Editorial
In the Footsteps of the Gods: Janus Revisited and the Pursuit of Timeliness
- Suzanne F. Bradley
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- 02 January 2015, pp. 373-374
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Obituary
Elias Abrutyn, MD, MACP (1940–2007)
- Allan R. Tunkel, Marla J. Gold
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- 02 January 2015, pp. 375-376
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Original Article
Predicting Clostridium difficile Toxin in Hospitalized Patients With Antibiotic-Associated Diarrhea
- Nir Peled, Silvio Pitlik, Zmira Samra, Arkadi Kazakov, Yoram Bloch, Jihad Bishara
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- 02 January 2015, pp. 377-381
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Objective.
Clostridium difficile infection is implicated in 20%-30% of cases of antibiotic-associated diarrhea. Studying hospitalized patients who received antibiotic therapy and developed diarrhea, our objective was to compare the clinical characteristics of patients who developed C. difficile–associated diarrhea (CDAD) with those of patients with a negative result of a stool assay for C. difficile toxin.
Methods.A prospective study was done with a cohort of 217 hospitalized patients who had received antibiotics and developed diarrhea. Patients with CDAD were defined as patients who had diarrhea and a positive result for C. difficile toxin A/B by an enzyme immunoassay of stool. The variables that yielded a significant difference on univariate analysis between patients with a positive assay result and patients with a negative assay result were entered into a logistic regression model for prediction of C. difficile toxin.
Setting.A 900-bed tertiary care medical center.
Results.Of 217 patients, 52 (24%) had a positive result of assay for C. difficile toxin A/B in their stool. The logistic regression model included impaired functional capacity, watery diarrhea, use of a proton pump inhibitor, use of a histamine receptor blocker, leukocytosis, and hypoalbuminemia. The area under the receiver operating characteristic curve for the model as a predictor of a positive result for the stool toxin assay was 0.896 (95% confidence interval, 0.661-1.000; P<.001), with 95% specificity and 68% sensitivity.
Conclusions.Our results may help clinicians to predict the risk of CDAD in hospitalized patients with antibiotic-associated diarrhea, to guide careful, specific empirical therapy, and to direct early attention to infection control issues.
Predictive Factors for Pneumonia Onset After Cardiac Surgery in Rio de Janeiro, Brazil
- Marisa Santos, José Ueleres Braga, Renato Vieira Gomes, Guilherme L. Werneck
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- 02 January 2015, pp. 382-388
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Objective.
To develop a predictive system for the occurrence of nosocomial pneumonia in patients who had cardiac surgery performed.
Design.Retrospective cohort study.
Setting.Two cardiologic tertiary care hospitals in Rio de Janeiro, Brazil.
Patients.Between June 2000 and August 2002, there were 1,158 consecutive patients who had complex heart surgery performed. Patients older than 18 years who survived the first 48 postoperative hours were included in the study. The occurrence of pneumonia was diagnosed through active surveillance by an infectious diseases specialist according to the following criteria: the presence of new infiltrate on a radiograph in association with purulent sputum and either fever or leukocytosis until day 10 after cardiac surgery. Predictive models were built on the basis of logistic regression analysis and classification and regression tree (CART) analysis. The original data set was divided randomly into 2 parts, one used to construct the models (ie, “test sample”) and the other used for validation (ie, “validation sample”).
Results.The area under the receiver–operating characteristic (ROC) curve was 69% for the logistic regression model and 76% for the CART model. Considering a probability greater than 7% to be predictive of pneumonia for both models, sensitivity was higher for the logistic regression models, compared with the CART models (64% vs 56%). However, the CART models had a higher specificity (92% vs 70%) and global accuracy (90% vs 70%) than the logistic regression models. Both models showed good performance, based on the 2-graph ROC, considering that 84.6% and 84.3% of the predictions obtained by regression and CART analyses were regarded as valid.
Conclusion.Although our findings are preliminary, the predictive models we created showed fairly good specificity and fair sensitivity.
Pathogens in Early-Onset and Late-Onset Intensive Care Unit–Acquired Pneumonia
- K. M. C. Verhamme, W. De Coster, L. De Roo, H. De Beenhouwer, G. Nollet, J. Verbeke, I. Demeyer, P. Jordens
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- 02 January 2015, pp. 389-397
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Objectives.
To compare the type of pathogens isolated from patients with early-onset intensive care unit (ICU)-acquired pneumonia with those isolated from patients with late-onset ICU-acquired pneumonia and to study risk factors for the isolation of pathogens that are potentially resistant to multiple drugs.
Design.Prospective cohort study.
Setting.Patients admitted to the ICU of a 677-bed, university-affiliated teaching hospital in Belgium during 1997-2002.
Methods.ICU-acquired pneumonia was defined as a case of pneumonia that occurred 2 days or more after admission to the ICU in combination with a positive results of radiologic analysis, clinical signs and symptoms, and a positive culture result. All cases of pneumonia were categorized as either early onset (within 7 days after admission) and late onset (7 days or more after admission), with or without previous antibiotic treatment, and the corresponding pathogens were analyzed. Risk factors for the isolation of pathogens potentially resistant to multiple drugs (ie, Pseudomonas aeruginosa, Serratia marcescens, Enterobacter species, Morganella morganii, methicillin-resistant Stapylococcus aureus, Citrobacter species, Acinetobacter species, Burkholderia species, extended-spectrum β-lactamase–producing pathogens, and Stenotrophomonas maltophilia) were analyzed using logistic regression analysis.
Results.A total of 4,200 patients stayed at the ICU for 2 or more days, 298 of whom developed ICU-acquired pneumonia, for an overall incidence of 13 cases (95% confidence interval [CI], 11-14 cases) per 1,000 ICU-days. Pathogens potentially resistant to multiple drugs were isolated from 52% of patients with early-onset pneumonia. Risk factors for the isolation of these pathogens were greater age and previous receipt of antibiotic prophylaxis (adjusted odds ratio [aOR], 4.6 [95% CI, 1.6-13.0]) or antibiotic therapy (aOR, 8.2 [95% CI, 2.8-23.8]). The length of ICU admission and hospital stay were weaker risk factors for the isolation of these pathogens.
Conclusions.Pathogens potentially resistant to multiple drugs were isolated in 52% of cases of early-onset ICU-acquired pneumonia. Previous antibiotic use (both prophylactic and therapeutic) is the main risk factor for the isolation of these pathogens.
Risk Adjustment for Surgical Site Infection After Median Sternotomy in Children
- Jessica Kagen, Warren B. Bilker, Ebbing Lautenbach, Louis M. Bell, Susan E. Coffin, Keith H. St. John, Eva Teszner, Troy Dominguez, J. William Gaynor, Samir S. Shah
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- 02 January 2015, pp. 398-405
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Objective.
To determine whether the National Nosocomial Infections Surveillance (NNIS) System risk index adequately stratified a population of pediatric patients undergoing cardiac surgery according to the risk of developing surgical site infection (SSI).
Design.A retrospective, case-control study.
Setting.An urban tertiary care children's hospital.
Patients.Patients who had a median sternotomy performed between January 1,1995, and December 31, 2003, were eligible for inclusion in the study. For all case patients, medical records were reviewed to verify that all patients met the case definition for SSI. Control subjects were chosen randomly from among all patients who underwent median sternotomy during the study period who did not develop SSI.
Results.Thirty-eight patients with SSI and 172 patients without SSI were included. One hundred six patients (50%) were male. The median patient age was 4 months. The sensitivity of the NNIS risk index with cutoff scores of 0 to 1 and 2 to 3 was 20%. The distribution of patients with SSI for an NNIS risk index score of 0 was 0%; for a score of 1, 80%; for a score of 2, 20%; and for a score of 3, 0%. The distribution of patients without SSI for a scores of 0 was 4%; for a score of 1, 87%; for a score of 2, 9%; and for a score of 3, 0%. The area under the receiver-operating characteristic curve (AUC) of the original NNIS risk index was 0.57. The modified risk indices did not perform significantly better, with an AUC range of 0.58 to 0.73.
Conclusions.The NNIS risk index did not adequately stratify pediatric patients undergoing median sternotomy according to their risk of developing an SSI. Various modifications to the risk index yielded only slightly higher AUC values.
Risk Factors for Neonatal Methicillin-Resistant Staphylococcus aureus Infection in a Well-Infant Nursery
- Dao M. Nguyen, Elizabeth Bancroft, Laurene Mascola, Ramon Guevara, Lori Yasuda
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- 02 January 2015, pp. 406-411
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Objective.
To determine risk factors for neonatal methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection in a well-infant nursery.
Design.Case-control studies.
Setting.A well-infant nursery in a nonteaching, community hospital.
Methods.Case infants were newborns in the nursery who were born in the period November 2003 through June 2004 and had onset of MRSA skin and soft-tissue infection within 21 days after discharge from the nursery. Site inspections were conducted. Control infants were randomly selected male infants in the nursery during the outbreak periods. MRSA isolates were characterized with pulsed-field gel electrophoresis.
Results.Eleven case infants were identified in 2 outbreaks: outbreak 1 occurred from November 18 through December 24, 2003, and outbreak 2 occurred from May 26 through June 5, 2004. All were full-term male infants with pustular-vesicular lesions in the groin. Inspection revealed uncovered circumcision equipment, multiple-dose lidocaine vials, and inadequate hand hygiene practices. In outbreak 1, case infants (n = 6) had a significantly higher mean length of stay than control infants (3.7 vs 2.5 days; P = .01). In outbreak 2, case infants (n = 5) were more likely to have been circumcised in the nursery (OR, undefined [95% CI, 1.7 to undefined]) and to have received lidocaine injections (OR, undefined [95% CI, 2.6 to undefined]). Controlling for length of stay, case infants were more likely to have been circumcised in the nursery (OR, 12.2 [95% CI, 1.5 to undefined]). Pulsed-field gel electrophoresis showed that 7 available isolates were indistinguishable from a community-associated MRSA strain (USA300-0114).
Conclusions.Newborns in well-infant nurseries are at risk for nosocomial infection with community-associated MRSA strains. Reducing length of stay, improving circumcision and hand hygiene practices, and eliminating use of multiple-dose lidocaine vials should decrease transmission of community-associated MRSA strains in nurseries.
Resource Consumption in the Infection Control Management of Pertussis Exposure Among Healthcare Workers in Pediatrics
- Irini Daskalaki, Patricia Hennessey, Robin Hubler, Sarah S. Long
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- 02 January 2015, pp. 412-417
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Objective.
To assess consumption of resources in the infection control management of healthcare workers (HCWs) exposed to pertussis and to assess avoidability of exposure.
Setting.Tertiary care children's medical center.
Methods.Analysis of the extent of and reasons for HCW exposure to pertussis during contact with children with the disease, whether exposures were avoidable (because of the failure to recognize a case or to order or adhere to isolation precautions) or unavoidable (because the case was not recognizable or because another diagnosis was confirmed), and the cost of implementing exposure management.
Interventions.Interventions consisted of an investigation of every HCW encounter with any patient who was confirmed later to have pertussis from the time of hospital admission of the patient, use of azithromycin as postexposure prophylaxis (PEP) for exposed HCWs, performance of 21-day surveillance for cough illness, testing of symptomatic exposed HCWs for Bordetella pertussis, and enhanced preexposure education of HCWs.
Results.From September 2003 through April 2005, pertussis was confirmed in 28 patients (median age, 62 days); 24 patients were admitted. For 11 patients, pertussis was suspected, appropriate precautions were taken, and no HCW was exposed. Inadequate precautions for 17 patients led to 355 HCW exposures. The median number of HCWs exposed per exposing patient was 9 (range, 1-86 HCWs; first quartile mean, 2; fourth quartile mean, 61). Exposure was definitely avoidable for only 61 (17%) of 355 HCWs and was probably unavoidable for 294 HCWs (83%). The cost of 20-month infection control management of HCWs exposed to pertussis was $69,770. The entire cohort of HCWs involved in direct patient care at the facility could be immunized for approximately $60,000.
Conclusions.Exposure of HCWs to pertussis during contact with children who have the disease is largely unavoidable, and management of this exposure is resource intensive. Universal preexposure vaccination of HCWs is a better utilization of resources than is case-based postexposure management.
Nosocomial Bacteremia in Children: A 15-Year Experience at a General Hospital in Mexico
- Luis Fernando Pérez-González, Juana María Ruiz-González, Daniel E. Noyola
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- 02 January 2015, pp. 418-422
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Objective.
To describe the incidence and etiology of nosocomial bloodstream infections in children at a general hospital.
Design.Review of nosocomial bloodstream infections detected in children during 1991-2005. Data were prospectively gathered through active surveillance. Annual rates of infection were compared.
Setting.A public general hospital in San Luis Potosi, Mexico.
Patients.Children younger than 15 years of age admitted to pediatric wards and subjected to prospective surveillance for nosocomial infection.
Interventions.Measures instituted to decrease the incidence of hospital-acquired infection during the 15-year study period included establishing active surveillance for hospital-acquired infection, reinforcing compliance with handwashing recommendations, decreasing the degree of crowding on wards, establishing guidelines for the management of intravenous catheters and solutions, preparing parenteral nutrition and intravenous solutions under a laminar air-flow hood, and increasing nursing personnel.
Results.There were 868 nosocomial bloodstream infections detected in 29,273 subjects (overall rate, 2.94 episodes per 100 discharges). Infection rates were greatest among children admitted to the neonatal intensive care unit and lowest for those admitted to the school-age ward and the infectious diseases ward. There was a significant decrease in rates of nosocomial bacteremia in all of the wards. The organisms isolated most commonly were Klebsiella pneumoniae, Candida species, and coagulase-negative staphylococci. Mortality rates were higher for children with a gram-negative bacterial bloodstream infection (45.2%) and lower for children with a gram-positive bacterial infection (19.2%).
Conclusions.Rates of nosocomial bloodstream infection decreased over the past 15 years at our hospital but continue to cause significant mortality. Continuing efforts to decrease the frequency of and mortality due to bloodstream infection are warranted.
Control of an Outbreak of Pandrug-Resistant Acinetobacter baumannii Colonization and Infection in a Neonatal Intensive Care Unit
- Pei-Chun Chan, Li-Min Huang, Hui-Chi Lin, Luan-Yin Chang, Mei-Ling Chen, Chun-Yi Lu, Ping-Ing Lee, Jung-Min Chen, Chin-Yun Lee, Hui-Jui Pan, Jann-Tay Wang, Shan-Chwen Chang, Yee-Chun Chen
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- 02 January 2015, pp. 423-429
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Objective.
To investigate the potential reservoir and mode of transmission of pandrug-resistant (PDR) Acinetobacter baumannii in a 7-day-old neonate who developed PDR A. baumannii bacteremia that was presumed to be the iceberg of a potential outbreak.
Design.Outbreak investigation based on a program of prospective hospital-wide surveillance for nosocomial infection.
Setting.A 24-bed neonatal intensive care unit in a 2,200-bed major teaching hospital in Taiwan that provides care for critically ill neonates born in this hospital and those transferred from other hospitals.
Interventions.Samples from 33 healthcare workers' hands and 40 samples from the environment were cultured. Surveillance cultures of anal swab specimens and sputum samples were performed for neonates on admission to the neonatal intensive care unit and every 2 weeks until discharge. The PDR A. baumannii isolates, defined as isolates resistant to all currently available systemic antimicrobials except polymyxin B, were analyzed by pulsed-field gel electrophoresis. Control measures consisted of implementing contact isolation, reinforcing hand hygiene adherence, cohorting of nurses, and environmental cleaning.
Results.One culture of an environmental sample and no cultures of samples from healthcare workers' hands grew PDR A. baumannii. The positive culture result involved a sample obtained from a ventilation tube used by the index patient. During the following 2 months, active surveillance identified PDR A. baumannii in 8 additional neonates, and isolates from 7 had the same electrokaryotype. Of the 9 neonates colonized or infected with PDR A. baumannii, 1 died from an unrelated condition. Reinforcement of infection control measures resulted in 100% adherence to proper hand hygiene protocol. The outbreak was stopped without compromising patient care.
Conclusions.In the absence of environmental contamination, transient hand carriage by personnel who cared for neonates colonized or infected with PDR A. baumannii was suspected to be the mode of transmission. Vigilance, prompt intervention and strict adherence to hand hygiene protocol were the key factors that led to the successful control of this outbreak. Active surveillance appears to be an effective measure to identify potential transmitters and reservoirs of PDR A. baumannii.
Outbreak of Varicella-Zoster Virus Infection Among Thai Healthcare Workers
- Anucha Apisarnthanarak, Rungrueng Kitphati, Pranee Tawatsupha, Kanokporn Thongphubeth, Piyaporn Apisarnthanarak, Linda M. Mundy
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- 02 January 2015, pp. 430-434
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Objective.
To evaluate the correlation between self-report of a prior history of chickenpox and results of varicella-zoster virus (VZV) immunoglobulin (Ig) G serologic test results in an outbreak of VZV infection among Thai healthcare workers (HCWs) and to conduct a cost-benefit analysis of establishing routine VZV immunization as part of an occupational health program on the basis of the outbreak data.
Methods.All exposed patients received prophylaxis and the HCWs in our 3 intensive care units (ICUs) were prospectively evaluated. HCWs were assessed for disease history and serologic evidence of VZV IgG. A cost-benefit analysis was performed.
Results.After 140 HCWs and 18 ICU patients were exposed to VZV, 10 HCWs (7%) with active VZV infection were relieved from work until skin lesions were crusted. Acyclovir (ACV) was prescribed to all 10 HCWs with active disease, and all 18 exposed patients received prophylaxis with ACV. Of 140 HCWs, 100 consented to longitudinal follow-up. Twenty-three (100%) of the HCWs who reported a history of chickenpox also had serologic test results that were postive for VZV IgG, compared with 30 (39%) of 77 HCWs who reported no prior history of chickenpox, yet had test results that were positive for VZV IgG. Reported history of chickenpox had a sensitivity of 43%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 61% with respect to VZV infection immunity. The total cost estimate for this outbreak investigation was $23,087.
Conclusions.An HCWs reported history of chickenpox was a reliable predictor of immunity; a report of no prior history of chickenpox was unreliable. Our cost-benefit analysis suggests that the costs of an occupational health program that included VZV surveillance and immunization for the next 323 HCWs would be approximately equal to the excess costs of $17,227 for the ACV therapy, HCW furloughs, and staff overtime associated with this outbreak.
Development and Application of Evaluation Indices for Hospital Infection Surveillance and Control Programs in the Republic of Korea
- Hyang Soon Oh, Hae Won Cheong, Seung Eun Yi, Ho Kim, Kang Won Choe, Sung Il Cho
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- 02 January 2015, pp. 435-445
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Objective.
To develop new evaluation indices of infection control and to use them to evaluate Korean infection surveillance and control programs (ISCPs).
Design.We performed a questionnaire-based survey to 164 acute care general hospitals throughout the Republic of Korea that had more than 300 beds. Study methods were based completely on those of the Study on the Efficacy of Nosocomial Infection Control (SENIC). Four SENIC indices (hospital epidemiologist index, infection control nurse index, surveillance index, and control index) and 4 newly developed indices (healthcare worker index, quality improvement index, resource index, and hand hygiene facilities index) were used to evaluate Korean ISCPs. Data were collected by questionnaire from June 17 to October 11, 2003.
Setting.One hundred sixty-four general hospitals with more than 300 beds in the Republic of Korea.
Results.Personnel from 85 general hospitals responded to the study questionnaire. The reliability and validity of the evaluation indices were statistically significant (P<.05). The 8 evaluation indices were categorized into 2 factor groups: personnel factors (hospital epidemiologist index and infection control nurse index) and activity factors (the remaining 6 indices). Korean ISCPs showed a major weakness in surveillance. The scores for the newly developed evaluation indices were better than those for the SENIC evaluation indices. However, most Korean hospitals were estimated to have had only slight reductions in nosocomial infection rates. The evaluation indices were influenced significantly by the number of beds in the hospital, whether the hospital was located in the Seoul-Gyonggi region, the presence of full-time infection control nurses at the hospital, the education level of the infection control nurses, and the nurses' experience in infection control (P<.05).
Conclusions.The reliability and validity of the SENIC evaluation indices and the newly developed evaluation indices were satisfactory in evaluating Korean ISCPs. However, surveillance should be improved to increase the efficacy of Korean ISCPs.
Development of a Surveillance System for Methicillin-Resistant Staphylococcus aureus in German Hospitals
- Iris F. Chaberny, Dorit Sohr, Henning Rüden, Petra Gastmeier
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- 02 January 2015, pp. 446-452
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Objective.
To determine the appropriate method to calculate the rate of methicillin-resistant Staphylococcus aureus (MRSA) infection and colonization (hereafter, MRSA rates) for interhospital comparisons, such that the large number of patients who are already MRSA positive on admission is taken into account.
Design.A prospective, multicenter, hospital-based surveillance of MRSA-positive case patients from January through December 2004.
Setting.Data from 31 hospitals participating in the German national nosocomial infections surveillance system (KISS) were recorded during routine surveillance by the infection control team at each hospital.
Results.Data for 4,215 MRSA-positive case patients were evaluated. From this data, the following values were calculated. The median incidence density was 0.71 MRSA-positive case patients per 1,000 patient-days, and the median nosocomial incidence density was 0.27 patients with nosocomial MRSA infection or colonization per 1,000 patient-days (95% CI, 0.18-0.34). The median average daily MRSA burden was 1.13 MRSA patient-days per 100 patient-days (95% CI, 0.86-1.51), with the average daily MRSA burden defined as the total number of MRSA patient-days divided by the total number of patient-days times 100. The median MRSA-days–associated nosocomial MRSA infection and colonization rate, which describes the MRSA infection risk for other patients in hospitals housing large numbers of MRSA-positive patients and/or many patients who were MRSA positive on admission, was 23.1 cases of nosocomial MRSA infection and colonization per 1,000 MRSA patient-days (95% CI, 17.4-28.6). The values were also calculated for various MRSA screening levels.
Conclusions.The MRSA-days–associated nosocomial MRSA rate allows investigators to assess the extent of MRSA colonization and infection at each hospital, taking into account cases that have been imported from other hospitals, as well as from the community. This information provides an appropriate incentive for hospitals to introduce further infection control measures.
Usefulness of Severity-of-Illness Scores Based on Admission Data Only in Nosocomial Infection Surveillance Systems
- Petra Gastmeier, Karin Menzel, Dorit Sohr, Henning Rüden
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- 02 January 2015, pp. 453-458
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Background.
Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).
Objective.To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.
Methods.This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI.
Results.During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction.
Conclusion.The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.
Prevalence of Hospital-Acquired Infections During Successive Surveillance Surveys Conducted at a University Hospital in The Netherlands
- T. E. M. Hopmans, H. E. M. Blok, A. Troelstra, M. J. M. Bonten
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- 02 January 2015, pp. 459-465
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Objective.
To monitor hospital-wide trends in the prevalence of hospital-acquired infections (HAIs) in order to identify areas where the risk of infection is increasing.
Methods.Successive surveillance surveys were conducted twice yearly, from November 2001 until May 2004, to determine the prevalence of HAIs at 2 Dutch hospitals, using Centers for Disease Control and Prevention criteria.
Results.In all, 340 HAIs were observed in 295 (11.1%) of 2,661 patients surveyed. The overall prevalence per survey varied from 10.2% to 15.6%, with no significant differences between successive surveys. In the surgical department, the prevalence of HAIs increased from 10.8 cases per 100 surgeries in November 2001 to 20.4 cases per 100 surgeries in May 2002. Further analysis revealed a high prevalence of surgical site infection among patients who had an orthopedic procedure performed. In the neurology-neurosurgery department, the prevalence increased from 13.0 cases per 100 patients in May 2002 to 26.6 cases per 100 patients in May 2003 and involved several types of infection. Further analysis retrieved exceptionally high incidences of infections associated with cerebrospinal fluid drainage. Specific infection control interventions were developed and implemented in both departments. The total cost of the surveys was estimated to be €9,100 per year.
Conclusion.Successive performance of surveillance surveys is a simple and cheap method to monitor the prevalence of infection throughout the hospital and appeared instrumental in identifying 2 departments with increased infection rates.
Risk Factors for Death Due to Nosocomial Infection in Intensive Care Unit Patients: Findings From the Krankenhaus Infektions Surveillance System
- P. Gastmeier, D. Sohr, C. Geffers, M. Behnke, H. Rüden
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- 02 January 2015, pp. 466-472
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Objective.
To determine risk factors for death among patients with nosocomial pneumonia and patients with primary bloodstream infections (BSI) in intensive care units (ICUs).
Design.Prospective cohort study.
Setting.Data collected from January 1997 through June 2003 from ICUs registered with the Krankenhaus Infektions Surveillance System in Germany.
Patients.A total of 8,432 patients with nosocomial pneumonia from 202 ICUs and 2,759 patients with nosocomial primary BSI from 190 ICUs.
Methods.The following risk factors were considered in the analysis: age, sex, time in the ICU before onset of infection, type of ICU, type and size of hospital, intubation, central venous catheter use, total parenteral nutrition, and type of pathogen.
Results.A total of 750 patients (8.9%) with nosocomial pneumonia and 302 patients (10.9%) with nosocomial primary BSI died. Multiple logistic regression analysis identified treatment in a medical or surgical ICU (odds ratio [OR], 1.55 [95% confidence interval {CI}, 1.32-1.82]) or a hospital with more than 1,000 beds (OR, 2.14 [95% CI, 1.81-2.56]), age older than 65 years (OR, 1.54 [95% CI, 1.31-1.81]), and infection with methicillin-resistant Staphylococcus aureus (OR, 2.39 [95% CI, 1.81-3.12]) or multidrug-resistant Pseudomonas aeruginosa (OR, 3.00 [95% CI, 1.90-4.63]) as independent determinants of death from nosocomial pneumonia. Age older than the median of 63 years (OR, 1.44 [95% CI, 1.12-1.86]) and methicillin-resistant S. aureus as the causative agent (OR, 2.98 [95% CI, 1.81-5.82]) were both associated with increased mortality from primary BSI. The types of infecting pathogens, particularly those resistant to multiple drugs, were also strong outcome predictors among ICU patients.
Conclusions.The study results underline the need for further investigations of the role of antimicrobial resistance in the outcome of patients with nosocomial pneumonia and patients with primary BSI.
Sharp-Device Injuries to Hospital Staff Nurses in 4 Countries
- Sean P. Clarke, Maria Schubert, Thorsten Körner
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- 02 January 2015, pp. 473-478
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Objective.
To compare sharp-device injury rates among hospital staff nurses in 4 Western countries.
Design.Cross-sectional survey.
Setting.Acute-care hospital nurses in the United States (Pennsylvania), Canada (Alberta, British Columbia, and Ontario), the United Kingdom (England and Scotland), and Germany.
Participants.A total of 34,318 acute-care hospital staff nurses in 1998-1999.
Results.Survey-based rates of retrospectively-reported needlestick injuries in the previous year for medical-surgical unit nurses ranged from 146 injuries per 1,000 full-time equivalent positions (FTEs) in the US sample to 488 injuries per 1,000 FTEs in Germany. In the United States and Canada, very high rates of sharp-device injury among nurses working in the operating room and/or perioperative care were observed (255 and 569 injuries per 1,000 FTEs per year, respectively). Reported use of safety-engineered sharp devices was considerably lower in Germany and Canada than it was in the United States. Some variation in injury rates was seen across nursing specialties among North American nurses, mostly in line with the frequency of risky procedures in the nurses' work.
Conclusions.Studies conducted in the United States over the past 15 years suggest that the rates of sharp-device injuries to front-line nurses have fallen over the past decade, probably at least in part because of increased awareness and adoption of safer technologies, suggesting that regulatory strategies have improved nurse safety. The much higher injury rate in Germany may be due to slow adoption of safety devices. Wider diffusion of safer technologies, as well as introduction and stronger enforcement of occupational safety and health regulations, are likely to decrease sharp-device injury rates in various countries even further.
Concise Communication
Risk Factors and Outcomes of Influenza A (H3N2) Pneumonia in an Area Where Avian Influenza (H5N1) Is Endemic
- Anucha Apisarnthanarak, Pilaipan Puthavathana, Linda M. Mundy
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- 02 January 2015, pp. 479-482
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We conducted a cohort study to identify the risks and outcomes of influenza A (H3N2) pneumonia. Of the 145 patients studied, 10 (7%) had influenza A pneumonia. Logistic regression identified multiple comorbidities (P<.001) and diarrhea at the initial presentation (P = .001) as associated risks. Infection with influenza A (P = .01) and receipt of inadequate antimicrobial therapy (P = .005) were predictors of mortality.
A Case of Healthcare-Associated, Multidrug-Resistant Tuberculosis in Austria: Reconsidering the Value of Cohorting of Patients with Culture-Positive Tuberculosis
- Alexander Indra, Barbara Robl, Ingrid Aumüller, Eva Magnet, Stefan Meusburger, Franz Allerberger
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- Published online by Cambridge University Press:
- 02 January 2015, pp. 483-485
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Cohorting of patients with culture-positive tuberculosis is still widely practiced in Austria, a country where approximately 1% of Mycobacterium tuberculosis isolates are multidrug resistant. Cohorting of patients with tuberculosis prior to determination of drug susceptibility is unacceptable because M. tuberculosis superinfection can occur.
Quality of Data Reported to a Smaller-Hospital Pilot Surveillance Program
- Noleen J. Bennett, Ann L. Bull, David R. Dunt, Michael J. Richards, Philip L. Russo, Denis W. Spelman
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- Published online by Cambridge University Press:
- 02 January 2015, pp. 486-488
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This data quality study assessed the accuracy of data collected as part of a pilot smaller-hospital surveillance program for methicillin-resistant Staphylococcus aureus (MRSA) infection and bloodstream infection (BSI). For reported MRSA infection, estimated values were as follows: sensitivity, 40%; specificity, 99.9%; and positive predictive value, 33.3%. For reported BSI, estimated values were as follows: sensitivity, 42.9%; specificity, 99.8%; and positive predictive value, 37.5%.