Showing papers on "Nosocomial infection control published in 2003"

Comparison of Culture Screening Methods for Detection of Nasal Carriage of Methicillin-Resistant Staphylococcus aureus: a Prospective Study Comparing 32 Methods

Abstract: Screening for carriage of methicillin-resistant Staphylococcus aureus (MRSA) is fundamental to modern-day nosocomial infection control, both for epidemiologic investigation and day-to-day decisions on barrier isolation. Numerous microbiologic techniques have been advocated for screening for nasal carriage of MRSA, including the use of charcoal rather than rayon swabs, preincubation of swabs in Stuart's medium, preincubation of swabs in salt-containing trypticase soy broth (TSB), use of mannitol-salt agar (MSA), use of MSA containing oxacillin (MSA(Ox)), use of Mueller-Hinton agar containing oxacillin (MHA(Ox)), and the use of MSA containing lipovitellin with an oxacillin disk (MSAL(Ox)). We report a prospective clinical trial undertaken to test all of these methods concurrently. Patients at high risk for MRSA carriage were screened with eight consecutive nasal swabs (four standard rayon, four charcoal-coated rayon), which were processed by primary plating on MSA, MSA(Ox), MHA(Ox), and MSAL(Ox); Stuart's preincubation for 72 h followed by plating on the solid media; overnight enrichment in salt-containing TSB followed by plating; and Stuart's preincubation for 72 h followed by overnight enrichment in TSB and plating. All of the above methods were repeated with charcoal swabs. Each patient was screened by 32 culture methods. Forty-three (42%) of 102 patients studied were positive for MRSA by one or more methods. Among the four media evaluated with direct plating, MSAL(Ox) was 11 to 25% more sensitive for detecting MRSA (MSAL(Ox) versus MSA(Ox) or MHA(Ox) or MSA, each P < 0.01). Preincubation in Stuart's medium for 72 h did not enhance recovery of MRSA. Enrichment in salt-containing TSB further increased yield 9%. MSAL(Ox) also showed the best specificity, 93%. Charcoal swabs showed no advantage over standard rayon swabs. Our results suggest that the highest yield will be achieved by using standard rayon swabs that are enriched overnight in TSB with inoculation onto MSAL(Ox) medium. Direct inoculation of swabs onto MSAL(Ox) allows detection of 90% of MRSA carriers.

Comparison of the incidence and predicted risk of early surgical site infections after breast reduction.

Abstract: In plastic surgery, clean, elective operations such as breast reductions are anticipated to have low risk factors for infections (1.1-2.1%). To further lower or prevent surgical site infections (SSI), the efficacy of a prophylactic administration of anti-microbacterials remains a current controversial issue in plastic surgery. We report here the findings of a retrospective study in which we examined two groups of patients with breast reductions, one of which received a single-shot antimicrobacterial prophylaxis with cefuroxime preoperatively and the other who were given no anti-microbacterials. The aims were to determine the early SSI incidence of both groups, to classify breast reductions with respect to their inherent SSI risk by two widespread, combined risk scores, i.e., the National Nosocomial Infection Surveillance (NNIS) score and the Study on the Efficacy of Nosocomial Infection Control (SENIC) score, and to compare the actual SSI incidence to the predicted risk of the scores. In the divisions of plastic surgery at two hospitals, 153 patients (group I) and 136 patients (group II) could be included in the study in the 4-year period April 1997 to December 2001. Excluded were all patients with unilateral breast reduction or breast reconstruction and patients who were followed up less than 30 days postoperatively. The two groups were comparable with respect to demographic and clinical features such as age and risk factors, and there were no detectable significant intergroup differences in the general perioperative data. According to the NNIS and the SENIC scores, all operations were "clean," and the American Society of Anesthesiologists (ASA) score was 2 h," which is obviously an inherent risk factor in breast reductions. Among the multitude of patient and nonpatient SSI risk factors, in healthy women operation time was the only factor which could be clearly identified.

Surveillance of surgical site infections: Decade of experience at a Colombian tertiary care center

Abstract: A protocol for surveillance of surgical site infections (SSIs) was established in a tertiary care center in 1991 in Bogota, Colombia and followed for 10 years. Wounds were classified according to the Centers for Disease Control guidelines. The National Nosocomial Infection Surveillance and Study of the Efficacy of Nosocomial Infection Control scores for risk factors were included from June 1999. A total of 33,027 surgical procedures were followed by the surveillance team. The overall infection rate was 2.6%. Most surgical procedures (70.6%) were classified as clean; 25.3%, 3.8%, and 0.26% were classified as clean/contaminated, contaminated, and dirty, respectively. Infection rates according to wound classification were 1.28%, 3.9%, 15.4%, and 38.4% for clean, clean/contaminated, contaminated, and dirty procedures, respectively. Escherichia coli and coagulase-negative staphylococci were the most frequently isolated microorganisms from SSI: 23.9% and 22.8% of isolates, respectively. A program of surveillance of SSIs has been successfully implemented in a country with limited resources and has maintained the infection rate within international standards.

Aplicación de un programa de control de infecciones intrahospitalarias en establecimientos de salud de la región San Martín, Perú

Abstract: Objective: To set up a nosocomial infection control program (NICP) in order to change knowledge, attitudes and practices (KAP) of health care providers in health care facilities in San Martin-Peru, July 2000 - January 2001. Material and methods: Prospective intervention study. The prevalence of basal, intermediate and final nosocomial infections (NI) was determined, the investigation-action methodology (“learning by doing”) was used to assess changes in KAP of the target population. The staff of four health care facilities located in rural areas: Banda de Shilcayo Hospital (HABS), Nueva Cajamarca Hospital (HNC), Maternal Health Center of Tarapoto (CMP) and Lluyllucucha Health Center took place in the study. National standardized indicators were used. Results: Physicians participated in less proportion (62%) compared to nonmedical health workers (90%). Good practices regarding tools and hand-washing, use of gloves and clinical wardrobe and the management of blood and other fluids improved significantly (p 0.05). Conclusions: The implementation of a NI control program improved significantly the attitudes and practices of health care workers of health facilities located in rural areas in San Martin, Peru.

Cycling chemotherapy: a promising approach to reducing the morbidity and mortality of nosocomial infections.

Abstract: In the past several decades, nosocomial infections have emerged as one of the most serious contributors to hospital morbidity and mortality, particularly amongst patients who require intensive care Resistant organisms, both Gram-negative and Gram-positive, are now to blame for a significant portion of hospital-acquired infections Efforts to prevent nosocomial infection had historically focused on infection control measures, such as patient isolation However, there have been numerous reports of the increasing prevalence of antibiotic resistance (1), as well as the dramatic, negative impact of the infections they cause, both in terms of patient outcomes and attributable costs (2, 3), demanding new methods to halt this growing epidemic The increasing threat of resistance may be attributed in part to the widespread and increasingly inappropriate use of antimicrobials (4), which inadvertently exert sufficient effect on the hospital (and now community) environment to allow the preferential selection of resistant microbes This idea of selective antibiotic pressure is supported by data showing volume of antibiotic use and inadequate antimicrobial coverage as risk factors for increased morbidity and mortality (5, 6) Accordingly, the focus of nosocomial infection control has now largely shifted towards the judicious use of antibiotic therapy There have been numerous attempts to curtail antibiotic usage through various forms of antibiotic stewardship: formulary restriction (7-9), computerized decision-support (10, 11) and abbreviated course empiric therapy (12) Aside from the inherent difficulty of effecting change in physician practice, we are burdened, particularly in the setting of empiric therapy, with the need to balance between adequate therapy for the individual and prudent drug selection so as not to endanger other patients in the environment through resistant organism selection (13) Cycling chemotherapy for empiric treatment of suspected infection is a method uniquely designed to address these challenges

Epidemiological analysis on SARS clustered cases in Guangdong province

Abstract: Objective To understand the epidemiological characteristics and clinical manifestations of clustered SARS cases in Guangdong province.Methods Descriptive epidemiological method was used to analyze the data of clustered SARS cases collected with uniformed questionnaire.Results A total of 1511 cumulative SARS cases were reported by 6 June 2003 in 15 cities in Guangdong and 483 were clustered cases accounting for 31.9% of total cases. Of 483 clustered cases, 64.0% (309) in hospital and 36.0% (165 in families and 9 in public place) in community. The peak of cluster cases (onset date) appeared in the period of 1～20 February. There were 157 hospital clustered cases in this period. Total number of Hospital cases was 292, mainly in Guangzhou (259 ), Jiangmen (20 ), Zhongshan (13 ), altogether accounting for 94 5%(292/309). 81.16% of them aged 20～49. The mean incubation period of the cluster was 4.5 days (ranging 1～12). Clinical symptoms, fever (100%), dry cough (32.6%). Case fatality in 1st,2 nd,3 rd,and 4 th generation cases were 45.5%(10/22),3.77%(8/212),0(0/53) and 0(0/1) respectively. As far as epidemicity is concerned, 22 of 1st (22) and10 in 2nd (212) could forward transmission of infection.Conclusion The clustered SARS cases mainly occurred in the early stage of the outbreak and mainly in hospital HCWs.Health care worker nosocomial infection control is a critical point in the epidemic control.

Environmental and behavioral analysis on the nosocomial SARS among health care workers

Abstract: Objective To find environmental and behavioral factors related with nosocomial SARS in health care workers (HCWs) in hospital received SARS patients.Methods Field investigation on environmental and behavioral factors related with nosocomial SARS were carried out in 9 hospitals received SARS patients.Monovariate analysis and non conditional logistic regression were used to analyzed.Results HCWs SARS attack rates were different in 9 hospitals ranging from 0 to 24.6% ( χ 2=141.73, P 0.01). The attack rates were 7%～24.6% in 4 hospitals received SARS patients before January 23, whilst no infection was found in 3 hospitals received SARS patients after January 30. Overall arrangement is reasonable in zero infection hospitals. The factors entered into the model of non conditional logistic regression were: participating in the first aid ( OR =1.841), entering into contaminated area routinely ( OR =6.527), isolation clothes ( OR =0.634), shoe cover ( OR =0.554), glove ( OR =0.487), gargling ( OR =0.582), eye protector ( OR =0.393), anti virus medicine ( OR =0.290). The first 2 factors were protective and the last 6 factors were risk.Conclusion Staff education and infection surveillance, Hand washing, strict self protection, barrier precautions, Improve ventilation in wards, strict disinfection measures and nosocomial infection control are key measures for SARS infection control of HCWs in hospital.

Study on the Epidemiology and Nosocomial Infection Control Measures of SARS

Abstract: OBJECTIVE To study the epidemiological characteristics and nosocomial infection control measures of SARS. METHODS Definite SARS patients (inpatients and medical stuffs) were selected from a general hospital in March and April. Individual and environment survey were carried out by a standardized questionnaire of China CDC. Contact history with SARS patient, place and route of infection, method of protection were included in the survey. RESULTS (1)Epidemiological characteristics: There were two peaks of incidence (Mar 13th -16th and Mar 24th). Distributions: places were confined to Ward 4, 5, 6 on the 7, 8, 12, 13 and 14th floors in west unit of the inpatient building. Among the SARS cases, the inpatients were older and most had severe original diseases, and the medical staffs were younger juniors. (2)Source of transmission Index patients were the first generation source of transmission and the secondary attacked inpatients and medical staffs were the second generation. The latent infected persons who had close contact with SARS patients were also possible latent sources of transmission. (3)Route of transmission The major transmission routes were near space droplet infection and close contact infection. There was also a clue to the probability of aerosol or droplet nuclei infection through air condition and ventilation system. (4)Many measures such as control and isolation of the source of transmission, enforcing ventilation and disinfection of the ward area, stopping fresh air system, strengthen prevention of medical staffs were carried out and the hospital infection was under control eventually. CONCLUSIONS Hospital infection was the main epidemic form of SARS in the early stage. Hospital infection of SARS can be prevented and controlled by a series of the efficient measures.

SARS outbreak and control in hospital health care workers in Guangzhou

Abstract: Objective Exploring the determinants of SARS epidemic and evaluating the corresponding control strategies through analyzing the epidemic characteristics among the health care workers, in order to guide the SARS case management and infection control in the health care settings. Methods Health care workers contracted SARS were interviewed with the uniform questionnaires, and field investigations for infection control measures and the effects were carried in the hospitals. Results A cumulative total of 280 SARS cases (accounting for 26.07% of the total cases reported) in health care workers in 29 health care settings from 13 January to 5 May 2003 and 92.22% of 180 SARS cases were infected during care delivery. The outbreak peak was in the first 20 days in February with 167 cases. 73.2% of the cases were in 6 hospitals received SARS patient before the end of January. The number of SARS cases declined dramatically after 20 February because of adopting the strategies including hospital designated for case admission, improving ventilation in wards and strengthening individual self protection. Conclusion The key for SARS control in health care settings was: 1. Early case identification and isolation; 2. Strict self protection 3. Nosocomial infection control 4. Improve ventilation in wards; 5. Strict disinfection measures.