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A. Introduction
The object of this page is to enable English speaking
users to access German Nosocomial Infection Surveillance System
(KISS) reference data.
In 1997 we initiated a nationwide nosocomial infection surveillance
system so as to create a database for hospital infections throughout
Germany, "KISS" being an acronym for "Krankenhaus-(=Hospital)-Infektions-Surveillance-System".
The number of hospitals participating has since been increasing
continuously.
B. General principles
Participation is on a voluntary basis and individual results from
each hospital are handled strictly confidentially. Before embarking
on surveillance staff have to attend an introductory course and
then participate in subsequent annual meetings in which the experiences
of other hospitals are discussed.
The participating hospitals receive their own standardized and
stratified infection rates on a regular basis in order to be able
to compare this data with data from the national data pool fed
in by all the other hospitals participating. Once a year a meeting
of these hospitals is organized for the discussion of methodological
points and exchanging the participants' experience with using
such data for infection control.
In the majority of hospitals infection control personnel are responsible
for recording data and dispatching it to the KISS data centre.
C. Surveillance components
The definitions and methods can be traced back
to the U.S. National Nosocomial Infection Surveillance (NNIS)
system with, however, some modifications. For instance, different
surveillance components have self-contained surveillance protocols,
each focused on a particular group of patients. These protocols
are unfortunately not yet available in English. Every hospital
participating in KISS chooses one or more components. Up till
now the following components have been established:
C1. ICU surveillance component
(= "ITS-KISS")
This component focuses on lower respiratory tract
infections (pneumonia and bronchitis), blood stream and urinary
tract infections in intensive care units. National reference data
are generated for device associated infection rates. This surveillance
component is unit based.
C2. Surgical patient surveillance
component (= "OP-KISS")
The surveillance of surgical site infections (SSI)
is concentrated in about 20 operative procedure categories (=
"Indikator-Operationen"), which may differ from NNIS
categories. Voluntarily participating surgical departments select
those procedures they wish to follow up from the KISS operative
procedure list. This surveillance component is patient based.
Infection rates are stratified
according to the NNIS system.
A risk point is attributed to patients if
- the patient's general condition, as measured
by the ASA score, is 3 or worse,
- the wound contamination class is classified
as contaminated or dirty/infected,
- the operation lasted longer than 75 % of all
other operations of the same type. (i.e., the cut-off time is
calculated in minutes from the actual German data instead of
using the NNIS cut-off time)
These three factors are considered as being of equal significance.
The NNIS risk index score ranges from 0 to 3, that is the number
of risk points.
KISS operative procedure category
list (= "Liste der Indikator-OP"):
Most of the KISS operative procedure categories
are identical to NNIS procedure categories or differ only in detail,
however, some procedures don't correspond to NNIS. The KISS operative
procedure categories are defined by their OPS-301-codes, which
is a specific German modification of the WHO's ICPM-procedure
codes. The following are the operative procedures with the highest
participation rates, for which reference data are published on
the web twice yearly:
The entire list (with OPS-301-codes) in German is shown here:
OP-LISTE
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Operative procedure
category
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Code (KISS)
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corresponding NNIS code
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Appendectomy
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APPE
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APPY
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Knee arthroscopy
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ART
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-
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Cholecystectomy (only fully
endoscopically performed operations)
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CHOL E
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CHOL
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Cholecystectomy (operations
with laparatomy)
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CHOL K
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CHOL
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Colon surgery
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COLO
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COLO
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Coronary artery bypass
with a graft harvested from an extremity
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COBY L
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CBGB
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Coronary artery bypass
with chest incision only
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COBY T
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CBGC
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Vascular surgery
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GC
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VS
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Herniorrhaphy
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HERN
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HER
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Hip prosthesis (only procedures
from orthopaedic departments, i.e. mostly elective surgery)
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HPRO O
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HPRO
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Hip prosthesis (only procedures
from traumatology departments, i.e. mostly indicated by
trauma)
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HPRO T
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HPRO
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Abdominal hysterectomy
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HYST
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HYST
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Knee prosthesis
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KPRO
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KPRO
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Mastectomy
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MAST
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MAST
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Nephrectomy
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NEPH
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NEPH
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Talocrural joint operation
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OSG
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-
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Hip fracture without joint
replacement
|
OSHF
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-
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|
Prostatectomy
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PRST
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PRST
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Caesarean section
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SECC
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CSEC
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Stripping of varicose veins
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STRIP
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-
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Thyroidectomy (strumectomy)
|
STRUM
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-
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C3. Neonatal ICU component (=
"NEO-KISS")
Surveillance is restricted to very low birth weight
infants (<1500 g) and includes pneumonia, blood stream infection
and necrotizing enterocolitis (NEC). The number of device days
(central / peripheral vascular catheter, mechanical ventilation
/ CPAP) and days with antibiotic treatment are registered for
every patient.
D. How to find current reference
data on the web
First go to the homepage www.nrz-hygiene.de
(Deutsche Version), then to SURVEILLANCE
and choose the surveillance component (as described above). The
reference data at the bottom of the page are in PDF files called
"Referenzdaten" .
Current reference data ICU component: ITS-KISS
Referenz
Current reference data SSI component: OP-KISS
Referenz
Current reference data NICU component: NEO-KISS
Referenz
E. German - English glossary
The purpose of this chapter is to help the user
to understand the most recent reference data, which is published
twice a year on the website. A translation and short explanation
are given for each surveillance component in the order of occurrence
in the German reference data files:
E1. ICU component (= "ITS-KISS")
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Art der Intensivstation
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ICUs are stratified
in ICU types as follows:
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chirurgisch
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surgical
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interdisziplinär
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medical-surgical (mostly
in smaller hospitals with only one ICU and where patients
from different specialist medical departments are treated)
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medizinisch
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medical
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neurochirurgisch
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neurosurgical
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pädiatrisch
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paediatric (ICU for children
no longer of neonatal age, surveillance for neonatal ICUs
is performed in a special component: NEO-KISS)
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Anzahl der Intensivstationen
|
number of participating
ICUs
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Anzahl der Beobachtungsmonate
|
number of months under
observation
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Anzahl Patienten
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number of patients included
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Anzahl Patiententage
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number of patient days
included
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Liegedauer (Tage)
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average length of stay
in the ICU in days
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Device-Anwendungsraten
über alle Intensivstationen dieser Art
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device utilisation ratio
for all ICU's of this type
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HWK = Harnwegkatheter
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urinary catheter
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ZVK = zentral-venöser
(oder -arterieller) Katheter
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central venous/arterial
catheter
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Beatmung
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mechanical ventilation
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Anzahl Devicetage
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number of device days
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gepoolte Device-Anwendungsrate
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pooled mean device utilisation
ratios
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Device-assoziierte Infektionsraten
über alle Intensivstationen dieser Art
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device associated infection
for all ICU's of this type
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Harnweginfektion*
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urinary tract infection
(UTI)
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Sepsis
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primary bloodstream infection
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Pneumonie
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pneumonia
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Bronchitis
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bronchitis (only those
ICUs are considered in the denominator data, which have
diagnosed at least one bronchitis, because not all ICUs
distinguish pneumonia and bronchitis within lower respiratory
tract infections.
|
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Anzahl Devicetage
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number of device days
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Anzahl nosokomialer Infektionen
|
number of nosocomial infections
(i.e., device associated)
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Device-assoziierte nosokomiale
Infektionsrate
|
rate of device associated
nosocomial infections
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* denominator data for UTI: ICUs are stratified
in those with (="mit") and without (="ohne")
routine urine screening for bacteria. The latter ones perform
microbiological exams of urine only when clinically indicated.
E.2 SSI component (= OP-KISS)
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Referenzdaten für
chirurgische Abteilungen
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reference data for surgical
departments
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Anzahl Abteilungen
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number of operating departments
participating
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Operationsart
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Operative procedure category
(see separate list in section C2). These categories may
be not identical with NNIS operative procedure categories
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Risikokategorie
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NNIS risk index category
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Anzahl
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number
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gepoolte Wundinfektionsrate
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pooled arithmetical mean
surgical site infection rate (of all hospitals)
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Wundinfektionen
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surgical site infections
(SSI)
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Wundinfektionsart
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type of surgical site infections (SSI),
defined by the CDC criteria:
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A1 = superficial
-
A2 = deep incisional
-
A3 = organ/space
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Verteilung der standardisierten
Wundinfektionsraten der Abteilungen (SIR)
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distribution of the departments
standardized SSI rate (SIR). The SIR is calculated in the
following way: the number of cases of SSI in a given hospital
is divided by the number of SSI cases, already expected
for this hospital and based on the risk index distribution
among that hospital's patients.
|
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OP-Dauer (in Minuten)
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cut off point for the duration
of the operation (in minutes). If the patient's operation
lasts for longer than this, a risk point is attributed.
This cut off time represents the 75th percentile of the
operations of the same type. (i.e., the cut-off time is
calculated in minutes from the actual German data instead
of using the NNIS cut-off time) and is recalculated every
6 month.
|
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Wundklassifikation
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wound contamination class
(1 clean, 2 clean-contaminated,
3 contaminated, 4 dirty-infected)
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Erklärung
|
-
Only hospitals performing
at least 30 operation surveillances for each type are
included in the reference data.
-
The number "-999"
in a list means that this value is non-defined (i.e.,
calculation by zero error)
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E3. Neo-KISS = component for neonatal
ICUs (NICUs):
Surveillance is concentrated on very low birth
weight (VLBW) neonates (<1500 g birth weight). These neonates
are under surveillance for infections until they have reached
a weight of
1800 g.
The results are stratified in 3 birth weight groups
(= "Geburtsgewichtsklasse"):up to (= "bis")
499g, 500 to (="bis") 999 g, 1000 to (="bis")
1499 g.
|
Anzahl Abteilungen
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number of participating
NICUs participating
|
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Anzahl Patienten
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number of patients included
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Anzahl Patiententage zu
erfassten Antibiotikatagen
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number of patient days
(denominator) and days with antibiotic treatment
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Mittlere Liegedauer (Tage)
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average length of stay
on the NICU in days
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gepoolte Wundinfektionsrate
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pooled arithmetical mean
surgical site infection rate (of all hospitals)
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Device-Anwendungsraten
(über alle Patienten in dieser Geburtsgewichtsklasse)
|
device utilisation ratio
(throughout all patients of this birth weight group):
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Devices
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devices
|
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ZVK = zentral-venöse
(oder -arterieller) Katheter
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central venous/arterial
catheter
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PVK = peripher venöser
Katheter
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peripheral venous catheter
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Tubus
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invasive mechanical ventilation
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CPAP
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non-invasivly administered
continuous positive airway pressure [CPAP]
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Antibiotika
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antibiotics
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Anzahl Device-Tage
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number of device days
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gepoolte Device-Anwendungsrate
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pooled mean device utilisation
ratios
|
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Inzidenzdichten und
Device-assozierte Infektionsraten
(über alle Patienten in dieser Geburtsgewichtsklasse)
|
device associated infection
rates
(throughout all patients of this birth weight group)
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Sepsis
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blood stream infection
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Pneumonie
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pneumonia
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NEC
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necrotizing enterocolitis
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Anzahl Infektionen
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number of infections (i.e.
device associated and not device associated)
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Inzidenzdichte
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incidence density (= no.
of infections no. of patient days x 1000)
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Antibiotika
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antibiotics
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Anzahl Device-ass. Infektionen
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number of device associated
infections
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Device-assoziierte Infektionsrate
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rate of device associated
infections (= no. of device associated infections no. of
device days x 1000)
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F. References in English:
1. Gastmeier P, Sohr D, Just HM, Nassauer A, Daschner
F and Rüden H. How to survey nosocomial infections. Infect
Control Hosp Epidemiol 2000;21:366-370
2. Gastmeier P, Sohr D, Geffers C, Nassauer A,
Daschner F and Rüden H. Are nosocomial infection rates in
intensive care units useful benchmark parameters? Infection 2000;28:346-350
3. Geffers C, Gastmeier P, Bräuer H, Daschner
F and Rüden H. Surveillance of nosocomial infections in ICUs:
is post discharge surveillance indispensable? Infect Control Hosp
Epidemiol 2001;22:157-159
4. Coello R, Gastmeier P and de Boer AS. Surveillance
of hospital acquired infection in England, Germany and The Netherlands:
will international comparison of rates be possible? Infect Control
Hosp Epidemiol 2001;22:393-397
5. Gastmeier P, Sohr D, Geffers C, Nassauer A,
Dettenkofer M and Rüden H. Occurrence of methicillin resistant
Staphylococcus aureus infections in German intensive care units.
Infection 2002;30:198-202
Contact:
You may contact us by email in English for any further questions.
nrz@charite.de
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