Before getting down to the content, let’s have a look at the reportitself. This is, after all, the only official source of information about hospital acquired infections. A few years ago, this was a chaotic, incomprehensible document, meaningless to the public. In 2016, the situation improved a tiny bit, but essentially the meaning still didn’t come through. Last year, as well, we needed an expert to help us decipher its meaning. This year, there are even more graphs, diagrams, tables, and sentences comprehensible for the public, but it is still far from straightforward.
It seems it was worth repeating for three years: everyone has the right to know hospital acquired infection data. It is a step forward that an increasing number of comparisons with previous years’ data are included in the report. Let’s have a look at the figures.
Still oriented to the medical profession
Unfortunately, even though this latest report is beginning to look like the ones in Western Europe, it is still not what we have been waiting for. This report is clearly oriented to the medical profession, and is not meant to help the orientation of lay people. If you get down to reading it, you won’t be completely lost anymore, but this report is not meant for the general public. (Which would be totally OK, if there was another document available for all.)
Last year, epidemiologist Karolina Böröcz helped us analyse the data; however, she passed away this past spring. However hard we have been trying, ever since then, we have not been able to contact an epidemiologist who would have been willing to help us understand the most important data. Here are the most important pieces of information that we as non-professionals could read from the report:
- Multidrug-resistant germs resist antibiotics; therefore, it is extremely hard to fight them. The number of infections caused by them is rising steeply. While in 2013, there were 19.3 infections caused by multidrug-resistant germs per 10.000 patients, in 2018, this number was 28.1 which means that this proportion has worsened. In total, 5442 cases were recorded, which is 500 more than in 2017. Moreover, the number of patients treated, as well as the time spent on them, has shown a steep decline in the course of 6 years; this means that the decrease in the number of patients did not improve the infection situation; in fact, it made it worse.
- Most infections were caused by catheters. Urinary tract infections constitute 31% of all reported infections (caused by multidrug-resistant germs); 21.8% were wound infections, and 19.1% were various respiratory infections.
- A slim majority (55%) of the patients are male, and the average age of those infected is 67 years. The vast majority (41%) are infected at the internal medicine ward, followed by surgery and intensive care.
- In total, 5485 tests were performed in microbiological labs.This means that only as many lab tests were performed as there were infections actually proven. Lab tests are simple, cheap, and fast, and should be carried out en masse in order to diagnose infections in time.
- By the year 2018, it is shared that 206 deaths occurred due to multi-resistant germs. We have learnt nothing about 2017, so we had to leave this column empty in our diagram.
- The rate of serious intestinal infection used to show a declining trend a few years ago, but it has been on the increase again since 2016. In 2017, there were 27.4 cases for every 10,000 patient; in 2018, this number was 28.1.
- In 2018, 5549 cases were diagnosed, which is 100 more than in 2017, but as fewer patients were treated in 2018 than in 2017, this rate is actually worse in this case, too.
- In 32% of the cases, the patient died, but in 47% of these, there was no correlation between the infection and the death. In 39% of these cases, the correlation was unknown, while in 14% of the cases, the death was related to the clostridium (it contributed to or caused the patient’s death). This means that it was confirmed in only 249 cases that the death was caused by clostridium.
- In 54% of the cases, the infected patient was female, in 46%, male. The average age of patients was 73 years.
- Major risk factors include previous hospital treatment (within 3 months), diabetes, and chronic kidney disease.
- The rate of blood poisoning skyrocketed: while in 2017, there were 18.2 cases for every 10,000 patient; in 2018, this number was 21.2. This means 4060 infections in total.
- In 38.5% of the cases, the patient died, but in 32% of the cases, there was no correlation between the infection and the death. In 45.9% of these cases, the correlation was unknown, while in 22% of the cases, the death was related to the infection (it contributed to or caused the patient’s death). This means that it was confirmed in only 86 cases that the death was caused by blood poisoning.
- 61.5% of the patients were male, 38.5% were female; the average age of patients was 61 years.
- Here, too, the majority of infections (32%) originated from the internal medicine ward; 23% at the intensive care units, and 11% at the surgery wards.
- Major risk factors include cardiovascular diseases and alien devices (central venous catheter, peripheral catheter), but treatment at the intensive care unit also represents high risk.
- The amount of alcoholic hand sanitiser used at hospitals provides a representative picture of protection against hospital acquired infections. Even though this number is on the increase,it still nowhere near the EU average: In 2017, 8.39 litres per 10.000 hospital days; in 2018, this number was 9.51. In the EU, this index was already 24 litres in 2015!
- It fails to inform. Patients are interested not only in numbers, but what these hospital acquired infections are, what has to be known about them, what measures hospitals are taking to prevent hospital acquired infections, what the chances for recovery are for infected patients, and what they themselves can do against them. It is important to comply with basic rules of hygiene, such as washing their hands and refraining from hospital visits while being sick.
It also turns out from the report that 131 epidemics (related cases of infection) were registered at hospitals, 78% of which was so-called non-specific, i.e. also occurring outside of hospitals. Of these, the leading cause of infections was calicivirus, but 10 epidemics were due to influenza. Even though the report does not mention this, it would be good to know how much of these are due to the carelessness of patients or visitors.
- It does not hold accountable.One of the most important pieces of professional criticism of the report is that it ignores the so-called “reporting discipline” – or the lack of it. Rumour has it that some hospitals have exemplary discipline, i.e. every single case is reported to the NNK. Other hospitals are said to take this obligation lightly. The NNK might as well disclose information about the reporting practice of hospitals. Instead, there only vague references in the report hinting at the fact that there is room for improvement regarding reporting discipline.
It is hard to decipher from the report how many people were infected in total, and how many died in hospital acquired infections in 2018. If our calculations are correct, the number of infection cases was 15.051 in the three reported categories only, and 541 of these patients died. However, this number is deceiving: it presupposes that each case was properly diagnosed and all diagnosed cases were reported. Hospitals have, on the contrary, bad reputation in terms of reporting discipline, and this report only makes the laconic comment that this discipline improved by 2018 – but it does not say how, and how much. Moreover, this number only reflects the three main reasons for hospital acquired infections (multidrug-resistant germs, clostridium difficile, and bloodstream infections), but there are numerous additional reasons, which hospitals report in a mandatory elective system. This means that we have no data about these infections, because not every hospital provides information.
More people die in hospital acquired infections than in car crashes?
As opposed to hospital acquired infections, up-to-date statistics are available about traffic accidents. From these it turns out that in 2018, a total of 567 people died on the roads, which seems more than the number of the victims of hospital acquired infections at first sight, but if we include the above addition, we can be certain that in 2018, more people died in hospital acquired infections than in car accidents.
What the National Health Centre could do: inform and stop tiptoeing around
We are criticising the report not only because it is incomprehensible, but also because the National Health Centre (NNK) fails to do two things.
For this reason, we ignored regional data. Even though these are disclosed by the report, as long as we don’t know about the reporting discipline of the individual hospitals, and regional features are ignored (the number of patients, the type of institutions, i.e. progression level), these data are not usable. Instead, we think that the data should be broken down by hospital, or at least by type of hospital, which would show the differences between the individual institutions much more clearly.
Since state bodies fail to do so, we would like to inform the public about hospital acquired infections in a professionally credible and comprehensible way; therefore, we are looking for an expert epidemiologist.
Dialogue with the NNK?
We have sent our suggestions to the NNK about how we think communication about hospital acquired infections should be carried out. We hope that these suggestions will be heard. In the meantime, it is worth taking a look at the American CDC (Centers for Disease Control and Prevention) brand-new, albeit beta-level website on healthcare-related infections. We hope that one day, official information about hospital infections will look the same in Hungary, too.