Showing papers on "Nosocomial infection control published in 2019"

Characterization of the clonal profile of methicillin resistant Staphylococcus aureus isolated from patients with early post-operative orthopedic implant based infections.

Abstract: To analyze the molecular epidemiology and to compare between the major methicillin resistant Staphylococcus aureus biotypes for association with patient characteristics who had an implant for closed fracture and developed early post-operative wound infections (POWI) in a tertiary care hospital of India. Pulsed-field gel electrophoresis (PFGE), antimicrobial resistance, accessory gene regulator (agr) and staphylococcal cassette chromosome mec (SCCmec) types, Paton–Valentine leukocidin (PVL) gene, toxin gene profiling, biofilm formation and patient demographics were correlated with MLST clonal complexes (CC). Overall eight different sequence types (STs) were detected with a predominance of ST239 (66%), ST22 (18%) and some minor types ST772, ST30 (4% each) ST1, ST642, ST6, ST107 (2% each). All ST239 isolates belong to CC239 and SCCmec III whereas ST22 isolates belong to CC22 and SCCmec IV. The isolates varied in the distribution of various toxin genes. With 63.63% biofilm formers ST239 were all multidrug resistant with frequent resistance to erythromycin, clindamycin, gentamicin, cefuroxime, amoxyclav and ciprofloxacin indicating doxycycline, amikacin, vancomycin and linezolid can be the drug of choice. This study shows that ST239 MRSA is still most prevalent strain with new emergence of ST642 and ST107 isolates in association with orthopedic implant based POWI. As compare to other ST types ST239 strain was associated with adverse treatment outcomes. This highlights the importance of improving nosocomial infection control measures in this unit.

Risk Factors And Clinical Outcomes Of Hospital-Acquired MRSA Infections In Chongqing, China.

Abstract: Background Methicillin-resistant Staphylococcus aureus (MRSA) is a common pathogen of hospital infection with multi-drug resistant characteristics. Its spread and epidemic pose great challenges to nosocomial infection control. This study was aimed to identify risk factors for hospital-acquired MRSA (HA-MRSA) infections and investigate its clinical outcome, developing infection control strategies and improving patient outcomes. Methods A retrospective case-case-control study was conducted to compare patients in Southwest Hospital, Chongqing, People's Republic of China from January 2018 to December 2018 with control patients. In this study, 251 patients with MRSA nosocomial infection, 339 patients with methicillin-sensitive Staphylococcus aureus strains (MSSA) nosocomial infection, and 300 patients with non-Staphylococcus aureus infection were included. Results Multivariate analysis showed that presence of central venous catheters (odds ratio [OR], 1.932; 95% confidence interval [CI], 1.074-3.477; P=0.028), sputum suction (OR, 2.887; 95% CI, 1.591-5.240; p<0.001), and total hospital stays more than 30 days (OR, 3.067; 95% CI, 2.063-4.559; P<0.001) were independent risk factors for HA-MRSA. Renal insufficiency (OR, 2.744; 95% CI, 1.089-6.914; P=0.032) and receipt of immunosuppressors (OR, 3.140; 95% CI, 1.284-7.678; P=0.012) were independent predictors of poor prognosis of MRSA nosocomial infection. Moreover, empirical use of antibiotics (OR, 0.514; 95% CI, 0.282-0.935; P=0.029) was a protective factor for poor prognosis of MRSA nosocomial infection. In-hospital mortality in the MRSA group was not statistically significant compared with the other two groups; however, the rate of poor prognosis in the MRSA group was higher than that of the MSSA group (27.5% vs 17.1%, χ2=9.200, P=0.002) and the control group (27.5% vs 16.0%, χ2=19.190, P=0.001). Conclusion Our results have shown presence of central venous catheters, sputum suction, and total hospital stays more than 30 days were associated with nosocomial MRSA infection. Patients with renal insufficiency and immunosuppressive therapy were more likely to cause poor prognosis with MRSA infection, and the empirical use of antibiotics can effectively reduce the adverse clinical outcomes caused by MRSA infection. Based on above findings, strategies to control MRSA infection should emphasize more attention to these patients and appropriate empirical use of antibiotics.

2CS-CHXT Operon Signature of Chlorhexidine Tolerance among Enterococcus faecium Isolates

Abstract: Chlorhexidine (CHX) is a broad-spectrum antiseptic widely used in community and clinical contexts for many years that has recently acquired higher relevance in nosocomial infection control worldwide. Despite this, CHX tolerance among Enterococcus faecium bacteria, representing one of the leading agents causing nosocomial infections, has been poorly understood. This study provides new phenotypic and molecular data for better identification of CHX-tolerant E. faecium subpopulations in community and clinical contexts. The chlorhexidine MIC (MICCHX) distribution of 106 E. faecium isolates suggested the occurrence of tolerant subpopulations in diverse sources (human, animal, food, environment) and phylogenomic backgrounds (clades A1/A2/B), with predominance in clade A1. They carried a specific variant of the 2CS-CHXT operon, identified here. It encodes glucose and amino acid-polyamine-organocation family transporters, besides the DNA-binding response regulator ChtR, with a P102H mutation previously described only in CHX-tolerant clade A1 E. faecium, and the ChtS sensor. 2CS-CHXT seems to be associated with three regulons modulating diverse bacterial biological functions. Combined data from normal MIC distribution and 2CS-CHXT operon characterization support a tentative epidemiological cutoff (ECOFF) of 8 mg/liter to CHX, which is useful to detect tolerant E. faecium populations in future surveillance studies. The spread of tolerant E. faecium in diverse epidemiological backgrounds calls for the prudent use of CHX in multiple contexts. IMPORTANCE Chlorhexidine is one of the substances included in the World Health Organization’s list of essential medicines, which comprises the safest and most effective medicines needed in global health systems. Although it has been widely applied as a disinfectant and antiseptic in health care (skin, hands, mouthwashes, eye drops) since the 1950s, its use in hospitals to prevent nosocomial infections has increased worldwide in recent years. Here, we provide a comprehensive study on chlorhexidine tolerance among strains of Enterococcus faecium, one of the leading nosocomial agents worldwide, and identify a novel 2CS-CHXT operon as a signature of tolerant strains occurring in diverse phylogenomic groups. Our data allowed for the proposal of a tentative epidemiological cutoff of 8 mg/liter, which is useful to detect tolerant E. faecium populations in surveillance studies in community and clinical contexts. The prediction of 2CS-CHXT regulons will also facilitate the design of future experimental studies to better uncover chlorhexidine tolerance among E. faecium bacteria.

Randomized community trial on nosocomial infection control educational module for nurses in public hospitals in Yemen: a study protocol

Abstract: Nosocomial infections remain a global health problem and they are considered as one of the leading causes of increased morbidity and mortality. In-service training courses related to infection control measures can help nurses to make informed and therapeutic decisions which could prevent or reduce the incidence of nosocomial infections. This study protocol is of a hospital-based trial to develop, implement and evaluate an educational module on nosocomial infection control among nurses in public hospitals in Yemen. This study is currently ongoing and at the analysis stage. A three-arm single-blinded randomized community hospital-based trial was conducted to evaluate the effectiveness of a newly developed nosocomial infection control educational module among nurses in public hospitals in Yemen. To ensure effective delivery and acquisition of knowledge, the Situated Learning Theory was applied during the course of the intervention. A total of 540 Yemeni in-ward nurses, who had three years nursing diploma and at least a year of working experience in the selected public hospitals were recruited in this study. The hospitals were the unit of randomization whereby eight hospitals were assigned randomly to intervention and waitlist groups. Intervention group-1 (n = 180) received an educational module supported by audio-video CD and a training course for eight weeks. Intervention group-2 (n = 180) was given only the educational module with audio-video CD (without the training course). The waitlist group received no intervention during the period of data collection but they will be given the same training and learning materials after the completion of the study. This study contributes to the lack of a nosocomial infection control educational module for nurses in Yemen. It is hoped that the educational module will serve as an effective approach to increase the nurses’ knowledge and improve their practices regarding nosocomial infection control measures and hence decrease the prevalence of nosocomial infections in the future. ID: ISRCTN19992640 , Date of registration: 20/6/2017. This study protocol was retrospectively registered.

Automatic detection of surgical site infections from a clinical data warehouse.

Abstract: Reducing the incidence of surgical site infections (SSIs) is one of the objectives of the French nosocomial infection control program. Manual monitoring of SSIs is carried out each year by the hospital hygiene team and surgeons at the University Hospital of Bordeaux. Our goal was to develop an automatic detection algorithm based on hospital information system data. Three years (2015, 2016 and 2017) of manual spine surgery monitoring have been used as a gold standard to extract features and train machine learning algorithms. The dataset contained 22 SSIs out of 2133 spine surgeries. Two different approaches were compared. The first used several data sources and achieved the best performance but is difficult to generalize to other institutions. The second was based on free text only with semiautomatic extraction of discriminant terms. The algorithms managed to identify all the SSIs with 20 and 26 false positives respectively on the dataset. Another evaluation is underway. These results are encouraging for the development of semi-automated surveillance methods.

병원감염관리 질에 대한 인식이 재이용의도에 미치는 영향 -지각된 위험과 신뢰의 매개효과를 중심으로-

Abstract: Objectives: The purpose of this study was to investigate the effect of the perception on the quality of nosocomial infection control on perceived risk, trust, and the intention to revisit among the medical consumers. Method: 361 patients and their guardians who were hospitalized in women''s hospital, Gangnam-gu, Seoul, participated in this study. The data was analyzed using SPSS Statistics 21.0. Results: The perception on the quality of nosocomial infection control had a negative(-) effect on perceived risk, a positive(+) effect on trust, a positive(+) effect on the intention to revisit. The perceived risk had a negative(-) effect on trust, a negative(-) effect on the intention to revisit. The trust had a positive(+) effect on the intention to revisit. The perceived risk was partially mediated by the perception on the quality of nosocomial infection control and the intention to revisit, while the trust was fully mediated by the perception on the quality of nosocomial infection control and the intention to revisit. Thus, it indicated that the perceived risk and trust had dual mediated effects as well as full mediated effects in the relationship between the perception on the quality of nosocomial infection control and the intention to revisit. Conclusions: The nosocomial infection control can be an important factor to contribute to hospital management by attract the loyal medical customers, not just cost-expenditure. The nosocomial infection control can help hospital revenue and customer management strategy. Thus, it will contribute to the effective marketing strategy in the medical field.

Evaluation of healthcare-acquired infection rates in a pediatric intensive care unit in Turkey.

Abstract: Healthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey's national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country's PICU, which may later supply useful data about other pediatric hospitals.

Vancomycin-resistant enterococcus faecalis among patients with urinary tract infection at aminu kano teaching hospital

Abstract: Background: Emergence of vancomycin-resistant enterococci (VRE) has become a serious issue for nosocomial infection control worldwide. The increase in antibiotic resistance among enterococci, specifically to vancomycin, has become a major clinical and epidemiological problem. Aim: The study aimed at the identification, phenotypic characterization of Enterococcus faecalis, and susceptibility pattern of vancomycin on E. faecalis associated with urinary tract infection (UTI) on patients admitted to the female medical ward and postnatal ward of Aminu Kano Teaching Hospital, Kano, Nigeria. Materials and Methods: A total of 114 urine samples were aseptically collected from patients suspected with UTI and cultured on blood agar and cystine–lactose–electrolyte-deficient agar and incubated under anaerobic and aerobic environment, respectively, at 37°C for 24 h. Bacterial growth was subjected to standard methods for the identification of E. faecalis and tested for their antibiotic susceptibility patterns on vancomycin (30 μg), ciprofloxacin (10 μg), streptomycin (10 μg), chloramphenicol (30 μg), tetracycline (10 μg), and co-trimoxazole (25 μg) (Oxoid, UK) using disk diffusion method. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) of vancomycin were determined. ATCC E. faecalis 29,212 was used as control organism for every test run. Data generated were analyzed using descriptive statistics. Results: A total of 8 (7.0%) E. faecalis were isolated from 114 samples studied. The prevalence of 50.0% and 25.0% VRE was obtained by disk diffusion and broth dilution methods, respectively. The result of antibiotics susceptibility pattern revealed that 6 (75.0%) of the E. faecalis isolates show multiple resistance to tetracycline (30 μg), co-trimoxazole (1.25/23.75 μg), and streptomycin (10 μg), but more sensitive to ciprofloxacin (5 μg) and chloramphenicol (30 μg). The MIC result revealed that vancomycin has high effect at lower concentration of 4 and 2 μg/ml and loses its effect at increase concentration of 8, 16, 32, and 64 μg/ml, and the result obtained from the MBC of vancomycin revealed that it has only a bacteriostatic effect against E. faecalis. Conclusion: Therefore, ciprofloxacin and chloramphenicol are the best therapeutic options to treat infection with VRE in Kano, and treatment with the resistant drugs obtained may affect feature treatment and management of infection with these drugs.

The Potential Effectiveness of Probiotic-Based Sanitation Procedures in Nosocomial Infection Control: A Review Article

Abstract: The sanitation of the hospital environment for the purpose of preventing the transmission of nosocomial infections has a major role in reducing the infection of hospitalized patients with the bacteria living on hospital surfaces. The excessive use of chemical detergents in recent decades has led to microbial resistance in nosocomial infectious bacteria. Researchers’ attention has therefore been drawn to the use of probiotics for disinfecting hospital surfaces. The present study was conducted to assess the potential effectiveness of probiotic products in controlling the contamination of inert surfaces in the environment and medical instruments in health centers and investigate the claim that the antagonistic property of probiotic microorganisms offers an effective method for controlling nosocomial infections and a suitable alternative to conventional disinfection methods. A search was carried out for relevant articles published from 2000 to 2018 in databases including ISI, PubMed, Scopus, EMBASE, and Google Scholar, using the keywords "nosocomial infections", "disinfection", "sanitation", "probiotics" and "infected surfaces". The articles published from 2000 to 2018 confirmed the greater effectiveness of probiotic disinfection (by up to 90%) compared to conventional chemical disinfection in controlling nosocomial infections. Nevertheless, more extensive studies are needed on probiotics to determine the possibility of replacing good bacteria with bad bacteria in future decades.

Evaluation of Washing Effect of Reusable Medical Devices by Different Pretreatment Methods and Its Application in Nosocomial Infection Control

Abstract: In order to analyze the risk factors of nosocomial infection in the use of reusable medical devices, a retrospective analysis was made of 370 original data of biological monitoring of reusable medical devices filed in the Hospital Infection Department from January 2018 to December 2018. The possible risk factors in the use of reusable medical devices and the corresponding preventive measures were analyzed. The data were compared with 340 original data of air organisms from January 2017 to December 2017. The qualified rate of surveillance, surface biology and manual surveillance were compared. By analyzing the use of reusable medical devices in hospitals in 2018, it was found that the main risk factors of nosocomial infection were air pollution, surface pollution of objects and hand pollution of staff. After taking active and effective preventive measures, the qualified rates of air biological monitoring, surface biological monitoring and hand monitoring of staff in 2018 were significantly higher than those in 2017. There was statistical significance (P < 0.05), and the satisfaction rate of doctors and nurses with reused medical devices was 98.86% after the implementation of preventive measures, which was significantly higher than 89.77% before the implementation. The experiment result shows that the air environment around the reusable medical devices, the surface of the carrying objects and the staff all have certain risk factors of inducing infection. It is necessary to strengthen the training and supervision of infection in order to effectively prevent the occurrence of nosocomial infection.

Carbapenemase-producing strain rapid detection method and kit, and application of kit

Abstract: The invention provides a carbapenemase-producing strain rapid detection method and kit, and an application of the kit. The rapid detection method includes the steps: carrying out common incubation ofimipenem with a to-be-tested bacterial lawn to prepare an MH agar culture medium containing bromcresol purple and acid-producing bacteria, pasting imipenem paper after incubation with the to-be-testedbacterial lawn on the MH agar culture medium containing the bromocresol purple and the acid-producing bacteria, incubating for 3.5-4.5 h, and determining whether the to-be-tested strain is a carbapenemase-producing strain directly through a fact whether bromocresol purple is discolored. The detection method has the advantages of simple operation, fast analysis, wide application range, high accuracy and specificity, and easy interpretation of the results. At the same time, the invention also provides the detection kit established based on the rapid detection method; the kit has important significance for early discovery of the carbapenemase-producing strain and adopting of effective measures, nosocomial infection control and clinical epidemiological detection, and has good application prospects.

Staphylococcal protein A (spa) typing of Staphylococcus aureus isolates causing nosocomial infections

Abstract: BACKGROUND: Staphylococcal protein A (spa) typing is a typing method based on the DNA sequence analysis of staphylococcal protein A g ene. The purpose of this study was to do molecular typing of Staphylococcus aureus isolated from patients in Toohid and Besat hospitals, Sanandaj, Iran, in 2014. METHODS: Clinical specimens were collected from hospitalized patients over a period of 1 year. Staphylococcus aureus isolates were identified using culture and biochemical standard methods based on the Clinical and Laboratory Standards Institute (CLSI) guideline. spa gene patterns in Staphylococcus aureus isolates were identified using spa-typing techniques. RESULTS: In total, 20 different patterns of spa gene were obtained in staphylococcus aureus isolates in this study, which included type t030 (6 cases), types t230, t459, and t701 (3 cases of each one), types t11332 and t304 (2 cases of each one), and types t325, t012, t1149, t1810, t197, t325, t7789, t808, t871, t937, t14896, t14913, t14928, and t14929 (1 case of each one). The highest prevalence belonged to types t030 (30.0%), and then, types t230, t459, and t701 (15.0% for each one). New types of t14896, t14913, t14928, and t14929 were identified during this study. CONCLUSION: There were some well-known patterns of spa types, and also we identified new types that should be studied more to qualify. Analysis of these patterns can improve insight to design nosocomial infection control programs.

A method for construct a cost-benefit evaluation model of nosocomial infection control measures

Abstract: The invention provides a method for constructing a cost-benefit evaluation model of nosocomial infection control measures, belonging to the medical technical field. By establishing a single type of direct medical cost model of nosocomial infection, the cost of items included in the direct medical cost of nosocomial infection was calculated, Transferring the SaaS service platform to the patient archives management interface, establishing the patient archives, and then transferring the SaaS service platform to the medical behavior comprehensive service interface, automatically matching the diagnosis and treatment behavior and the patient expense data, and calculating the direct medical expense of the patient due to the hospital infection; According to P1 and P2, the number of nosocomial infection cases reduced by the control measures in a certain period is calculated, and the direct medical cost saved by the control measures, that is, the direct benefit, is calculated. Accounting the investment cost of hospital infection control measures; The cost-benefit ratio of nosocomial infection control measures = direct benefit/input cost of nosocomial infection control measures was calculatedto evaluate the cost-effectiveness.