Book•
Prevention and Control of Nosocomial Infections
01 Jan 1997-
TL;DR: The role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support and protection from blood and blood products.
Abstract: Section 1 Perspectives: the control of infections in hospitals - 1750-1950 cost-effectiveness and cost-benefit analysis in infection control the modern infection control practitioner heath care reform and the hospital epidemiologist in the US. Section 2 Management: regulatory, accreditation, and professional agencies influencing infection control programs controversies in isolation policies and practices organizing for infection control with limited resources microbiology: the role of the clinical laboratory health psychology. Section 3 Epidemiology methods: surveillance, reporting and use of computers what to do about high endemic rates of infection epidemics: identification and management design and analytical issues in studies of infectious diseases statistics in infection control studies. Section 4 Special locations: outpatient/out of hospital care issues infection contra issues in same-day surgery extended care facilities. Section 5 Special problems: the threat of antibiotic resistance optimal use of antibiotics multidrug resistant enterococci and the threat of vancomycin-resistant staphylococcus aurous epidemiology of nosocomial tuberculosis. Section 6 Protecting employees: protecting employees from injury and infection management of exposures to infections. Section 7 Environmental issues: hospital environment for high-risk patients environment issues and nosocomial infections the operating theatre: a special environment area disinfection, sterilization and waste disposal the hospital and pollution: role of the hospital epidemiologist in protecting the environment laboratory-acquired infections infectious biohazards associated with laboratory animal research nosocomial infections related to patient care support. Section 8 Preventing specific infections: handwashing, hand disinfestation, and skin disinfestation nosocomial blood stream infections IV-related infections nosocomial pneumonia urinary tract infections surgical infections including burns perioperative antibiotic prophylaxis infection in implantable prosthetic devices nosocomial gastrointestinal infections uncommon infections of the eye prevention and control of nosocomial infections in obstetrics and gynaecology. Section 9 Special patients: infection in the newborn the paediatric patient the elderly solid-organ transplant patients bone marrow transplant patients the AIDS patient protecting recipients from blood and blood products.
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TL;DR: The guidelines for the prevention of surgical wound infections (SSI) were published by the Centers for Disease Control and Prevention (CDC) in 1999 as discussed by the authors, with the goal of reducing infectious complications associated with these procedures.
4,730 citations
TL;DR: The “Guideline for Prevention of Surgical Site Infection, 1999” presents the Centers for Disease Control and Prevention's recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections, and replaces previous guidelines.
Abstract: 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.
4,059 citations
TL;DR: Elimination of carriage of S. aureus has been found to reduce the infection rates in surgical patients and those on hemodialysis and CAPD, and those colonized with MRSA.
Abstract: Staphylococcus aureus has long been recognized as an important pathogen in human disease. Due to an increasing number of infections caused by methicillin-resistant S. aureus (MRSA) strains, therapy has become problematic. Therefore, prevention of staphylococcal infections has become more important. Carriage of S. aureus appears to play a key role in the epidemiology and pathogenesis of infection. The ecological niches of S. aureus are the anterior nares. In healthy subjects, over time, three patterns of carriage can be distinguished: about 20% of people are persistent carriers, 60% are intermittent carriers, and approximately 20% almost never carry S. aureus. The molecular basis of the carrier state remains to be elucidated. In patients who repeatedly puncture the skin (e.g., hemodialysis or continuous ambulatory peritoneal dialysis [CAPD] patients and intravenous drug addicts) and patients with human immunodeficiency virus (HIV) infection, increased carriage rates are found. Carriage has been identified as an important risk factor for infection in patients undergoing surgery, those on hemodialysis or CAPD, those with HIV infection and AIDS, those with intravascular devices, and those colonized with MRSA. Elimination of carriage has been found to reduce the infection rates in surgical patients and those on hemodialysis and CAPD. Elimination of carriage appears to be an attractive preventive strategy in patients at risk. Further studies are needed to optimize this strategy and to define the groups at risk.
2,637 citations
TL;DR: Pneumonias occurring in ventilated patients, especially those due to Pseudomonas or Acinetobacter species, are associated with considerable mortality in excess of that resulting from the underlying disease alone, and significantly prolong the length of stay in the intensive care unit.
1,151 citations
30 Dec 2005
TL;DR: The threat of MDR TB is decreasing, and the transmission of M. tuberculosis in health-care settings continues to decrease because of implementation of infection-control measures and reductions in community rates of TB.
Abstract: In 1994, CDC published the Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in HealthCare Facilities, 1994. The guidelines were issued in response to 1) a resurgence of tuberculosis (TB) disease that occurred in the United States in the mid-1980s and early 1990s, 2) the documentation of several high-profile health-care--associated (previously termed "nosocomial") outbreaks related to an increase in the prevalence of TB disease and human immunodeficiency virus (HIV) coinfection, 3) lapses in infection control practices, 4) delays in the diagnosis and treatment of persons with infectious TB disease, and 5) the appearance and transmission of multidrug-resistant (MDR) TB strains. The 1994 guidelines, which followed statements issued in 1982 and 1990, presented recommendations for TB infection control based on a risk assessment process that classified health-care facilities according to categories of TB risk, with a corresponding series of administrative, environmental, and respiratory protection control measures. The TB infection control measures recommended by CDC in 1994 were implemented widely in health-care facilities in the United States. The result has been a decrease in the number of TB outbreaks in health-care settings reported to CDC and a reduction in health-care-associated transmission of Mycobacterium tuberculosis to patients and health-care workers (HCWs). Concurrent with this success, mobilization of the nation's TB control programs succeeded in reversing the upsurge in reported cases of TB disease, and case rates have declined in the subsequent 10 years. Findings indicate that although the 2004 TB rate was the lowest recorded in the United States since national reporting began in 1953, the declines in rates for 2003 (2.3%) and 2004 (3.2%) were the smallest since 1993. In addition, TB infection rates greater than the U.S. average continue to be reported in certain racial/ethnic populations. The threat of MDR TB is decreasing, and the transmission of M. tuberculosis in health-care settings continues to decrease because of implementation of infection-control measures and reductions in community rates of TB. Given the changes in epidemiology and a request by the Advisory Council for the Elimination of Tuberculosis (ACET) for review and update of the 1994 TB infection control document, CDC has reassessed the TB infection control guidelines for health-care settings. This report updates TB control recommendations reflecting shifts in the epidemiology of TB, advances in scientific understanding, and changes in health-care practice that have occurred in the United States during the preceding decade. In the context of diminished risk for health-care-associated transmission of M. tuberculosis, this document places emphasis on actions to maintain momentum and expertise needed to avert another TB resurgence and to eliminate the lingering threat to HCWs, which is mainly from patients or others with unsuspected and undiagnosed infectious TB disease. CDC prepared the current guidelines in consultation with experts in TB, infection control, environmental control, respiratory protection, and occupational health. The new guidelines have been expanded to address a broader concept; health-care--associated settings go beyond the previously defined facilities. The term "health-care setting" includes many types, such as inpatient settings, outpatient settings, TB clinics, settings in correctional facilities in which health care is delivered, settings in which home-based health-care and emergency medical services are provided, and laboratories handling clinical specimens that might contain M. tuberculosis. The term "setting" has been chosen over the term "facility," used in the previous guidelines, to broaden the potential places for which these guidelines apply.
1,136 citations
References
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TL;DR: Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.
Abstract: To determine the cause of the acute urethral syndrome, we studied 59 women with dysuria and frequent urination without "significant bacteriuria" (defined as greater than or equal to 10(5) organisms per milliliter), 35 women with typical cystitis and 66 women with no symptoms of urinary-tract infection. Although none of the 59 women with urethral syndrome had greater than 3.4 x 10(4) bacteria per milliliter in either of two successive midstream urine specimens, samples of bladder urine obtained by suprapubic aspiration or catheterization from 24 women contained coliforms, and samples from three contained Staphylococcus saprophyticus; all but one of these 27 women also had pyuria. Of the 32 women with sterile bladder urine, 10 of 16 with pyuria and one of 16 without pyuria were infected with Chlamydia trachomatis (P = 0.002). Chlamydial infection was found in 11 of 42 women with urethral syndrome and pyuria, in three of 66 without symptoms, and in one of 35 with cystitis (P less than 0.01 when the group with urethral syndrome is compared with either of the other groups). Thus, 42 of 59 women with urethral syndrome had abnormal pyuria and 37 of these 42 were infected with coliforms, S. saprophyticus, or C. trachomatis, whereas few women without pyuria had demonstrable infection. Bacteriuria of greater than or equal to 10(5) per milliliter may be an insensitive diagnostic criterion when applied to symptomatic lower-urinary-tract infection.
441 citations
TL;DR: The economic consequences of nosocomial infection in three hospitals that differed in size, administrative characteristics and patients' economic status were influenced more by site of infection than by differences among hospitals, and their magnitude emphasizes the need for continued preventive efforts.
351 citations
Additional excerpts
...США, а продолжительность пребывания в больнице увеличивается приблизительно на 2 дня [1, 10, 11]....
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TL;DR: A prospective study of patients admitted to a hospital where there was endemic nosocomial infection with multidrug-resistant klebsiella was undertaken to evaluate the role of intestinal col...
Abstract: Excerpt A prospective study of patients admitted to a hospital where there was endemic nosocomial infection with multidrug-resistant klebsiella was undertaken to evaluate the role of intestinal col...
336 citations
TL;DR: The rate of disconnections of the junctions in the group given irrigation was almost twice that of the control group, which represents the result of two opposing phenomena: the increased entry of organisms and the suppression of a portion of them.
Abstract: To investigate the efficacy of antibiotic irrigation in preventing catheter-associated urinarytract infection, we carried out a randomized controlled trial of a neomycin-polymyxin irrigant administered through closed urinary catheters. Eighteen of 98 (18 per cent) of the patients not given irrigation became infected, as compared with 14 of 89 (16 per cent) of those given irrigation, yielding a mean daily incidence of 5 per cent in each group. The distribution of organisms and their antibiotic sensitivities differed in the two groups, the organisms from the patients with irrigation being more resistant. Disconnections of the catheter junctions were associated with high rates of infection. The rate of disconnections of the junctions in the group given irrigation was almost twice that of the control group because of the presence of the extra junction on overall infection rate represents the result of two opposing phenomena: the increased entry of organisms and the suppression of a portion of them.
285 citations
TL;DR: In this paper, randomized, controlled trials of two widely recommended regimens for meatal care were completed to evaluate the efficacy of daily cleansing of the urethral meatus-catheter junction in preventing bacteriuria during closed urinary drainage.
213 citations