China Against Drug Resistance (CARE) Point Prevalence Study: A Tool for Evaluating Hospital Acquired Infections and Antimicrobial Prescription at Patient Bedside

Abstract

China Against Drug Resistance (CARE) project was launched for improving antimicrobial use and infection control in Chinese hospitals. The first step was developing a Point Prevalence Survey (PPS) tool for assessing at patient bedside risk factors and rates of hospital acquired infections (HAIs) and quality indicators of antimicrobial usage and testing its workability. After a pilot phase (2016), the CARE PPS tool was deployed in 2018-9 in eight large Chinese hospitals. Each hospital selected 3-5 adult departments (intensive care, surgery, medicine). The questionnaire in English and Chinese, on paper and tablet computer, was filled out directly at the patient's bedside by local infection control teams, microbiologists, pharmacists and clinicians. The number of patients visited per day and per investigator team increased from 20-30 during the pilot phase in the first hospital to 40-50 in the eight other hospitals. The main characteristics of the 1,170 patients included (ICU 138, medicine 430, surgery 602) were: median age 60 years; Mac Cabe score 1 74.7%; catheters: central vascular 14.3%, peripheral vascular 50.9%, urinary 19.8%; surgery during stay 31.8%. HAIs prevalence was 6.3% (mainly respiratory tract, surgical-site; main bacteria: Acinetobacter, Pseudomonas, Klebsiella). 54.4% of the patients were receiving antimicrobials for therapeutical use (≈3/4 single drug): from 36% in surgery to 78.3% in ICU, mostly large spectrum beta-lactams. Examination of patient records at the bedside found the reason for the treatment (53%), treatments based on microbiological results (9.3%), and prescription reassessment (30.7%). The study showed that antimicrobial policy and HAI prevention could be improved by using Care-PPS in Chinese hospitals. Although obtained on a limited number of patients, the results demonstrated that there is room for improvement in antimicrobial policy and HAI prevention in the participating hospitals.