Inpatient questions

PARTICIPATION:

Any hospital admitting inpatients can participate in the inpatient module, both in the basic and healthcare-associated infections module. Other healthcare facilities with admitted patients can also participate, such as revalidation centres, long-term healthcare facilities, nursing homes.

If you have a mixed facility or mixed departments, consisting of inpatient beds and outpatient beds/consultation rooms, please survey these patients separately in the Global-PPS. Please survey all inpatient beds following the inpatient protocol and outpatient beds/consultation rooms following the outpatient protocol.

Pharmacies cannot participate in the Global-PPS, since our method is focused on prescribing and not dispensing patterns.

All antibiotics for systemic use (J01), antifungals (J02) and antimycotics (D01BA) for systemic use, antimalarials (P01B), antivirals for systemic use (J05), drugs for treatment of tuberculosis (J04A), antibiotics used as intestinal anti-infectives (A07AA), and nitroimidazole derivatives used as antiprotozoal agents (P01AB) are included in the Global-PPS. Antimicrobials for topical use are excluded (including creams, eye drops, ear drops, etc.).

For the Global-PPS antimicrobials are recorded according to the WHO ATC classification system. Please find a list of all included antimicrobial agents under Documentos > ‘antimicrobial list’.

Oral antibiotics that are not absorbed by the gastro-intestinal tract into the blood, and hence are locally active, are included in the Global-PPS. These antibiotics fall under the WHO ATC class of A07AA, the intestinal anti-infectives.

However, please exclude antibiotics for topical or vaginal use, such as nystatin creams. Oral nystatin formulations, e.g. for oropharyngeal candidiasis, can be included.

Please find all specific intestinal anti-infectives and other antimicrobials included in the Global-PPS under Documentos > ‘antimicrobial list’.

INCLUSION CRITERIA – PATIENTS:

All patients admitted on a ward (excluding day admissions such as endoscopy or renal units) at 8 a.m (or another time point of your choosing, but preferably when patients who stayed overnight have not been discharged yet). These patients are the denominator. The number of all admitted patients and beds should be filled in on the Ward form.

All patients admitted on the same ward receiving antimicrobial treatment are included as numerator. Please fill in a Patient form for each of these patients.

Exclude day hospitalizations and outpatients (these can be surveyed according to the outpatient module), and exclude patients admitted after 8 a.m. (or your respective time point) on the day of the survey. All patients who do not meet the inclusion criteria should be excluded from both the numerator and denominator data.

If the 1st dose of the antimicrobial is scheduled to be administered after the survey, do not include this antimicrobial in the survey. Record this patient in the denominator, but do not include this patient in the numerator: i.e., do not fill in a Patient Form for this patient.

Exception: if the patient was previously on e.g. parenteral antibiotic use, which was stopped the day before the survey, but a new oral antibiotic was started a few hours after the survey, you should consider this antibiotic as an ongoing antibiotic and hence include this antibiotic and this patient in the survey. Record the parenteral antibiotic in this case, as the oral antibiotic was started after the survey.

No, only count the patients (and beds) physically present in the ward you are auditing on the day of the PPS.  Look at the actual situation of the specific ward at the time of the PPS.

No, these patients should not be counted as inpatients in the survey if they are not admitted in the hospital. For example, if a nurse administers IV antibiotics at the patient’s home or if they are reviewed in the hospital without being re-admitted, they are not considered inpatients. While such patients may technically be classified as inpatients, their care resembles that of day patients, and they should be excluded from the Global-PPS.

Mothers who deliver in a polyclinic and are discharged within 24 hours of admission, along with their babies, are considered day care admissions and should be excluded from the survey. These are defined as ambulatory care patients (day cases).

Additionally, always follow the inclusion criteria as defined in protocol:

  • Include women who were admitted before 8 a.m. and still present at 8 a.m. Women admitted after 8 a.m. are excluded and should not be counted in either the denominator or numerator.
  • Babies present on the ward before 8 a.m. should be counted (unless they fall under day care admission, as noted above). Babies born after 8 a.m. are excluded from the survey.

INCLUSION CRITERIA – DEPARTMENTS & WARDS:

Yes, we recommend that you survey the entire hospital if you participate for the first time in the Global-PPS (to obtain baseline data for all wards).

If it is not your first time participating in the Global-PPS with your hospital, you can also survey a selection of the departments, but we recommend that you include all wards for a certain main activity (medical, surgical, ICU): e.g., all adult ICU wards, all paediatric surgical departments, etc. We recommend this so that you collect sufficient data by activity, and subsequently, you will obtain valid rates by activity. For smaller hospitals (<250 beds), it remains advisable to survey the entire hospital.

Yes, also include the psychiatric wards/cases. Encode these wards as PSY-AMW (Psychiatry). This allows for the differentiation of these wards in the analyses, as prescribing patterns are likely different from those of other adult medical wards.