Hospital Epidemiology

Antibiotic Stewardship

The use of antimicrobials is associated with alterations of the normal bacterial flora, the development of antibiotic resistance, Clostridium difficile infections, adverse effects, drug-drug interactions and last but not least increased healthcare costs. Antimicrobial stewardship programs aim to systematically assess and improve rational antibiotic use in hospitals. The Division of Infectious Diseases and Hospital Epidemiology has been leading the Antibiotic Stewardship Program at the University Hospital Zürich since 2007.

The goals of our program are to promote rational use of antimicrobials and to improve outcomes for patients through optimizing antimicrobial use with regard to spectra of activity, application, dosage and duration, and through minimizing adverse effects, drug-drug interactions and costs. Cornerstones of the Antibiotic Stewardship Program are the surveillance of antimicrobial use and bacterial resistance, our consultation service, active surveillance of blood cultures, teaching and education and the publication of antibiotic treatment guidelines.

Antibiotic Guidelines

Our antibiotic guidelines entitled ‚Initiale antimikrobielle Therapie' are being issued and regularly updated in close collaboration with the Divisions and Clinics of the University Hospital Zürich, the Institute of Medical Microbiology of the University of Zürich, the Institute of Medical Virology of the University of Zürich, the Institute of Parasitology of the University of Zürich, Dr. B. Beck, tropical medicine consultant, and the Cantonal Pharmacy of Zürich. The guidelines are based on most current evidence, international and national guidance, the epidemiology of antimicrobial resistance at the University Hospital Zürich and ex-factory prices of the drugs.

How to order

The print version of the guidelines can be ordered via email at the price of 20.00 CHF at the secretariat of the Hospital Epidemiology Service (spitalhygiene@usz.ch).).

Reference Center

National Reference Center For Blood Borne Infectious Diseases In Healthcare Settings

A mandate from the Federal Office of Public Health, Bern

What are blood borne infections?

Viral infections (Hepatitis C and B as well as HIV), where pathogens are present in the blood and, therefore can be transmitted through exposure (injuries, mucocutaneous exposures) or by blood-contaminated instruments.

Who is at risk?

Persons active in the medical setting may, through their professional activities, potentially be exposed to blood or other infectious biological liquids; such individuals may include employees of hospitals, doctors and dentist offices, home care settings and long term care institutions, staff of correctional facilities, police, fire department and others.

Reference Center: what is offered

Telephone information and consultancy for medical doctors
•questions about exposure and infection risk, to primary and secondary prophylaxis measures
•consultation regarding medicinal prophylaxis for HIV and Hepatitis B

Telephone information and consultation for affected health care workers
•questions and issues in the context of blood transmissible infections
•safety precautions and prevention of exposure
•post-exposure procedures

Quality Audits

By request: inspection of medical institutions and facilities, their materials, equipment and operational procedures. The outcome of such an audit is a safety report identifying the deficiencies and practical recommendations for optimizing the processes.

Education and training

We offer education and training classes for the following target groups:
Training schools for healthcare professionals
Nursing professionals
General practitioner and dentist office assistants
Paramedics
Other medico-technical occupations

Content Epidemiology
Transmission modes
Exposure and infectious risks
Safety precautions
Post-exposure prophylaxis

Staff
Carlo Colombo, RN MPH (Employee Reference Center)
Prof. Dr. med. Hugo Sax, Senior Staff Physician (Head of Reference Center)

Publications

Francioli P, Saghafi L, Jost J. Berufsbedingtes Risiko von HIV-Expositionen im medizinischen Bereich. BAG Bulletin 1990;33:487-491.

SKK/EKAF HIV-Exposition im medizinischen Tätigkeitsbereich, Verhütungsmaß-nahmen und Chemoprophylaxe mit Azidothymidine (AZT). BAG Bulletin 1990:492-500.

Iten A., Jost J., Maziéro A., Saghafi L, Ledergerber B, Francioli P. Beruflich bedingte HIV-Exposition in der Schweiz 31.12.92. BAG Bulletin 1994;3:36-43.

SKK/EKAF Richtlinien betreffend HIV-Exposition im Medizinalbereich, Allgemeine Maßnahmen und Chemoprophylaxe und Meldung. BAG Bulletin 1994:617-630.

Iten A, Maziéro A, Jost J, Colombo C, Ledergerber B, Francioli P. Die Situation in der Schweiz am 31.12.1994. Überwachung der beruflich bedingten Expositionen mit Blut oder Körperflüssigkeiten. BAG Bulletin 1995;24:4-10.

Jost J. Berufsbedingte HIV-Infektion – Erster Fall in der Schweiz. BAG Bulletin 1995;8:4.

Ruef C. HIV-Expositionen im Gesundheitsbereich. HIV-Infektion nach Nadelstich: Risikoreduktion durch Zidovudin. BAG Bulletin 1996;6:3.

Jost J., Iten A., Meylan P., Colombo C., Maziéro A, Francioli P. HIV-Exposition im Medizinalbereich. Allgemeine Maßnahmen, Chemoprophylaxe und Meldung. BAG Bulletin 1997;7:5-12.

Jost J., Colombo C., Maziéro A., Ledergerber B., Francioli P. Beruflich bedingte Blut-Expositionen und medikamentöse HIV-Postexpositionsprophylaxe (PEP) in der Schweiz bis Ende 1996. BAG Bulletin 1998;27:14-19.

Greub G., Jost J., Ruef C., Telenti P., Francioli P. Aktualisierte Empfehlungen 2003 zur beruflichen Exposition mit Blut oder biologischen Flüssigkeiten. und Fachkommission Klinik und Therapie HIV/AIDS. BAG Bulletin 2002;10:192-198.

Ruef C., Colombo C., Maziéro A., Ledergerber B., Zysset F., Francioli P Beruflich bedingte Blutexpositionen mit Hepatitis C-Virus im Medizinalbereich in der Schweiz bis Ende 2000. BAG Bulletin 2002;40:685-691.

Greub G, Maziéro A., Kaufmann G., Colombo C., Zysset F., Ruef C., Francioli P. HIV-, HBV- und HCV-Expositionen im medizinischen Bereich in der Schweiz von 1997 bis 2000. BAG Bulletin 2002;40:692-696.

Colombo C., Ruef C.HIV-Postexpositionsprophylaxe (PEP)-Management: Umsetzung in medizinischen Institutionen der Deutschschweiz – Ergebnisse einer Umfrage. BAG Bulletin 2004;22:356-361.

Zysset F. Kammerlander R, Francioli P., Colombo C. Ruef C., Vernazza P., Cavassini M Vorgehen nach Exposition gegenüber Blut oder anderen biologischen Flüssigkeiten (EBF) von Personal im Gesundheitswesen – aktualisierte Empfehlung 2007. BAG Bulletin 2007;31:543-555.

Colombo C., Ledergerber B., Zysset F., Francioli P., Cavassini M., Ruef C. HIV-, HBV- und HCV-Expositionen im medizinischen Bereich in der Schweiz von 2001 bis 2006. BAG Bulletin 2009

• Verhütung blutübertragbarer Infektionen beim Umgang mit Patienten ‘SUVA-Broschüren Arbeitssicherheit
• Verhütung blutübertragbarer Infektionen in medizinischen Laboratorien‘ (1997, 5. Auflage)
• Verhütung blutübertragbarer Infektionen‘ (1998, 2. Auflage)
• Verhütung blutübertragbarer Infektionen im Gesundheitswesen‘ (2008, 14. Auflage)

Contact address

Klinik für Infektionskrankheiten und Spitalhygiene

UniversitätsSpital Zürich
HAL 14
Rämistrasse 100
CH - 8091 Zürich

Tel. 044 / 255 37 76 direct
Tel. 044 / 255 57 30 Office
Mail: carlo.colombo@usz.ch

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