Guideline for Prevention of Surgical Site Infection, 1999 ☆ ☆☆ ★ ★★

The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention (CDC)'s recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections. This two-part guideline updates and replaces previous guidelines.Part I, “Surgical Site Infection: An Overview,” describes the epidemiology, definitions, microbiology, pathogenesis, and surveillance of SSIs. Included is a detailed discussion of the pre-, intra-, and postoperative issues relevant to SSI genesis.

/pdf/guideline-for-prevention-of-surgical-site-infection-1999-2k3en33kqw.pdf

Guideline for Prevention of Surgical Site Infection, 1999

https://www.cdc.gov/coronavirus/mers/downloads/Isolation2007.pdf

2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings.

Objective. —To determine the prevalence of intensive care unit (ICU)—acquired infections and the risk factors for these infections, identify the predominant infecting organisms, and evaluate the relationship between ICU-acquired infection and mortality. Design. —A 1-day point-prevalence study. Setting. —Intensive care units in 17 countries in Western Europe, excluding coronary care units and pediatric and special care infant units. Patients. —All patients (>10 years of age) occupying an ICU bed over a 24-hour period. A total of 1417 ICUs provided 10 038 patient case reports. Main Outcome Measures. —Rates of ICU-acquired infection, prescription of antimicrobials, resistance patterns of microbiological isolates, and potential risk factors for ICU-acquired infection and death. Results. —A total of 4501 patients (44.8%) were infected, and 2064 (20.6%) had ICU-acquired infection. Pneumonia (46.9%), lower respiratory tract infection (17.8%), urinary tract infection (17.6%), and bloodstream infection (12%) were the most frequent types of ICU infection reported. Most frequently reported microorganisms were Enterobacteriaceae (34.4%),Staphylococcus aureus(30.1%; [60% resistant to methicillin]),Pseudomonas aeruginosa(28.7%), coagulase-negative staphylococci (19.1%), and fungi (17.1%). Seven risk factors for ICU-acquired infection were identified: increasing length of ICU stay (>48 hours), mechanical ventilation, diagnosis of trauma, central venous, pulmonary artery, and urinary catheterization, and stress ulcer prophylaxis. ICU-acquired pneumonia (odds ratio [OR], 1.91; 95% confidence interval [CI], 1.6 to 2.29), clinical sepsis (OR, 3.50; 95% CI, 1.71 to 7.18), and bloodstream infection (OR, 1.73; 95% CI, 1.25 to 2.41) increased the risk of ICU death. Conclusions. —ICU-acquired infection is common and often associated with microbiological isolates of resistant organisms. The potential effects on outcome emphasize the importance of specific measures for infection control in critically ill patients. (JAMA. 1995;274:639-644)

The prevalence of nosocomial infection in intensive care units in Europe. Results of the European Prevalence of Infection in Intensive Care (EPIC) Study. EPIC International Advisory Committee.

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(10)61458-4.pdf

Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis

In a representative sample of US general hospitals, the authors found that the establishment of intensive infection surveillance and control programs was strongly associated with reductions in rates of nosocomial urinary tract infection, surgical wound infection, pneumonia, and bacteremia between 1970 and 1975-1976, after controlling for other characteristics of the hospitals and their patients. Essential components of effective programs included conducting organized surveillance and control activities and having a trained, effectual infection control physician, an infection control nurse per 250 beds, and a system for reporting infection rates to practicing surgeons. Programs with these components reduced their hospitals' infection rates by 32%. Since relatively few hospitals had very effective programs, however, only 6% of the nation's approximately 2 million nosocomial infections were being prevented in the mid-1970s, leaving another 26% to be prevented by universal adoption of these programs. Among hospitals without effective programs, the overall infection rate increased by 18% from 1970 to 1976.

The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.

Klebsiella pneumoniae causes serious epidemic and endemic nosocomial infections We conducted a literature review to characterize the epidemiology of epidemic K pneumoniae outbreaks Eighty percent of the outbreaks (20/25) involved infections of the bloodstream or urinary tract Person-to-person spread was the most common mode of transmission, and nearly 50% of the outbreaks occurred in neonatal intensive care units No one serotype predominated, and no association was found between serotype and either the site of infection or antimicrobial susceptibility pattern We used data reported to the Centers for Disease Control (CDC) by hospitals participating in the National Nosocomial Infections Study (NNIS) to describe the epidemiology of endemic K pneumoniae infections In the 8-year period from 1975 through 1982 the nosocomial K pneumoniae infection rate was 167 infections per 10,000 patients discharged The rate of infection at medical school-affiliated hospitals was significantly greater than at nonaffiliated hospitals; furthermore, the rate of infection at large affiliated hospitals was greater than at small affiliated hospitals The rate of infection varied by service, with the highest rate found on the medicine service During the 8-year period, 184 deaths were caused by nosocomial K pneumoniae infections (184 deaths/16,969 infections, case-fatality ratio 11%), with higher ratios in pediatrics (5%) where there was a 12% mortality in children infected with an aminoglycoside-resistant strain

Van P. Munn

Papers

The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals.

The Epidemiology of Nosocomial Infections Caused by Klebsiella pneumoniae