Carriage of Gram-negative bacteria on the hands of nursing staff

Abstract

s 129 observed neurosurgical procedures for a total of 169 h. Analysis yielded some risk factors associated with characteristics of the patient such as age, ethnic origin and diagnosis, and some potentially modifiable risk factors such as preparation of the patient for the operation, behaviour of the staff in the operating theatre, etc. Consequent upon these findings the awareness of the problem was heightened by a series of meetings with the entire staff involved (operating theatre nurses, ward nurses, neurosurgeons, anaesthetists, cleaning and laundry personnel). Following these meetings a protocol was issued for each of the above groups, six in all. Each of the proltocols specified items for the modification of behaviour. ‘Preparation of the patient for the operation’ for example, involved more than one protocol: careful bathing of the patient on thse night before and the morning of the operation involved ward staff; the special kit of clean bedding and clothes, laundry personnel; the change introduced in shaving the operative site, operating room team. The nurse epidemiologist thereafter measured compliance with the protocols and resurveyed the service after high compliance was achieved. Evaluation involving 343 patients yielded a drop in ward infection,, rates. During the first period after initiation of the protocols, rates of infection dropped from 11.4 per cent to 8.9 per cent, not statistically significant and later to 6.7 per cent (P~0.07). The biggest reduction was noted in cranial operations where the wound infection rates were reduced from 13.1 to 5.9 per cent in the later period (P= 0.02), these reductions could not be related to any specific intervention measures, but rather to the total programme. Patterns of antibiotic usage in a surgical intensive care unit J. Klimek, E. Ajemian, K. Hryb, L. Jimenez, D. Drezner and S. Ahn Hartford Hospital, Hartford, Connecticut, USA In order to determine the effectiveness and cost implications of antibiotic therapy in our surgical ICU, the charts of 96 consecutive patients who received antibiotic therapy was studied prospectively. The prophylactic or therapeutic indications as well as the cost of each course of therapy was reviewed. Each course of antibiotic therapy was classified as either appropriate (A); probably appropriate (PA); inappropriate due to less expensive or less toxic alternatives, inappropriate due to improper dose, duration and frequency, inappropriate based on microbiological susceptibility data (I); or as unjustified usage (U). The pharmacy’s cost of each course was calculated ftor each category and compared to suggested alternatives. Of 148 courses of antibiotic therapy in 96 patients, 125 were A with 108 of these being without a suggested alternative and 17 with a less expensive drug. Seventeen courses of therapy were classified as I and six were considered U. Savings of $9,414.00 could have been realized by using less expensive alternatives or no antibiotic at all. Since this audit was conducted over a 3-month interval, a possible annual savings of $38,000.00 in a single ICU was possible. We also examined the patterns of antibiotic administration as therapy for hospitalacquired pneumonia. During the study period, 20 patients received antibiotics for this indication. Eight patients were given a single antibiotic, 12 received more than one antibiotic concomitantly. ‘Monotherapy’ appeared to be as effective as combination therapy and may result in cost savings. Further prospectively acquired data will be presented. We concluded that although the majority of therapeutic decisions concerning antibiotics are appropriate, even a small percentage of errors can lead to a significant added expense. Ongoing or periodic audits of antibiotic usage may provide an effective method of cost control.