialized theoretical and practical training is unmet. |
